Editor’s Note: Dr. Lara Freidenfelds is a historian of health, reproduction, and parenting. She is the author of “The Modern Period: Menstruation in Twentieth-Century America” and “The Myth of the Perfect Pregnancy: A History of Miscarriage in America.” The opinions expressed in this commentary are her own. View more opinion on CNN.
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Gen X is dealing with menopause, and women of this generation are looking for new and better solutions to manage the disruptions menopause can cause, and safely and effectively ease the transition past their menstruating years. Ostensibly noting this demand, in August, Clearblue released a menopause test kit. Noting that menopause is often “shrouded in mystery,” the company’s head of scientific and medical affairs, Lucy Broadbent, has stated that the objective of the test is to alleviate some of the confusion. While other at-home tests are already on the market, Clearblue says that, unlike many alternatives, its test can be used any time during a women’s cycle.
Will women buy it? Should they?
Women themselves were the original drivers of hormone therapies for menopause. As Judith Houck noted in her book “Hot and Bothered,” Premarin, a mix of estrogen compounds introduced in 1941 to treat hot flashes and other symptoms of menopause, was touted in newspaper and magazine articles as the latest and greatest medical breakthroughs. Exasperated doctors complained that demanding women read the articles and then told them how to practice medicine, but they nevertheless wrote the prescriptions.
In 1966, gynecologist Robert Wilson advocated long-term hormone replacement therapy for all women in the bestseller “Feminine Forever.” He had a misogynistic contempt for older women that was appalling; in a prior academic article Wilson described menopausal women as sexual “eunuch[s]” with dried up sexual organs and flabby, shrunken breasts, who saw the world through the “gray veil” of a “vapid cow-like feeling called a negative state.” But, nonetheless, many women embraced Wilson’s promise that hormone replacement therapy (HRT) would give them enduring sex appeal, tame hot flashes in the workplaces women increasingly inhabited and even promote heart and bone health. Doctors liberally prescribed HRT, often at their patients’ behest.
Prescriptions diminished briefly in the mid-1970s after HRT was found to increase the rate of endometrial cancer, but bounced back after physicians began routinely prescribing progestin alongside estrogen to reduce the cancer risk. According to a 1998 survey, cited by Houck, around a third of women aged 50 and older used HRT.
But in 2002 there was more bad news: the National Institutes of Health sponsored Women’s Health Initiative trial revealed the shocking finding that HRT as it was then prescribed increased rates of heart disease, stroke and invasive breast cancer. While further research and more nuanced analysis of the findings would show that HRT is safe and appropriate to prescribe for women who are under 60 or within 10 years of menopause, at the time women and their doctors were alarmed, and women cancelled their prescriptions in droves. Some turned to feminist ideas about embracing “natural” aging. Menopause was still miserable for many, though, and women searched for alternate pharmaceutical solutions.
Some clinicians, especially alternative providers such as naturopaths, proposed that hormones derived from plants should be safer than those synthesized in the lab. They began to prescribe what they called “bioidentical hormone replacement therapy,” compounding personalized combinations of estrogens and progestins and tweaking treatment regimens regularly on the basis of saliva and urine tests.
Professional organizations such as The North American Menopause Society and The American College of Obstetricians and Gynecologists have pointed out the these “bioidentical” hormones actually require laboratory synthesis of the natural ingredients, and the end product is indistinguishable from standard HRT. Compounded bioidenticals are also not regulated by the FDA, so they do not have that imprimatur of safety.
Nonetheless, the market for bioidenticals is booming. It was a $36 million market in 2022, and is forecasted by market research firm Fact.MR to be an almost $60 million market by 2032. Some analysts calculate a potential market in the billions of dollars, if women can be persuaded to take up bioidentical hormones in larger numbers. Women are searching for safe, effective, personalized menopause care, and they are clearly spending a lot of money trying to get it.
It is not surprising, then, that companies like Clearblue would see that market and hope to cash in. But the Clearblue menopause test kit seems like a solution in search of a problem. Even assuming the test is accurate, there isn’t much to do with the results except show them to a health care provider. A respectful provider will order a clinical version of this test if it is relevant to treatment (which it may not be). And if a woman is being blown off by her medical provider, she is unlikely to be able to forge a useful clinical relationship to get assistance through perimenopause by showing that provider these test results.
What’s more, this test is not suitable for the women who might have been most likely to find it informative: Those who do not get regular periods because they use hormonal birth control or a hormone-based IUD, have had a hysterectomy, have polycystic ovarian syndrome (PCOS) and so on. While the test involves urine samples, the algorithm that interprets these samples can only do so in combination with the test-taker’s menstrual cycle history. It’s not clear how much value the test can add if it simply confirms that yes, your less-frequent periods likely mean that you are approaching menopause.
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This is not to discourage companies from addressing menopause, if they really mean to tackle the frustrations women want solved. There is plenty of room for innovation. New non-hormonal pharmaceuticals that seek to address hot flashes are on the horizon, and more research can be done. Physicians can stay abreast of HRT -prescribing guidelines and communicate better with patients about balancing risks with benefits. Workplaces can fund benefits for menopause treatments, address age-related discrimination and take steps to destigmatize menopause in the workplace (hot flash jokes are reserved for those having the hot flashes!).
Companies selling consumer products could be a welcome addition to making menopause more comfortable, and treating female bodies as fully worthy of care in all their stages is imperative.
But the menopausal women of Gen X are practical and demand respect. If you have a product to sell us, ask us if we want it first. It won’t do to simply take a lab test and wrap it in a pink package and expect us to be impressed. Show us that the product will make our lives meaningfully easier, more pleasant, healthier and safer. Then you might get to cash in on the spending power of women in the full flush of their prime years.
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