The “Natural Menopause” Myth: A Fresh Perspective

As a women’s health educator and a woman in her mid-50s, I have countless conversations about menopause. One sentiment I hear repeatedly, whether in professional settings or casual chats with friends, is “I want to transition through menopause naturally.” It’s become such a common refrain that I felt compelled to explore what’s really behind this thinking.

Understanding the Language We Use

Before we dive deeper, let’s talk about terminology. You may be more familiar with the term Hormone Replacement Treatment (HRT). However, there is a move away from this term as your body does not need hormones to be replaced. Menopause is a natural process that reduces sex hormones, like oestrogen and progesterone, to stop reproduction abilities.

The term HRT stems from medicine that historically viewed menopause as a disease or a disorder rather than the natural aging process. Words matter, and I wholeheartedly encourage you to adopt this updated acronym, MHT.

Why the Push for “Natural”?

As someone who has worked in women’s health for many years, I’ve observed how the “natural birth” movement of the past 20-30 years has profoundly influenced women’s attitudes toward their health. The idea that birthing “naturally” – without pain medication or medical intervention – somehow makes for a better birth experience has permeated deeply into our collective consciousness.

In my personal experience and through working with women dealing with birth trauma, I’ve come to see how dangerous this mindset can be. It often leaves women feeling like failures when they need medical intervention or, worse, enduring unnecessary pain and trauma in pursuit of a “natural” ideal. I’m concerned that we’re now seeing this same potentially harmful thinking transfer to menopause care.

This “natural is better” attitude found particularly fertile ground in the aftermath of one of the most controversial and misunderstood studies in women’s health: the Women’s Health Initiative (WHI).

Understanding the WHI Controversy

The Women’s Health Initiative, launched in 1991, was meant to be groundbreaking research into preventing heart disease, breast cancer, and osteoporosis in postmenopausal women. However, when the study was dramatically halted in 2002, it sparked a medical controversy that continues to impact women’s healthcare decisions today.

The study’s premature termination and subsequent media coverage created widespread panic about hormone therapy. However, there were significant problems with both the study’s design and how its results were interpreted:

• The study primarily included women well past menopause (average age 63) rather than women actually transitioning through menopause
• It used only one type of hormone therapy (Prempro-conjugated equine oestrogens plus medroxyprogesterone acetate), yet the results were generalised to all hormone therapy
• Many participants had existing cardiovascular risk factors
• The media focused on relative rather than absolute risks, making the dangers appear much greater than they actually were

Subsequent reanalysis of the WHI data has shown that the timing of starting hormone therapy is crucial (the “timing hypothesis”), and women starting MHT closer to menopause have very different risk profiles. We also now know that different formulations and delivery methods of hormones have different risk profiles.

Despite this updated understanding, the damage was done. Many women and even some healthcare providers remain needlessly fearful of MHT, leading to a surge in interest in “natural” alternatives.