Misinformation on Perimenopause Risks Unintended Pregnancies, Missed Diagnoses

Misinformation about perimenopause is putting women at risk of unintended pregnancies, unnecessary medication and missed diagnoses, experts have said.

Awareness of menopause and treatments such as hormone replacement therapy (HRT) has been raised by efforts including a prominent documentary by Davina McCall.

But as a growing number of women encounter misleading information on social media, there are concerns that some could be led to false conclusions that can obscure real underlying health difficulties.

“Everyone thinks they’re menopausal,” said Dr Paula Briggs, a consultant in sexual and reproductive health. “So we are seeing younger and younger women asking for HRT when what they need is hormonal contraception, as they’re still fertile.

“I work in an abortion service and we’re seeing more women over 35 now who believe themselves to be menopausal and are gobsmacked when they become pregnant.”

According to the British Menopause Society (BMS), more than 80% of women will be menopausal by the age of 54 – meaning they haven’t had a period for 12 months or more – with about 5% of women reaching menopause before the age of 45.

But menopause is not a sudden cessation: instead, women experience a transition, known as perimenopause, over a period of months or years. During this time hormone levels fluctuate and can result in symptoms such as a change in menstrual patterns, hot flushes and difficulty sleeping.

Briggs said misinformation around perimenopause is concerning.

“I look at things like Instagram to see what they are exposed to and I am horrified,” she said, citing examples of women in their 30s being told to demand HRT if they are unable to sleep or are struggling with migraines – and to switch GPs if denied. Or women being told they should seek testosterone treatment.

“I’m not anti any of these things in the right person, but females produce their own testosterone lifelong, even women without ovaries, so the idea that everybody has to demand testosterone is bonkers,” Briggs said.

Dr Channa Jayasena, an expert in reproductive endocrinology at Imperial College London, also raised concerns.

“It’s great that there’s better [public] awareness [about perimenopause]. And I think many doctors are completely unaware about how debilitating the symptoms of perimenopause can be,” he said. “But the flipside of that, I think there’s a risk that some women are being mislabelled as having perimenopause when they have other things that are wrong.”

Prof Janice Rymer, chair of the British Menopause Society, agreed.

“[If you are] having regular periods naturally, then you’re not perimenopausal – end of story. You’ve got good hormone levels,” she said.

Rymer added that there is a perception that any symptom affecting women between the ages of 40 and 60 is due to perimenopause or menopause and that HRT is required.

“I think HRT is completely wonderful,” Rymer said. But, she added, “it’s not for women who don’t need it,” noting that in such situations it can cause heavy bleeding.

Briggs said a key concern arising from misinformation around perimenopause is that women are stopping contraception, thinking it is no longer needed.

Jayasena suggested that could be because of messaging around how fertility declines with age.

“I think we’ve got a real awareness about the timelines for optimum fertility and optimum response for IVF. IVF stops working well beyond the age of 42. It’s easy to translate that to an assumption that you can’t get pregnant naturally, when actually you can,” he said.

Experts have also raised concerns over a pushback against hormonal contraception – something that is particularly acute among younger women – even though demand for HRT is growing.

While they stress contraception is not a one-size-fits-all issue, Briggs noted there are many progestogen-only contraceptives that can be used alongside HRT to protect against pregnancy while managing symptoms associated with perimenopase.

In addition, she said, there are modern forms of the combined pill that are safer for use in women experiencing perimenopause than traditional combined pills, as they contain a natural form of oestrogen. Essentially, said Jayaesna, “it’s a mini pill plus a bit of HRT.”

Dr Zara Haider, president of the College of Sexual and Reproductive Healthcare, said misinformation is a significant issue, particularly around fertility and hormone use.

“We still see women stopping contraception too early because they assume they can’t get pregnant, when in reality contraception is needed until menopause is confirmed or until age 55. There’s also been a lasting impact from outdated or flawed studies around risks like breast cancer, which has understandably made some women cautious about hormones,” she said.

“At the same time, it’s positive that public conversations, including high-profile campaigns, have helped bring menopause into the mainstream. The challenge now is making sure women are getting accurate, evidence-based information to make informed decisions.”