What We Know, What We're Still Learning
One of the hardest things for physicians to say is, "I don't know." And yet, when it comes to menopause, it's often the most honest and useful place to start. My answer to patients, friends, and colleagues is frequently the same: "We know some things very well. Many things, we're still figuring out." That statement isn't a failure of medicine. It's an accurate description of where menopause science stands today.
The Uneven Landscape of Evidence
Research on menopause has expanded significantly over the past few decades, particularly since the early 2000s. But it hasn't grown evenly. Some aspects of the menopausal transition are well studied, well understood, and supported by consistent data. Others remain active areas of research, shaped by individual variability and historically limited investment in women's health.
Where the Evidence Is Strong
- Vasomotor symptoms (hot flashes and night sweats): These are among the most studied menopausal symptoms. Large population studies show that up to 75-80% of women experience vasomotor symptoms. Hormone therapy remains the most effective treatment, reducing frequency and severity by 70-90%.
- Bone density and fracture risk: The relationship between declining estrogen and bone loss is well established. Women can lose up to 20% of bone density in the first five to seven years after menopause.
- Genitourinary symptoms of menopause (GSM): Vaginal dryness, discomfort, and urinary symptoms affect an estimated 40-60% of postmenopausal women. Local estrogen therapy has strong evidence supporting safety and effectiveness.
- Hormone therapy for symptom relief: For healthy women under age 60 or within 10 years of menopause onset, hormone therapy is generally safe and effective for symptom management.
Where We're Still Learning
- Cognitive symptoms and "brain fog": While observational studies confirm these are common, the mechanisms are still being studied.
- Joint pain and inflammatory symptoms: Joint aches are frequently reported, yet data on causation and optimal treatment are still evolving.
- Why symptoms vary so widely: Genetics, stress, sleep, and social context play a role, but we don't yet have predictive models that explain individual experiences well.
Why Uncertainty Isn't the Enemy
In clinical practice, uncertainty is often mistaken for dismissal or neglect. In reality, it usually reflects honesty. Good medicine doesn't require perfect data. It requires knowing what's established, acknowledging what's still emerging, and making individualized decisions. Uncertainty doesn't mean we have nothing to offer. It means we listen more carefully and avoid one-size-fits-all answers so women can move through this transition with less fear and more clarity.