FDA bans women of "childbearing potential" from early drug trials
Women largely excluded from medical research for decades. Most drugs never tested on female bodies.
The Research Gap
Menopause affects half the population — yet remains one of the most understudied areas of medicine. Here's how we got here and what's missing.
<1%
of NIH Budget
Goes to menopause research
20%
of OB-GYN Programs
Have menopause curriculum
0
FDA-Approved Treatments
For brain fog specifically
30+
Years
Of neglect to correct
How did we get here? A combination of historical exclusion of women from research, stigma, a flawed study that derailed HRT for two decades, and chronic underfunding. The result: millions of women suffering without evidence-based options.
How We Got Here
The research gap didn't happen by accident. It's the result of decades of systemic neglect.
A Brief History of Neglect
1977
1993
NIH Revitalization Act requires inclusion of women in clinical trials
A start — but compliance is inconsistent, and sex-specific analysis often missing.
2002
Women's Health Initiative (WHI) HRT arm halted early
Headline: "HRT causes cancer and heart attacks." HRT use collapses 80%. Research funding dries up. Fear persists for 20+ years.
2010s
WHI data re-analyzed — original conclusions were misleading
For younger women near menopause, HRT is actually protective. But the messaging had lasting effects — caution persists among some providers and patients.
2020s
Menopause finally gets attention
Cultural shift, celebrity advocacy, startup investment. But decades of lost research to make up for.
The WHI Study: A Closer Look
1991
WHI launched — largest women's health study ever. Tested HRT in older women (avg age 63).
2002
Estrogen+progestin arm stopped early. Headlines scream danger. HRT prescriptions plummet.
2010s
Re-analysis shows timing matters. For women under 60 or within 10 years of menopause, HRT benefits outweigh risks.
Today
Medical societies support HRT for appropriate candidates. But fear lingers among doctors and patients.
The WHI paradox: The initial interpretation and broad application of WHI findings to all menopausal women — regardless of age or timing — had unintended consequences. The average participant was 63, far past typical menopause onset. Applying those findings to younger women in their 40s and 50s without nuance led to widespread fear and undertreament that persisted for decades.
What We Don't Know
The list of unanswered questions is staggering for such a universal experience.
Major Research Gaps
Cognitive Changes
Why do some women get severe brain fog while others don't? Does HRT prevent cognitive decline? What's the long-term trajectory?
Impact: 60% of women affected, zero approved treatments
Perimenopause
The transition phase is barely studied. When does it start? How to diagnose? How to treat during wild hormone swings?
Impact: Can last 4-10 years, no clear treatment guidelines
Personalized Treatment
Who benefits most from HRT? Who's at risk? How to match treatments to individual women? Genetic factors?
Impact: One-size-fits-all approach fails many women
Long-Term HRT
Is it safe to stay on HRT indefinitely? What about starting later? Stopping and restarting? Different formulations?
Impact: Women forced to stop treatment without guidance
Non-Hormonal Options
What works for women who can't or won't use HRT? Which supplements actually help? What's the evidence?
Impact: Huge market of unproven products
Racial/Ethnic Differences
Symptoms and timing vary by race. Why? How should treatment differ? Most research is on white women.
Impact: Diverse women systematically understudied
Mental Health
Why does menopause trigger depression/anxiety in some women? Best treatments? Role of hormones vs. life stage?
Impact: 2-4x higher depression risk, unclear treatment path
Cardiovascular Connection
How exactly does estrogen loss affect heart health? Optimal prevention strategies? HRT's role in heart protection?
Impact: Heart disease is #1 killer of women post-menopause
The Funding Gap
Money talks — and the research funding disparity speaks volumes about priorities.
NIH Research Funding Comparison (Approximate)
Erectile dysfunction affects ~30M American men. Menopause affects ~50M American women. Funding is 10x higher for ED.
The disparity is systemic. Across the board, conditions primarily affecting women receive less research funding than those affecting men. Menopause is perhaps the starkest example — a universal female experience treated as a niche concern.
The Training Gap
Even if we had more research, most doctors aren't trained to apply it.
Medical Education on Menopause
20%
of OB-GYN residencies have a menopause curriculum
7%
of internal medicine residents feel competent managing menopause
~1,800
NAMS-certified menopause practitioners (vs. 50M+ women in menopause)
😔 The Result
- Women told their symptoms are "normal aging"
- Doctors afraid to prescribe HRT due to outdated fears
- Average 2+ years to get proper diagnosis
- Many women see 3+ doctors before getting help
- Telehealth menopause specialists filling the gap
- Women turning to unregulated supplements
🩺 Finding Trained Providers
- NAMS Directory: menopause.org — certified practitioners
- Telehealth: Midi, Evernow, Gennev, Alloy
- Questions to ask: "How many menopause patients do you see?" "Are you comfortable prescribing HRT?"
- Red flag: Doctor dismisses symptoms without discussion
Questions That Need Answers
Specific research questions that would transform menopause care if answered.
Does early HRT prevent Alzheimer's?
Observational data suggests yes, but we need randomized trials. Stakes are enormous — Alzheimer's affects women 2:1.
What's the optimal HRT duration?
Current guidance says "use lowest dose for shortest time" — but this isn't evidence-based. Many women need long-term treatment.
How do we diagnose perimenopause?
Currently diagnosed by symptoms + exclusion. No reliable biomarker. Leads to years of uncertainty and undertreatment.
Which supplements actually work?
Billions spent on supplements with minimal evidence. Rigorous trials needed to separate signal from noise.
Why do symptoms vary so much?
Some women sail through, others are debilitated. Genetic factors? Lifestyle? Microbiome? We don't know.
How to manage menopause in cancer survivors?
Many breast cancer survivors can't use HRT. What are the best alternatives? Urgent need for options.
Signs of Progress
After decades of neglect, things are finally starting to change.
Recent Positive Developments
New Drug Approvals
Veozah (fezolinetant) approved 2023 — first new non-hormonal hot flash drug in decades. More in pipeline.
NIH Attention
NIH announcing new menopause research initiatives. Increased focus on women's health overall.
UK Leadership
UK appointed Menopause Employment Champion. NHS improving access. Workplace policies advancing.
Medical Society Updates
NAMS, ACOG, Endocrine Society all updating guidelines to support HRT for appropriate candidates.
VC Investment
Hundreds of millions flowing into menopause startups. Money drives innovation and legitimacy.
Cultural Shift
Celebrities, executives speaking out. Media coverage increasing. Stigma slowly lifting.
✓ What You Can Do
✓ Support organizations funding menopause research
✓ Participate in research studies if eligible
✓ Talk openly about menopause — reduce stigma
✓ Advocate for workplace policies
✓ Contact legislators about research funding
✓ Demand better from your healthcare providers
✓ Share accurate information — counter myths
✓ Support menopause-focused businesses and media