Experts warn against unnecessary menopause testing and treatments

Many direct to consumer menopause services are unnecessary and do not improve care, warn experts in The BMJ today.

They argue that the sharp rise in commercial services for women seeking relief for menopausal symptoms raises concerns about the reliability and potential commercial bias of the information, and that symptoms are best assessed by a thorough clinical history with treatment decisions guided by clinical response and patient preferences.

One of the most troubling trends arising from this surge is the promotion of routine hormone panel testing for the evaluation of menopausal symptoms, they write. These tests can cost hundreds of dollars and are marketed to patients and clinicians as necessary for “individualising” hormone therapy.

Yet in reality, these tests are of limited clinical use because there is no clearly defined therapeutic window for menopausal hormone therapy, and some testing techniques do not offer accurate or precise assessment of hormone levels.

For perimenopause and menopause, hormone testing offers no reliable way to determine who will benefit from treatment, when the final menstrual period will occur, or whether it is safe to discontinue contraception, they explain.

Clinical guidelines from the British Menopause Society, National Institute for Health and Care Excellence, American College of Obstetricians and Gynecologists and others agree: in women over age 45 presenting with validated symptoms of menopause, including menstrual irregularity, menopause is a clinical diagnosis, and hormone testing is unnecessary.

Despite this, many women now present with detailed hormone panels from wellness providers or online services that are often used to justify taking custom-made hormone preparations or supplements based on marginal deviations from hormone thresholds that are not grounded in evidence, write the authors.

Such custom-made hormone preparations (known as compounded hormone regimens) are not regulated in the same way as standard menopausal hormone therapy and have not been tested for effectiveness and safety.

There is also concern that inconsistencies in the quantities of oestrogen or progestogen in compounded hormone regimens can result in abnormal cell growth or cancer in the womb (uterus) lining, they add.

Until we can establish individualised target hormone levels, there is no role for commercial hormonal panel testing to guide therapy, they argue. In the meantime, such testing offers only a false sense of precision.

They acknowledge that innovation is needed but suggest that the normalisation of hormone panel testing could be a symptom of a larger problem: the commercialisation of women’s health and a movement away from evidence based practice. 

For midlife women, effective treatment begins not with numbers, but with listening, they conclude.