12 Steps to Evaluate Menopause Content

How to Separate the Snake Oil from the Science

How do I decide whose menopause content to believe?

This is a common question, and it’s a very valid one. 

Often, people will read my posts here on The Vajenda or on Instagram, and they will leave a comment that goes something like this:

Well, now I am confused because I heard the opposite from someone else. Why should I believe you?

If you are a woman 40 years or older, you probably receive a flood of menopause recommendations each time you log on to a social media platform. So, how do you sort it all out? What is science, and what is snake oil? 

Menopause can be complicated. Symptoms vary, and in addition, they occur at the same time as we age, so sorting out the two can be challenging. Many women have historically been dismissed by medical professionals, and some of the research is conflicting. This makes menopause ripe for profiteering. 

Misinformation is tricky because the first piece of data we receive will likely be the one we believe. In addition, misinformation is often buried amongst the truth…your basic shit sandwich. Here is a sad example from a doctor recommending a thermogram, which is NOT recommended by any medical society for breast cancer screening, along with a mammogram and self-check. You, the consumer of information, might be easily led to believe that a thermogram is on par with a mammogram when, in reality, it is a way to scam you out of several hundred dollars and mislead you about your health. 

The problem is that learning that a thermogram is not recommended by any valid medical society doesn’t remove the misinformation. That is why it is important for anyone who is on social media and plans to consume health information to vet and screen who they follow so they can reduce their exposure to inaccurate or biased content. Because misinformation is so sticky, it’s really worth the 15 minutes. 

Many people look to credentials, and while it is important that a medical provider be board-certified, sadly, there are many awful doctors. For example, I’ve previously profiled Dr. Christiane Northrup, a  board-certified  OB/GYN who has been promoted by Oprah and NPR. It would be easy for someone to think that she is an expert worthy of attention, first because of her credentials and second because celebrity lends a veneer of authority. Except she is a full-on conspiracy theorist, her books are nonsensical screeds that include antisemitism and blame women for their medical conditions (you can read more here). But unless you investigated her, you wouldn’t know that she has always been awful. I am very suspicious that there are OB/GYNs who get certified by the Menopause Society just so they can claim they are experts with the sole purpose of adding credentials to help them sell scammy services and products from which they profit but are contrary to the Menopause Society guidelines—unfortunately, medical societies rarely police members. In many cases, someone needs to have committed a felony, lost their ability to prescribe opioids through the DEA, had their medical license suspended, or been on probation with their medical board to get the attention of a medical society. This is a huge failing. 

I think the best way to sort out expertise is to favor content over credentials. This helps weed out OB/GYNs and anyone else who is giving bad advice.  Also, it acknowledges that there are great advocates who may not be medical providers but do a wonderful job of promoting quality information.

This list is what I consider the low-hanging fruit, and most can be identified with a fairly quick Google search. This is a one-and-done kind of list, so if you hit one of the problem points, you can stop there.

1. If they are not prescribers, are they staying in their lane? If you follow physical therapists, nurses, dietitians, health coaches, or other non-prescribers, and there are some excellent ones, just remember, like doctors, there are also some truly awful ones. Pay attention to how they promote their content: you want someone who refers to the guidelines and stays within their scope of practice. If they have recommendations for what hormones you should take–hormones that they cannot prescribe- walk away. Someone who can't prescribe medication should not make recommendations about what medication to take, when to start it, or how to dose a medication. It is out of their scope of practice. For example, there are functional nutritionists (not a recognized field) who recommend against using an estrogen patch because “it doesn’t get levels high enough.” One, this is bullshit, but two, people who are not licensed prescribers should not be cosplaying as if they have actual expertise. Keep in mind they don’t have to live with the consequences of their bad advice.

2. Avoid chiropractors. They are not medical experts. I don’t know what they study, but it’s not medicine. 

3. Do they recommend thermography? As mentioned above, thermography is not recommended for breast cancer screening. At best, it is a completely unnecessary add-on that provides a false sense of security, but the real harm comes from people choosing thermograms over mammograms. Imagine if you decided to avoid mammograms because your provider offers both, and hey, why would they offer something that wasn’t indicated for breast cancer screening? Or perhaps you had an abnormal mammogram, but the thermogram was normal, so decided to go with the latter. In these situations, there is a real risk of missing a cancer when it is treatable. Thermograms appear to be an easy way for providers to make an additional $150-400 a year from their unsuspecting patients. Do they recommend them because they actually believe they are useful or because they don’t care and just want the easy $150-400 a year from their unsuspecting patients, or perhaps a bit of both? It’s problematic either way. 

4. Do they recommend compounded hormones? This includes testosterone and estrogen pellets, as well as the Wiley protocol. No menopause society recommends compounded hormones because the dosing and absorption are erratic. You have no idea if you are getting too much or too little hormone. It turns out it takes years of research to figure out how to formulate hormones so they can be absorbed, and we do not have that research with compounded hormones. In addition, compound hormones are not batch-tested, so you have no idea how much you are really getting. The only indication for compounded hormones over standard pharmaceutical hormones is when someone has a true allergy to a component, and the best example here is someone who wants to take progesterone but has a peanut allergy. In the United States, oral progesterone is made with peanut oil, and a compounding pharmacy can make it with a different oil. Why do some providers push compounded hormones? They are big money makers because providers usually upcharge for the faux customization (it’s an illusion) and often do unnecessary blood work to “manage” the therapy, and you absorb the cost with zero benefit and possibly risk. You may not be getting enough hormones or too much. Who knows? That’s compounded hormones. 

5. Do they use the term estrogen dominance? This is a meaningless term. It is in no medical dictionary. Do you want to listen to someone who believes and spouts gibberish? No, no, you don’t. 

6. Do they recommend testing for MTHFR variation? I have covered this before here. Real experts do not recommend testing for this variation as it is common and meaningless. No, you don’t need special folate if you have one or two copies of the variant. MTHFR variants are incredibly common; about 30-40% of the population has one, so it’s a great gift. With one simple test, a provider can pick up many people to whom they can sell scammy tests and supplements. Testing for this variant is like checking eye color and then making special recommendations for everyone who doesn’t have brown eyes. Some people have an MTHFR variant, and some have blue eyes. It’s irrelevant.

7. Do they recommend salivary hormone testing? Super scam. It's like old-school scamming. As in this is the dial-up Internet of scams. The results as far as estrogen, progesterone, and testosterone are concerned are meaningless. 

8. Do they recommend the DUTCH test? You can read more about this test here. There is no indication for this test. We don’t make any therapeutic recommendations based on these results. I saw a clip where Mindy Pelz, who is a chiropractor (and you have to do a little digging to find out she is a chiropractor and not a medical doctor), said, “I think we could end breast cancer if every woman were to take a DUTCH test every single year.” That is as wrong as it is predatory. It’s repulsive to me that someone would take advantage of fears of breast cancer. 

9. Is hormone therapy their ONLY recommended solution?? There are many ways to manage menopause symptoms, and they are not all estrogen-based. If the only content you see is estrogen, estrogen, estrogen, there is a good chance you are not getting evidence-based recommendations. For example, right before fezolinetant, the nonhormonal medication for hot flashes, was approved, the company had an ad during the Super Bowl to raise awareness about hot flashes. Of course, this was to increase sales for their product if approved, but also, if approved, this meant we would have another good tool in the kit. Don’t women deserve more options? Haven’t we been complaining that women’s health is understudied? What happened next was several doctors on Instagram made videos about how predatory this was. Why would you get angry about more science-backed options? And how different is it for a drug company to buy ads to promote their product from an OB/GYN buying ads on Instagram to sell her supplements? Well, there is one difference, the pharmaceutical will have quality studies to back it up and will contain what it claims. The same cannot be said about supplements. While MHT is the gold standard for hot flashes, there are non-hormone therapies and, of course, non, non-hormonal therapies for osteoporosis. Exercise is vital, and so is a balanced diet. Sometimes, an antidepressant is the right choice. A truly holistic approach means offering a wide complement of therapies, and if an influencer insists that estrogen is the only game in town, that means the provider isn’t a menopause expert; they are an estrogen prescriber, and there’s a big difference. 

10. Do their recommendations match the guidelines? The 2022 Menopause Society Guidelines are here, and the 2023 International Menopause Society (IMS) Provider’s Toolkit is here. I think the IMS Toolkit is friendlier for the public, so I‘d personally start there. I encourage everyone to reference the advice they get in the office or online with one of these documents. Here is a quick shortcut for anyone who doesn’t want to do that: Do they recommend hormone therapy to prevent dementia? If so, they are not following the evidence-based guidelines set out by every single menopause society (read more about that here). If they are wrong here, then where else are they wrong? Another piece of advice about guidelines is to be wary of people who cherry-pick and use the pieces that serve them but then claim the guidelines are out of date when they don’t serve their purpose. And speaking about out of date, it irks me when providers make that claim about the guidelines. If you look at the 2022 guidelines from the Menopause Society and the 2023 IMS Toolkit, they match. There is no pivotal clinical trial that would change medical practice about hormones that has been published since these two guidelines were released. 

11. How do they profit? This is a big one. You need to consider the tests they order, the hormones they prescribe, whether they get money from Pharma or from selling supplements, and even the ads that they take. For example, if a doctor does an advertisement for the ClearBlue menopause test, a test that is not supported by an evidence-based approach to medicine, what does that say about their menopause content? Did they shrug at the guidelines that don’t recommend this testing for the $5,000 or whatever they got for the ad, or do they really believe in urine testing to help with the menopause journey, and so they aren’t following the guidelines? Also, when a company pays for an ad on Instagram, it’s not just the potential sales from the product related to that reel; they are also hoping the provider will be affected and thus recommend their non-evidence-based product again and again. If it just takes one free lunch from a pharmaceutical company to make a doctor more likely to prescribe that company's medication, think of the impact of the money made for an Instagram post or reel. Or what about the chiropractor, Mindy Pelz, and her beloved DUCTH test? Does it change your opinion about what she says when you know that you need to pay to be a member of her Academy first and then pay an additional $550 for the DUTCH test? 

    

    

    If I owned a pharmaceutical company that sold oral contraceptives, you would rightly be suspicious of any contraception content that I promoted. In fact, you might be suspicious of any gynecology content because how much of it might be subtly designed to make the sale that puts money in my pocket? If I made $50,000 in 2023 from consulting with the company that makes fezolinetant, a non-hormonal medication for hot flashes, you might rightly think my menopause content could be biased. How would you know when I was promoting the drug correctly and when I had been influenced by the money the company had paid me? That same critical eye should be pointed at people who profit from supplements, especially when they have their own branded product because now they are an unregulated pharmaceutical company. And then there is the supplement misinformation because if these menopause supplements worked, they would be in the guidelines. For example, turmeric is in no medical guidelines, which is no shocker as there is plenty of evidence to show it does nothing useful. How, then, do you approach information from the menopause influencer selling turmeric who claims it can benefit bone density? Are they unaware of the medical literature, or don’t they care? And if they are unaware or don’t care here, what else are they promoting that might not be grounded in evidence-based medicine? And how do you know? After all, you came for expertise.

    But let’s say, for the sake of the argument, that all of a supplement-selling influencer’s non-supplement content is medically accurate, but you see their biased supplement content interspersed in the posts on this person’s Instagram or mentioned in the interviews they give. Now, you’ve had multiple exposures. You might think you are immune, but studies show that propaganda works. It takes just five exposures to get people to start to believe something that is wildly inaccurate like the earth is a perfect square (this has been tested, and with enough repetition, people do start believing). Believing that turmeric can benefit bone density is way less of a stretch than a square earth.  

12. Do they lead with fear about recommendations for hormone therapy? Do you come away from the content regularly worried or anxious that you will get dementia or heart disease or crumble up and die if you don’t take menopause hormone therapy? Fear seems to be favored by the social media algorithm, and so I suppose if the goal were to build a large following, then fear would be a great way to start. 

You might look at this list and think, wow, Gunter, that’s a lot of searching. But truthfully, it isn’t that much time. When it comes to making sure you are getting accurate information and protecting yourself from misinformation, the investment is worth it. Remember, protecting yourself from misinformation is far more effective than undoing it after the fact.

References

NAMS Position Statement. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29:767-794.

Cynthia A. Stuenkel et. al. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 11, 1 November 2015, Pages 3975–4011, https://doi.org/10.1210/jc.2015-2236.

Eastell R, Rosen CJ, Black DM. et. al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2019;104:1595-162

S. R. Davis, S. Taylor, C. Hemachandra, K. Magraith, P. R. Ebeling, F. Jane & R. M. Islam (2023) The 2023 Practitioner’s Toolkit for Managing Menopause, Climacteric, 26:6, 517-536, DOI: 10.1080/13697137.2023.2258783.

Henderson EL, et al. The Trajectory of Truth: A Longitudinal Study of the Illusory Truth Effect. Journal of Cognition, 2021:4.

Fazio LK, et al. Repetition increased perceived truth equally for plausible and implausible statements. Psychonomic Bulletin & Review Aug 2019;26.

Fazio LK, et al. Knowledge Does Not Protect Against Illusory Truth. Journal of Experimental Psychology:General. 2015;144.

Fazio LK, Sherry CL. The Effects of Repetition on Truth Judgments Across Development. Psychological Science.2020.

Lacassagna D, et al. Is Earth a Perfect Square? Repetition Increases the Perceived Truth of Highly Implausible Statements. June 2021 PsyArXiv