Opinion: The women’s issue that Halle Berry, Naomi Watts and others are rightly shedding light on

Opinion by Megan L. Ranney and Karen Tang

(CNN) — As middle-aged women, doctors and public health professionals, we are glad to be able to say out loud: Perimenopause and menopause are real. If you’re feeling depressed, anxious sweaty or angry, it’s not in your head.

But here’s the good news. You don’t have to just deal with it as women have had to do for generations. There are ways to feel better.

Perimenopause, the years of hormonal and physical transition into menopause, is perhaps least understood by women — and society at large — and often goes undiagnosed and undiscussed. Luckily, that is changing. Women are starting to break their silence about their experiences with perimenopause, and their voices are being amplified and heard. But what’s needed is even more awareness by women and their doctors of potential symptoms, and of the options for managing them.

A big part of the problem is that perimenopause, and menopause itself (starting a year after a woman’s last menstrual period), can be complicated for physicians to treat effectively. That’s because one of the main treatments for severe symptoms is hormone replacement therapy, or HRT.

Twenty-two years ago, a single study transformed how hormone replacement and menopause were perceived by an entire generation of health care providers. A huge, randomized control trial of hormone replacement therapy, called the Women’s Health Initiative, was stopped ahead of schedule because an analysis had identified risks. The landmark paper published soon thereafter reported that combined estrogen and progesterone hormone replacement therapy increased the risk of cardiovascular disease and stroke, as well as breast cancer, among women in the trial. It concluded: “Overall health risks exceeded benefits.”

This study mattered because it shed a light on menopause — something that was rarely paid proper attention. (Remember, until the mid-1990s, there was no mandate to include women in clinical trials, and studies such as this one would never have happened.) After the paper was published, prescriptions for HRT plummeted. Hormones were still prescribed but were more often treated like a last resort. In many situations, women were told that we just had to suffer through it, because the risks of hormones seemed too high. Entire industries of unverified supplements and snake oil “cures” arose, promising miracles to women who were desperate for relief from their untreated menopause symptoms.

Over the last 22 years, however, both the narrative around menopause and the data around HRT have started to change.

To start, there’s been a cultural shift. We Generation X and millennial women are aging, and we refuse to accept that perimenopause and menopause symptoms must be hidden or even tolerated. To quote Halle Berry: “I’m in menopause, OK? The shame has to be taken out.”

Berry isn’t alone. Celebrities ranging from Naomi Watts to Drew Barrymore are talking about not just the physical symptoms but also the confusion, uncertainty and sometimes outright dismissal by medical providers around symptoms of perimenopause and menopause itself.

These famous voices are having an impact that those of us in the medical and public health professions know is urgently needed. Colleagues such as Dr. Jen Gunter have called out how destructive it is to dismiss the symptoms as all in our head.  And Dr. Tang’s book is titled “It’s Not Hysteria” because for too long, women’s health issues such as menopause have been treated as matters of anxiety, rather than genuine medical concerns that can be truly debilitating. But now, some media sources are sharing what menopause specialists have been saying for years: The hormone shifts of perimenopause can wreak just as much havoc on the mind and body as puberty.

Equally, if not more importantly, the science about hormone replacement therapy has evolved.

It turns out that the data on HRT is more nuanced than the initial results suggested in 2002. In fact, this month, a new publication by some of the same people who wrote the 2002 article reports that “hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms.” After 22 years of following the previously enrolled study participants, the researchers were able to see that the benefit of HRT likely outweighs the risk for certain people and certain problems — particularly for those of us in our 40s and 50s, when the symptoms of perimenopause (hot flashes, depression, disturbed sleep and bladder or vaginal symptoms) are at their worst.

Over the last two decades, physicians and researchers have also learned that different types of hormones, or different ways of taking hormones, can be helpful. For example, transdermal estrogen (administered through patches worn on the skin) does not seem to increase the risk of blood clots. And vaginal estrogen is minimally absorbed, so it has no significant effect on the risk of cardiovascular disease or clots. It has even been shown that vaginal estrogen can be used safely in many breast cancer patients. And there is a new nonhormonal medication, fezolinetant (Veozah), that can treat hot flashes among women who don’t want to or can’t take any form of hormones.

This evolution of science is good. We particularly applaud the National Institutes of Health and the Women’s Health Initiative study for continuing to pursue the best possible data for women’s health.

But it’s not enough.

That is why we are so glad to see Berry not just discussing her own experiences but also supporting bipartisan legislation that would earmark $275 million toward education and clinical trials about menopause and hormone therapy. The White House has launched a new Initiative on Women’s Health Research and has called on Congress to appropriate $12 billion toward getting good science on women’s health problems. These efforts would be truly transformative.

We also encourage women to share data and the evolving science with each other. Although there’s no magic bullet, the symptoms are real. For those of us who do need treatment, there are safe and effective options. We hope that the new headlines declaring that the risks of hormonal menopause treatment was overblown will prompt renewed discussions between doctors and perimenopausal patients about what options exist and what the best fit for each person may be.

We also hope that we all remember how much the science of women’s health really matters.

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