10The Menopause Consultation: Equity, Risk Communication and Review
Structuring 15 minutes so the woman leaves with a plan, a number, and a date.
Key takeaways
- —In SWAN, Black women reported the longest total VMS duration (over 10 years) and Chinese and Japanese women the shortest — and treatment access runs in the opposite direction to need.
- —There is no arbitrary stop date for MHT; continuation is a repeated shared decision, reviewed annually.
- —Documenting a natural-frequency risk discussion protects the patient's autonomy and the clinician equally.
- —Testosterone in women is licensed or supported only for hypoactive sexual desire disorder, at female physiological doses with level monitoring.
- —Most 'treatment failure' is under-dosing, wrong route, wrong progestogen, or an unaddressed second diagnosis.
Graded claims
VMS duration and burden differ by ethnicity
Supported in defined populationsSWAN — longest in Black participants, shortest in Chinese and Japanese participants.
Arbitrary 5-year stop rules for MHT are evidence-based
Refuted or actively misleadingExplicitly rejected by NICE and the Menopause Society.
Natural frequencies improve risk comprehension over percentages
Established — RCT / guideline-gradeRobust risk-communication literature (Gigerenzer and colleagues).
Testosterone is supported for hypoactive sexual desire disorder in postmenopausal women
Supported in defined populationsGlobal Consensus Position Statement 2019.
Testosterone improves mood, energy or cognition in women
Biologically plausible, unprovenNot supported by the consensus statement; frequently marketed regardless.
Menopause symptoms measurably affect work participation
Supported in defined populationsMultiple national surveys and occupational cohort studies.
Supporting references
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society — Menopause 2022 https://pubmed.ncbi.nlm.nih.gov/35797481/
- Duration of menopausal vasomotor symptoms — racial/ethnic differences (SWAN) — Avis et al., JAMA Intern Med 2015 https://pubmed.ncbi.nlm.nih.gov/25686030/
- Simple tools for understanding risks: from innumeracy to insight — Gigerenzer & Edwards, BMJ 2003 https://pubmed.ncbi.nlm.nih.gov/14512488/