The bipartisan Menopause Research Act was introduced in Congress but never passed. It is high time to get this federal legislation over the finish line.
To an estimated 200 million viewers, Super Bowl Sunday is as much about the showcasing of iconic brands as it is a football showdown. A surprising entry emerged this year among the lineup of beer, car and dog food commercials. Astellas Pharma ran a pre-kickoff ad that focused on menopause awareness. The purported price tag for the coveted spot: upward of $7 million.
Menopause is clearly having a prime-time moment—and we think that’s worth cheering. Just last week, a New York Times magazine cover feature, “Women Have Been Misled About Menopause,” quickly went viral. Readers around the world weighed in, as hungry for information as they were for validation.
For too long, menopause has been sorely neglected by the mainstream medical establishment, by lawmakers, by employers and by just about everyone. As a result, millions of women are left to navigate its most debilitating symptoms with little support.
Take hot flashes. Long portrayed as a comical rite of passage, they’re hardly a punchline for those who endure them. Hot flashes are tied to profound short- and long-term health consequences including sleep disruption, mood disturbances, brain fog and increased risk for cardiovascular disease. Once thought to be an evanescent phase of menopause, hot flashes can persist for the better part of a decade. And they have a disproportionate impact on Black women, for whom menopause starts earlier and symptoms last longer and/or are experienced with increased intensity.
The indifference, even ignorance, with which women have been met is largely the result of a study reported over 20 years ago that was ill-designed to answer the most important questions about women’s health as they age. Women have half the risk of cardiovascular disease as men but only until menopause—then the risks equalize. Women have twice the incidence of Alzheimer’s disease, a phenomenon not simply explained by a longer lifespan. Worse than the immediate harm inflicted by the study—scaring doctors and women away from the most effective treatment for the symptoms of menopause, hormone therapy—it chilled future large research projects that could have answered these questions.
Menopause ushers in myriad physiological changes, of which hot flashes are but one. Experts like the North American Menopause Society, American College of Obstetricians and Gynecologists and many others agree that estrogen or estrogen-progestin therapy (also known as menopause hormone therapy, or MHT) is simply the most effective treatment for hot flashes, but there are many other benefits. The FDA has approved MHT for the prevention of osteoporosis and the treatment of the genitourinary syndrome of menopause—a bothersome and expensive constellation of symptoms that include painful sex, vulvovaginal discomfort and frequent urinary tract infections. MHT also decreases the risk of developing type 2 diabetes by as much as 30 percent.
We must also acknowledge that everyone is not a candidate for MHT, including those with a personal history of breast or uterine cancer, a history of heart attack or stroke, and those at increased risk for developing blood clots. For those patients who are unduly hindered by hot flashes, we applaud an effective alternative to MHT.
Which brings us back to the Astellas Pharma ad—presumably purchased as a prelude to its forthcoming market entry: a non-hormonal medication, Fezolinetant, that will be available in the near future.
Raising awareness about menopause is a laudable goal which has been too long in the making. But our concern is this: Because of persistent misinformation about MHT, and the mass marketing of many ineffective non-hormonal options—not just to those who cannot or should not take estrogen, but to all menopausal women—this ad campaign could similarly reinforce the marginalization of hormone therapy.
As long as medication is marketed appropriately, we support alternatives for women who suffer from hot flashes. What we cannot abide by is leveraging non-hormonal status as a selling point to people fearful of an otherwise effective and safe option.
Which is exactly why the government needs to step up, quickly—in particular, to direct the National Institutes for Health to design and launch a modern initiative that can assert the long-term benefits of hormone therapy and accurately assess its risks. Last fall, the bipartisan Menopause Research Act of 2022 was introduced in Congress to initiate that very process; it is now high time to get federal legislation over the finish line.
Menopause and all of its implications deserve more than stony silence—or even a 30-second product promo at the Super Bowl. Only with thorough, transparent research and robust public discussion can people make truly informed decisions.
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