From the blog

You Were Dismissed. Then You Were Sold To.

Quick answers

What did the new Lancet review find?
A scoping review screening 4,056 records and analysing 89 studies found that women commonly experience fragmented care and limited access to evidence-based treatment, and report feeling dismissed, unsupported and uninformed about their options. Provider training was inadequate and national guidelines were inconsistently applied.
Is it true that not every midlife symptom is hormonal?
The critics' strongest evidence is a 2005 NIH consensus statement which concluded that vasomotor symptoms and vaginal dryness were clearly attributable to menopause, with sleep disturbance possible, and that the evidence did not support attributing much else. It is also twenty-one years old, which is a real weakness in leaning on it today.
So who should you believe?
Both, on the parts each one gets right. The care gap is documented. The overselling is documented. A woman can be genuinely dismissed by her doctor and genuinely oversold to by the people who offered to help.

Two arguments about perimenopause are running side by side this summer, and if you have been anywhere near the internet you have met both.

The first says that medicine is failing women in midlife, that you are dismissed and under-treated and left to work it out yourself.

The second says the opposite. That perimenopause has been turned into an industry, that ordinary midlife is being medicalised, and that women are being told a hundred different things are hormonal by people who happen to be selling the fix.

They are usually presented as sides. You are supposed to pick one.

I do not think they are sides at all. I think both are true, and that the second one happened because of the first.

The dismissal is documented now

A scoping review published this summer in The Lancet Obstetrics, Gynaecology & Women's Health screened 4,056 published records and analysed 89 studies, drawing mainly on evidence from the UK, United States and Australia [1].

What it found will not surprise you if you have lived it. Women commonly experience fragmented services and limited access to evidence-based treatment. They report feeling dismissed, unsupported and uninformed about what their options even are. Provider training on menopause remains inadequate, and national guidelines are applied inconsistently [1].

The gaps are not evenly distributed either. Race, socioeconomic status, cultural background and geography all shaped the barriers women ran into, and the burden fell hardest on LGBTQ+ people, Indigenous communities, migrant women and women who went through surgical menopause [1].

That is a serious journal, eighty-nine studies, saying plainly that the dismissal you experienced is a documented feature of the system rather than something you imagined.

The overselling is also real

Now the part my own corner of the world does not enjoy.

There is a growing critique, argued most sharply by researchers at Georgetown, that the perimenopause movement has gone well past its evidence. That the lists of a hundred symptoms are not supported. That midlife men report a good deal of the same forgetfulness, weight gain and disturbed sleep. And that almost everybody amplifying those lists is, one way or another, selling something [3].

Their strongest card is an NIH State-of-the-Science consensus statement, which concluded that vasomotor symptoms and vaginal dryness were clearly attributable to menopause, with sleep disturbance possible, and that the evidence did not support confidently attributing much beyond that [2].

I have watched that overselling up close. I have seen women handed a symptom checklist so broad that no living human could fail it, then sold a protocol on the strength of it. That is not education. It is a funnel with a lab coat on.

Where the critique is weaker than it sounds

Fairness cuts both ways, so let me say where I think the critics overreach.

That NIH consensus statement is from 2005 [2]. It is twenty-one years old. Menopause research has moved a great deal since, and leaning on a two-decade-old document to declare a question settled is exactly the move the critics accuse the other side of making.

There is also something worth noticing about the argument that midlife men report similar symptoms. It is a real observation. It is also being used to imply that if a symptom is not uniquely hormonal, it does not warrant attention. A woman who cannot sleep and cannot think clearly has a problem worth taking seriously whether or not the cause turns out to be her ovaries.

And the accusation that everyone in this space is selling something applies to more people than it is usually pointed at. I sell books. I am not exempt from that scrutiny and I would not ask to be.

Why the two things are connected

Here is the part almost nobody says out loud.

The overselling did not arrive from nowhere. It arrived because women went looking for answers and the system did not give them any.

Read those two findings next to each other. Women are dismissed, under-informed and poorly supported by conventional care [1]. Women are then met by an industry that is confident, warm, available at eleven at night, and prepared to explain everything [3].

Of course they went. When someone tells you your labs are normal and to reduce your stress, and someone else tells you there are one hundred symptoms and here is the protocol, the second one is the only one treating you like a person with a real problem. That it is also overstating its evidence is a separate matter, and one you have no way to assess from the inside.

You were failed twice. First by the people who should have investigated and did not. Then by the people who filled the silence with more certainty than they had earned.

What that means for you, practically

Hold both truths at once, because you need both.

Do not let the backlash talk you out of your own experience. The care gap is documented in eighty-nine studies [1], and your symptoms are not less real because somebody wrote an article about over-medicalisation.

And do not let the certainty of the internet substitute for actual investigation. If someone attributes everything you are feeling to hormones without looking for anything else, they have not answered your question. They have relabelled it.

The useful posture in the middle is the same one I keep coming back to. Ask what was measured. Ask who it was measured in. Ask what would change the plan. Notice when a claim arrives attached to a product, mine included.

Being taken seriously and being told the truth are not opposites. You are entitled to both, and this summer's arguments are only unusual in that each side is loudly right about the other's failure and quiet about its own.

Bad Medicine Blues is my attempt at the third position, which is careful about the evidence and refuses to dismiss you. Read a free chapter.

Sources

  1. Kalbarczyk A, Morgan R, et al. Navigating menopausal care- a scoping review of health system responsiveness and gaps. Lancet Obstet Gynaecol Womens Health. 2026. doi.org/10.1016/S3050-5038(26)00083-X
  2. National Institutes of Health State-of-the-Science Conference statement- management of menopause-related symptoms. Ann Intern Med. 2005;142(12 Pt 1):1003-1013. pubmed.ncbi.nlm.nih.gov/15968015
  3. Fugh-Berman A, et al. The perimenopause movement sells women the lie that they are ruled by their hormones. STAT News, March 2026. (Opinion, not a study.) statnews.com/2026/03/26/perimenopause-symptoms-evidence-supplements

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