Both concerns are alive in the field, and they are not simply opposites.

One influential 2024 medical journal series argued against framing menopause purely as a hormone-deficiency disease, proposing instead a model where social and psychological context shapes the experience, and warning against commercially driven over-treatment narratives. At the same time, the actual documentation and treatment numbers, roughly 7-8 percent of women getting a formal diagnosis code, under 5 percent of US postmenopausal women using hormone therapy, are hard to reconcile with widespread over-medicalization at a population level. The strongest honest synthesis is that the values debate about how to frame menopause is real, but the data currently point overwhelmingly toward under-recognition and under-treatment being the bigger problem.

What to know about this answer

This is a genuine values debate layered on top of measurable data, and both sides claim to be taking women seriously - the disagreement is over which failure mode is more common right now.

What the research shows, and which source each finding rests on

A 2024 medical journal empowerment-model paper argues against framing menopause as an endocrine deficiency disease, proposes an empowerment model shaped by modifiable psychological, social, and contextual factors, and warns against commercially driven over-treatment narratives.

A[1]

Documentation rates around 7-8% (Israeli and US claims data) are difficult to reconcile with a population-level over-medicalization pattern.

D[2]E[3]

Treatment rates are similarly low across independent sources: 4.7% of all US postmenopausal women use hormone therapy; 29.1% of symptomatic Israeli women receive any treatment; roughly 1 in 4 receive any treatment in the Mayo HERA survey.

D[4]D[5]C[6]

Where the real disagreement is

Each position is shown with its own sources. A position listed here is not necessarily the accepted view.

Beware over-medicalization; empowerment model

the authors of the 2024 empowerment-model paper

Framing the menopause transition primarily as a hormone-deficiency disease can obscure the modifiable psychological, social, and contextual factors that shape a woman's experience, and fear-based or commercially driven marketing narratives can themselves cause harm; the paper does not deny symptoms exist or oppose hormone therapy, it opposes reducing a life transition to a single deficiency framework.

A[1]

Under-recognition and under-treatment are the dominant problem

clinician-advocates including Dr. Kelly Casperson, Dr. Lisa Mosconi, and Dr. Avrum Bluming, pointing to the documentation and treatment numbers

Documentation rates around 7-8% and treatment rates under 5-30% across multiple independent data sources are difficult to reconcile with a population-level over-medicalization problem; one clinician's direct response to the 'stop medicalizing menopause' critique is that helping people live and function better is simply a physician's job.

D[2]E[3]D[4]D[5]C[6]

What would settle it: Population-level treatment-appropriateness studies that separately identify who is symptomatic, eligible, informed, and still untreated, versus who is treated without a clear indication - current data overwhelmingly find the first group larger, but a formal appropriateness study would settle the values debate on firmer ground.

What is really going on here

  1. Is the concern about over-medicalization about hormone therapy specifically, or about how menopause is talked about culturally?
  2. Do the documentation and treatment numbers in my own healthcare system support over-treatment or under-treatment as the bigger risk?

Questions for your doctor

  1. Given my specific symptoms, are we discussing treatment because it's clearly indicated, or should we be more conservative here?
  2. What would over-treatment look like in my case, and how would we know if we were headed that way?
  3. What are the risks of doing nothing, not just the risks of treating?

Questions with no answer yet

Among women currently receiving hormone therapy or another menopause treatment, what share would be considered appropriately treated by a formal eligibility standard, versus treated without clear symptomatic indication?

Not directly studied yet

No research does not mean it does not work, and it does not mean it works. It means nobody has tested it yet.

What is known: Current data measure documentation rates and overall treatment rates, both of which are low, but no formal appropriateness study has separately identified who is symptomatic, eligible, informed, and still untreated, versus who is treated without a clear indication, which is exactly the comparison that would settle the values debate on firmer ground.

What would test it: Population-level treatment-appropriateness studies that separately identify who is symptomatic, eligible, informed, and still untreated, versus who is treated without a clear indication.

Does commercially driven marketing about menopause treatment actually lead to inappropriate treatment at a measurable scale, or is this mainly a theoretical risk raised without population-level evidence behind it?

Not directly studied yet

No research does not mean it does not work, and it does not mean it works. It means nobody has tested it yet.

What is known: One influential position explicitly warns against commercially driven over-treatment narratives, but this concern is not accompanied in the source material by a population-level measurement of how often marketing-driven treatment actually occurs or how it compares in scale to the documented under-treatment pattern.

What would test it: A study measuring rates of hormone therapy initiation without a documented symptomatic indication, ideally tracking exposure to direct marketing, to see whether a measurable inappropriate-treatment pattern exists and how large it is relative to under-treatment.

Sources

  1. 1.An empowerment model for managing menopause.Hickey M, LaCroix AZ, Doust J, Mishra GD, Sivakami M, Garlick D, Hunter MS. An empowerment model for managing menopause. Lancet 2024;403(10430):947-57. · Systematic review or guideline
  2. 2.Healthcare Utilization and Prevalence of Symptoms in Women with Menopause: A Real-World Analysis.Sharman Moser S, Chodick G, Bar-On S, Shalev V. Healthcare utilization and prevalence of symptoms in women with menopause: a real-world analysis. Int J Womens Health 2020;12:445-54. · Comparative or small study
  3. 3.Komodo Health. Lost in Transition: despite growing awareness, perimenopause remains vastly underrecognized and undertreated. March 2025.Review, opinion or mechanism
  4. 4.Menopausal Hormone Therapy Use Among Postmenopausal Women.Yang L, Toriola AT. Menopausal hormone therapy use among postmenopausal women. JAMA Health Forum 2024;5(9):e243128. · Comparative or small study
  5. 5.Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women.Frankenthal D, Karni-Efrati Z, Zatlawi M, Keinan-Boker L, Bromberg M. Menopausal symptoms and attitudes toward hormone replacement therapy among Israeli women. J Women Aging 2024;36(1):1-13. · Comparative or small study
  6. 6.Addressing Menopause Symptoms: Barriers and Opportunities for Improvement.Kapoor E, Safwan N, Chaudhry R, et al. Addressing menopause symptoms: barriers and opportunities for improvement. Mayo Clin Proc 2025;100(11):1897-1907. · Observational study

The letter grades the type of study behind a claim, not the answer itself.

This page is general information based on published research and public sources. It is not medical advice and not a personal assessment, and it does not replace a conversation with your doctor. Peritale is a wellness product, not a medical device, and is not intended to diagnose, treat, cure or prevent any disease. For any medical question, speak with a licensed clinician.

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