Menopause
About the Menopause Priority Setting Partnership
Menopause is a condition that arises due to ageing and a health priority area identified through clinical practice and those with lived experience. Although menopause eventually affects all women it is an under-researched area.
Basic understanding of why menopause occurs and why experiences differ so much between women is lacking. There is a lack of consensus about what symptoms menopause causes and this is problematic for patients and clinicians. Not surprisingly, many women report feeling unprepared for menopause and dissatisfied with information and education available.
There are racial/ethnic variations in menopause timing and symptoms which are poorly understood . This uncertainty and substantial variation between women impacts on the quality of care provided to women experiencing menopause and limits provision of evidence-based care by their healthcare providers.
The Menopause Priority Setting Partnership (MAPS) group was a clinician researcher led project that brought together clinicians and those with lived experience on an equal footing to identify evidence gaps that are important to both groups.
The Menopause PSP Top 10 was published in October 2024.
Top 10 priorities
The most important questions
- What are the safest and most effective non-hormone treatments (including prescribed medicines, herbal remedies, and complementary therapies) for perimenopause/ menopause in people who cannot, or do not wish to take HT (hormone therapy)?
- What lifestyle changes (e.g. diet, exercise, reducing stress) benefit people at different stages of the menopause? How can people be supported to make these changes?
- Does perimenopause/menopause lead to cognitive problems e.g. brain fog and memory loss? If yes, why, and how does this happen? How are these problems best detected and managed? Can they be prevented and/or reversed?
- Why and how is sleep affected during perimenopause, menopause, and post-menopause? What are the best ways to manage these sleep problems?
- How long should people take HT (hormone therapy)? What is the best way to stop?
- What are the best ways to help people prepare for perimenopause/ menopause and recognize when it is happening? What helps them know when to seek professional help and to make informed decisions about treatment?
- How do menopausal experiences vary across different countries, cultures, and ethnic backgrounds worldwide?
- What are the best ways to manage perimenopause/ menopause in people who are living with/ or have survived breast cancer?
- Does HT (hormone therapy) change the risk of dementia?
- How long can people with a personal risk of heart disease or cancer safely take HT (hormone therapy)? If yes, which type, and dose of HT is best?
The following questions were also discussed and put in order of priority at the workshop:
- What causes early menopause (aged 40-44), or premature menopause before age 40, other than surgery or medical treatment?
- Are the benefits and risks of HT (hormone therapy) different for specific groups of people e.g. people from different ethnic backgrounds?
- Which types of hormones, synthetic or non-synthetic, are safest and most effective for HT (hormone therapy)? What is the best way to deliver hormonal treatment e.g. patches, creams and/or pills?
- Does perimenopause/ menopause lead to joint and/ or muscle pain? If yes how and why does this happen? How is this best managed?
- Does a person’s genetic make-up affect their experience of menopause e.g. when it starts and how severe their symptoms are? What is causing the average age at menopause to change over time?
- How does menopause after surgical removal of ovaries or medical treatment (e.g. cancer treatment) differ from natural menopause? What is the impact on future health, and can any health risks be reduced?
- What are the safest and most effective ways to treat symptoms of surgical menopause?
- Does vaginal estrogen increase the risk of breast cancer returning or worsening in people who have had, or have breast cancer?
- Is testosterone safe and effective for the treatment of symptoms other than low libido in perimenopause/ menopause? If yes, what is the optimum dose and best way to deliver it?
- Does perimenopause/ menopause cause low libido (sex drive) and changes in orgasms? If yes, why, and how does this happen? What are the best ways to restore a person’s sex drive?
- What are the best ways to help people prepare for surgical menopause? Can treatment and/ or lifestyle changes before surgery reduce menopausal symptoms?
- Why do some people have menopausal symptoms past age 60? What are the best ways to manage symptoms at a late age?
- How do neurodiverse people (e.g. autistic people or people with attention deficit disorder) experience perimenopause/ menopause? How are they best treated and supported?
- How do trans-men and non-binary people experience menopause? Are there long-term risks from combining testosterone with premature menopause in younger trans-men?
- How can treatment and care for perimenopause/ menopause be better integrated into other healthcare areas e.g. mental health care?
- Why are people’s concerns about perimenopause/ menopause sometimes overlooked or dismissed by healthcare professionals?
Key documents
These documents set out the aims, objectives and commitments of the PSP.