OZ.VGI.CO.ID - MELBOURNE, AUSTRALIA – A recent characterization of menopause as a "physiological cliff" in a study published in the journal Nature Medicine has drawn sharp criticism from medical experts, who argue the term is scientifically inaccurate and potentially misleading. This framing, they contend, not only misrepresents the biological reality of menopause but also serves as fertile ground for the commercialization of unproven remedies and treatments, contributing to a burgeoning global market estimated at approximately $US15 billion ($21.4 billion AUD).
The Nature Medicine study, which analyzed laboratory data from over one million women, suggested a "physiological cliff" at the point of the final menstrual period, impacting hormone, skeletal, liver, kidney, and lipid systems. It also noted a "transient rise" in average depression and sleep issue ratings. However, medical professionals argue that this portrayal exaggerates the biological shifts and fails to acknowledge the highly individual nature of the menopausal transition.
Varied Experiences of Perimenopause and Menopause
Perimenopause, the transitional phase leading up to menopause (the permanent cessation of menstruation), typically spans four to six years.
During this period, women can experience a wide spectrum of symptoms, or none at all.
"Women can have vastly different experiences of perimenopause and menopause," states Professor Martha Hickey, a leading figure in obstetrics and gynaecology at the University of Melbourne and head of menopause services at The Women’s Hospital.
"About one in four women will have no menopausal symptoms.
A similar proportion will have severe symptoms, while the rest will experience manageable, albeit annoying symptoms." This diversity directly contradicts the monolithic "cliff" narrative.
The personal accounts of women experiencing perimenopause highlight this variability. For instance, 46-year-old author and entrepreneur Zoë Foster Blake shared on The Imperfects podcast that her perimenopause began in her late 30s, manifesting as significantly increased anxiety, severe sleep disturbances, and irritability bordering on rage. "So anxiety ramped up to an 11," Blake stated. "And sleep was terrible: waking up all through the night and never feeling rested. [I was] irritable: fury, rage over things that shouldn’t have been inciting that level of rage." While these experiences can feel abrupt, Stuart Phillips, Professor and Chairman of Kinesiology at McMaster University in Canada, acknowledges that for some, the term "cliff" may resonate with their lived experience. However, he firmly maintains that labeling it a "physiological cliff" is inaccurate.
Challenging the 'Cliff' Narrative with Data
Professor Hickey asserts, "It’s not a thing." She points out that the new Nature Medicine study is not the first to employ cliff-like terminology. A study published earlier in February corrected the long-held notion of menopause as a "muscle cliff," finding that women do not suddenly experience muscle wasting but rather lose muscle mass with age similarly to men. Phillips elaborates that the Nature Medicine study itself found hormonal changes begin 12 to 15 years before menopause, with many of these shifts being microscopic. "Nobody needed Nature Medicine to tell them estrogen falls when the ovaries stop," Phillips remarked. "The shifts in everything else – liver enzymes, lipids, kidney markers – are mostly a tenth to four tenths of a standard deviation, at the population level. Probably real. Invisible in any one woman’s blood work." He explains that by highlighting the sharpest changes across millions of tests, the study creates a perception of dramatic decline where the individual experience is often far more subtle.
Bone Health: An Exception and a Solution
The primary physiological change that does accelerate significantly in the decade preceding a woman's final period is bone loss.
However, Phillips offers a straightforward and accessible solution: weight training.
"And there’s a cheap fix for that, he adds: lift weights." This practical advice contrasts sharply with the alarmist "cliff" metaphor.
The Commercialization of Menopause
The persistent use of dramatic language like "physiological cliff" is not only biologically inaccurate but also serves a powerful marketing purpose. Dr. Fatima Khan, a menopause doctor and author of Hormone Health is Mental Health, observes, "One dramatic moment is an easier story to tell than a 10-year one." She notes that many women perceive menopause as an abrupt event at age 51, a notion she says is far from reality. "Most women I see think of menopause as something that happens at 51, like a switch. It really doesn’t work like that." Phillips echoes this sentiment, stating, "Watch the menoposse jump on this. Calling it a cliff is good marketing, not good biology."
This marketing-driven approach is contributing to the "weaponization" of menopause, according to Professor Hickey.
"There’s a huge amount of money to be made in remedies and treatments and prevention." A September analysis of #womenshealth posts on social media revealed a significant focus on hormones and reproductive health, with many posts promoting interventions and demonstrating financial interests.
Dr.
Brooke Nickel from the School of Public Health at the University of Sydney commented on this trend: "A common trend in these health posts is sensationalised language that’s being used to market an intervention to women."
Focusing on Well-being, Not Alarms
Experts emphasize that menopause is a normal, inevitable life stage for individuals born with functioning ovaries.
"Menopause is a normal and inevitable life stage for all those born with functioning ovaries," Hickey asserts.
"Describing this as a ‘physiological cliff’ is potentially alarming for women and implies a dramatic physical and mental decline, which this study does not demonstrate." She clarifies that there is no compelling evidence suggesting women in perimenopause or menopause need to undertake drastically different health regimens compared to anyone else.
The foundational principles of health remain consistent: "The basics are the same for everyone: sleep, stress, nutrition, movement," says Dr.
Khan.
While the nature of the changes may not differ, the perimenopausal and menopausal phases call for a more deliberate approach to self-care.
Phillips advises, "Lift something a couple of times a week, mostly for [your] bones, and because strength is what keeps you independent at 80.
Eat enough protein; the number doesn’t change at menopause.
Guard your sleep because that’s where the symptoms do their damage to everything else." For women experiencing distressing symptoms that interfere with their daily lives, consulting a doctor about menopausal hormone therapy (MHT) is a valid option.
"It is a legitimate treatment for symptoms, and it helps your bones," Phillips states.
"It won’t build muscle.
Training does that, at any age, with or without oestrogen.
But I fully acknowledge that less symptoms can equal better sleep, better sleep equals better everything..."
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