Every claim, graded
59 claims from across the curriculum, graded from A (guideline-grade RCT evidence) to F (refuted or actively misleading). Use it to answer a patient in clinic, or to check yourself before you reassure someone.
Menopause in a woman over 45 can be diagnosed clinically without biochemistry
Established — RCT / guideline-grade — NICE NG23 and Menopause Society position statements concur.
Module 01 · Reproductive Aging and the STRAW+10 Map →Two FSH values >25 IU/L confirm POI in a woman under 40 with 4 months of amenorrhoea
Established — RCT / guideline-grade — ESHRE POI guideline diagnostic criteria.
Module 01 · Reproductive Aging and the STRAW+10 Map →Untreated POI increases fracture and cardiovascular risk
Supported in defined populations — Consistent cohort data; hormone therapy until ~51 is standard of care despite absence of RCT mortality endpoints.
Module 01 · Reproductive Aging and the STRAW+10 Map →AMH can predict an individual woman's date of final menstrual period
Biologically plausible, unproven — Population-level association only; individual prediction intervals span years.
Module 01 · Reproductive Aging and the STRAW+10 Map →Salivary hormone testing guides menopause management
Refuted or actively misleading — No analytic validity for clinical decisions; marketed heavily by compounding pharmacies.
Module 01 · Reproductive Aging and the STRAW+10 Map →Median total VMS duration exceeds 7 years
Established — RCT / guideline-grade — SWAN, Avis et al. JAMA Intern Med 2015 — 7.4 years median, 4.5 years post-FMP.
Module 02 · Vasomotor Symptoms: KNDy Neurons and the Thermoneutral Zone →NK3 receptor antagonism reduces moderate-severe VMS frequency vs placebo
Established — RCT / guideline-grade — SKYLIGHT and OASIS phase 3 programmes.
Module 02 · Vasomotor Symptoms: KNDy Neurons and the Thermoneutral Zone →Frequent VMS is associated with subclinical cardiovascular disease markers
Supported in defined populations — SWAN Heart, MsHeart cohorts — consistent association; causality unproven.
Module 02 · Vasomotor Symptoms: KNDy Neurons and the Thermoneutral Zone →Serum estradiol level predicts individual VMS severity
Popular, weak or conflicting support — Weak and inconsistent correlation.
Module 02 · Vasomotor Symptoms: KNDy Neurons and the Thermoneutral Zone →Black cohosh reliably reduces moderate-to-severe VMS
Popular, weak or conflicting support — Meta-analyses are heterogeneous and largely null against placebo; hepatotoxicity case reports exist.
Module 02 · Vasomotor Symptoms: KNDy Neurons and the Thermoneutral Zone →Systemic MHT is the most effective treatment for moderate-severe VMS
Established — RCT / guideline-grade — Consistent RCT evidence; 75–90% reduction in frequency.
Module 03 · Menopausal Hormone Therapy: Reading WHI Properly →CEE-alone in hysterectomised women did not increase breast cancer incidence in WHI
Established — RCT / guideline-grade — Non-significant reduction sustained in long-term follow-up.
Module 03 · Menopausal Hormone Therapy: Reading WHI Properly →Combined MHT increases breast cancer incidence with duration of use
Established — RCT / guideline-grade — Small absolute excess; risk attenuates after cessation.
Module 03 · Menopausal Hormone Therapy: Reading WHI Properly →Transdermal estradiol carries lower VTE risk than oral
Supported in defined populations — Large observational and nested case-control evidence; no dedicated RCT.
Module 03 · Menopausal Hormone Therapy: Reading WHI Properly →MHT started in women aged 50–59 reduces all-cause mortality
Promising but preliminary — Suggestive pooled and subgroup data; not a primary endpoint finding.
Module 03 · Menopausal Hormone Therapy: Reading WHI Properly →MHT should be prescribed to prevent dementia
Refuted or actively misleading — WHIMS showed increased dementia risk with late initiation; prevention is not an indication.
Module 03 · Menopausal Hormone Therapy: Reading WHI Properly →Transdermal estradiol does not increase VTE risk
Supported in defined populations — Consistent observational and nested case-control data (ESTHER, UK CPRD).
Module 04 · Prescribing MHT: Routes, Regimens and Progestogen Choice →Systemic oestrogen without a progestogen in a woman with a uterus causes endometrial hyperplasia and carcinoma
Established — RCT / guideline-grade — Established; unopposed oestrogen is never acceptable with an intact uterus.
Module 04 · Prescribing MHT: Routes, Regimens and Progestogen Choice →The LNG-IUS provides adequate endometrial protection with systemic oestrogen
Established — RCT / guideline-grade — Licensed for this indication in many jurisdictions; typically 4–5 years of protection.
Module 04 · Prescribing MHT: Routes, Regimens and Progestogen Choice →Micronised progesterone carries lower breast cancer risk than synthetic progestins
Promising but preliminary — Observational (E3N) signal; no RCT with breast cancer endpoints.
Module 04 · Prescribing MHT: Routes, Regimens and Progestogen Choice →Compounded bioidentical hormones are safer than regulated preparations
Refuted or actively misleading — No supporting evidence; documented harms and regulatory warnings.
Module 04 · Prescribing MHT: Routes, Regimens and Progestogen Choice →Testosterone supplementation improves hypoactive sexual desire disorder in postmenopausal women
Supported in defined populations — Global Consensus Position Statement 2019 — supported for HSDD only, at female physiological doses.
Module 04 · Prescribing MHT: Routes, Regimens and Progestogen Choice →Fezolinetant reduces moderate-severe VMS frequency and severity vs placebo
Established — RCT / guideline-grade — SKYLIGHT 1 and 2, replicated.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →Elinzanetant improves VMS and sleep disturbance vs placebo
Established — RCT / guideline-grade — OASIS 1–3.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →Venlafaxine and escitalopram reduce VMS frequency vs placebo
Supported in defined populations — MsFLASH network trials — modest but consistent.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →Paroxetine should be avoided in women on tamoxifen
Established — RCT / guideline-grade — CYP2D6 inhibition reduces endoxifen; associated with worse breast cancer outcomes in cohort data.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →CBT reduces the bother and impact of hot flushes
Supported in defined populations — MENOS trials — impact scores improve more than objective frequency.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →Black cohosh reduces moderate-severe VMS
Popular, weak or conflicting support — Heterogeneous, largely null vs placebo; hepatotoxicity case reports.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →Evening primrose oil relieves VMS
Refuted or actively misleading — No convincing controlled evidence.
Module 05 · Non-Hormonal Therapy for Vasomotor Symptoms →Low-dose vaginal oestrogen relieves GSM symptoms
Established — RCT / guideline-grade — Multiple RCTs and Cochrane review.
Module 06 · Genitourinary Syndrome of Menopause →Vaginal oestrogen reduces recurrent UTI in postmenopausal women
Established — RCT / guideline-grade — RCT evidence (Raz & Stamm) plus guideline endorsement.
Module 06 · Genitourinary Syndrome of Menopause →Vaginal oestrogen requires added progestogen for endometrial protection
Refuted or actively misleading — Not required at licensed low doses in women with an intact uterus.
Module 06 · Genitourinary Syndrome of Menopause →Prasterone improves dyspareunia
Supported in defined populations — Licensed on RCT evidence for moderate-severe dyspareunia.
Module 06 · Genitourinary Syndrome of Menopause →Fractional CO2 laser is superior to sham for GSM
Popular, weak or conflicting support — Best-quality sham-controlled trials show no difference; FDA safety communication issued.
Module 06 · Genitourinary Syndrome of Menopause →Vaginal oestrogen is absolutely contraindicated after breast cancer
Popular, weak or conflicting support — Most guidelines permit it after non-hormonal failure, with oncology input.
Module 06 · Genitourinary Syndrome of Menopause →MHT reduces hip and vertebral fracture risk in unselected postmenopausal women
Established — RCT / guideline-grade — WHI both arms — a rare positive primary-prevention fracture finding.
Module 07 · Bone Loss, Fracture Risk and the Sarcopenia Overlap →Bone loss accelerates in the late transition, before the final menstrual period
Established — RCT / guideline-grade — SWAN Bone substudy.
Module 07 · Bone Loss, Fracture Risk and the Sarcopenia Overlap →Stopping denosumab without follow-on therapy causes rebound vertebral fractures
Established — RCT / guideline-grade — FREEDOM extension analyses and multiple case series.
Module 07 · Bone Loss, Fracture Risk and the Sarcopenia Overlap →Progressive resistance training reduces falls and improves function in postmenopausal women
Established — RCT / guideline-grade — Consistent meta-analytic evidence.
Module 07 · Bone Loss, Fracture Risk and the Sarcopenia Overlap →Routine calcium plus vitamin D prevents fractures in replete community-dwelling adults
Popular, weak or conflicting support — USPSTF and large meta-analyses show little to no benefit.
Module 07 · Bone Loss, Fracture Risk and the Sarcopenia Overlap →Whole body vibration platforms prevent fractures
Biologically plausible, unproven — Small BMD signals, no fracture endpoint evidence.
Module 07 · Bone Loss, Fracture Risk and the Sarcopenia Overlap →Visceral adiposity increases across the menopause transition independent of ageing
Supported in defined populations — SWAN and longitudinal imaging cohorts.
Module 08 · Cardiometabolic Change After 50 →Menopause before age 45 is an independent cardiovascular risk factor
Supported in defined populations — Consistent large cohort and meta-analytic data.
Module 08 · Cardiometabolic Change After 50 →Adverse pregnancy outcomes are cardiovascular risk enhancers
Supported in defined populations — Endorsed in ACC/AHA and ESC prevention guidelines.
Module 08 · Cardiometabolic Change After 50 →MHT should be prescribed for primary prevention of coronary disease
Refuted or actively misleading — Not an indication in any major guideline.
Module 08 · Cardiometabolic Change After 50 →Transdermal estradiol has a neutral effect on triglycerides compared with oral
Supported in defined populations — Pharmacological first-pass effect, consistently demonstrated.
Module 08 · Cardiometabolic Change After 50 →Statins are equally effective for secondary prevention in women and men
Established — RCT / guideline-grade — CTT collaboration individual-participant meta-analysis.
Module 08 · Cardiometabolic Change After 50 →Cognitive performance dips during the transition and recovers postmenopause
Supported in defined populations — SWAN cognitive substudy, longitudinal within-woman design.
Module 09 · Brain Fog, Mood and Sleep →The perimenopause is a window of increased depression risk
Supported in defined populations — Harvard Study of Moods and Cycles, SWAN, Penn Ovarian Aging Study.
Module 09 · Brain Fog, Mood and Sleep →Transdermal estradiol reduces depressive symptoms in perimenopausal women
Supported in defined populations — Multiple small RCTs including Gordon 2018 prevention trial.
Module 09 · Brain Fog, Mood and Sleep →MHT started after age 65 increases dementia risk
Supported in defined populations — WHIMS — combined arm; oestrogen-alone arm directionally similar but non-significant.
Module 09 · Brain Fog, Mood and Sleep →MHT prevents Alzheimer's disease
Refuted or actively misleading — No supporting RCT evidence; not an indication.
Module 09 · Brain Fog, Mood and Sleep →Obstructive sleep apnoea prevalence increases after menopause
Supported in defined populations — Consistent cohort data; often missed because presentation differs from men.
Module 09 · Brain Fog, Mood and Sleep →VMS duration and burden differ by ethnicity
Supported in defined populations — SWAN — longest in Black participants, shortest in Chinese and Japanese participants.
Module 10 · The Menopause Consultation: Equity, Risk Communication and Review →Arbitrary 5-year stop rules for MHT are evidence-based
Refuted or actively misleading — Explicitly rejected by NICE and the Menopause Society.
Module 10 · The Menopause Consultation: Equity, Risk Communication and Review →Natural frequencies improve risk comprehension over percentages
Established — RCT / guideline-grade — Robust risk-communication literature (Gigerenzer and colleagues).
Module 10 · The Menopause Consultation: Equity, Risk Communication and Review →Testosterone is supported for hypoactive sexual desire disorder in postmenopausal women
Supported in defined populations — Global Consensus Position Statement 2019.
Module 10 · The Menopause Consultation: Equity, Risk Communication and Review →Testosterone improves mood, energy or cognition in women
Biologically plausible, unproven — Not supported by the consensus statement; frequently marketed regardless.
Module 10 · The Menopause Consultation: Equity, Risk Communication and Review →Menopause symptoms measurably affect work participation
Supported in defined populations — Multiple national surveys and occupational cohort studies.
Module 10 · The Menopause Consultation: Equity, Risk Communication and Review →