What is ‘menopause washing’ and how can nurses challenge it?

Women seeking help for menopausal symptoms are increasingly being persuaded to buy supplements that are of no benefit, as part of a worrying process of ‘menopause washing’ by industry, a nurse specialist has warned.

Nurse practitioner Caroline Wheeler told attendees at a recent Nursing in Practice event in Liverpool that it is now common for women to attend her clinic with ‘an array of supplements’ that they have bought online after being targeted by persuasive advertising.

‘They’ve spent hundreds of pounds. They have no idea what’s working and what isn’t, but they’ve seen it online,’ Ms Wheeler said.

‘Menopause washing’ on the rise

The trend has given rise to what Ms Wheeler described as ‘menopause washing’, where companies are profiting from increased public attention around menopause to sell their products.

Ms Wheeler urged clinicians to use trusted, evidence-based resources, in particular the British Menopause Society (BMS) standards and clinical tools and National Institute for Care Excellence (NICE) guidance on diagnosis and management

‘If you follow [these resources], you’re not going to go far wrong. Most women can be managed in primary care,’ she said.

Revised NICE menopause guidance was published in November 2024, including updates on the use of cognitive behavioural therapy (CBT) as a treatment option, the management of genitourinary syndrome of menopause (GSM), including options for women with a history of breast cancer, and discussion around the long-term impact of HRT on health outcomes.

Understanding menopause: key phases and symptoms

Ms Wheeler reiterated the importance of helping patients understand the different life-stage transitions:

• Perimenopause: cycle changes and symptoms (average onset age 45)
• Menopause: final menstrual period
• Post-menopause: 12 months without a period (average UK age 51)
• Premature ovarian insufficiency (POI) symptoms before age 40

‘As healthcare professionals, it is vital to understand the different life-stage transitions that women experience in their reproductive health.

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‘These stages of perimenopause, menopause, post-menopause, and premature ovarian insufficiency (POI) pose unique challenges and require informed support,’ Ms Wheeler explained.

What should nurses cover in a menopause consultation?

A thorough consultation, Ms Wheeler said, should include:

• Reviewing symptoms (which may fluctuate)
• Medical and family history
• Menstrual history and contraception
• Blood pressure, height and weight
• Options for treatment
• Risks, benefits and side effects
• Lifestyle discussions
• What Hormone Replacement Therapy (HRT) can and cannot do
• Follow-up at three months, then annually once stable

The power of listening

Ms Wheeler sees listening to patients as ‘essential’ to impactful menopause care.

‘A thorough menopause consultation is essential for empowering women to navigate this significant life transition,’ she noted.

Ms Wheeler emphasised the importance of a holistic nursing approach, which includes an assessment of ‘fluctuating symptoms, medical and family histories, and menstrual patterns’.

She explained that by ‘discussing treatment options and their associated risks, benefits, and side effects’, nurses equip patients with the knowledge needed to make informed decisions. Ms Wheeler also highlights that lifestyle discussions are vital, as they can ‘significantly impact a woman’s experience during menopause’.

HRT: choice, side effects and when to avoid it

Ms Wheeler stressed the need for an ‘individualised approach to HRT’ and added that HRT is not necessary for all patients and needs careful assessment.

She also emphasised that HRT is not a ‘magic bullet’ and stressed that patients will respond to the medication in different ways, with potential for positive and negative potential side effects.

‘It takes time. Some women feel better relatively quickly, others come back after three months with improvements in some areas but not others. We tailor treatment as needed,’ she said.

HRT options include gels, patches, sprays, oral preparations, and various progestogen forms including vaginal products.

Ms Wheeler also outlined the common side effects for both oestrogen and progesterone when given as HRT. Most side effects settle reasonably quickly, she noted, but if they don’t then nurses should consider changing the dose, route or type of HRT.

Common oestrogen side effects:

• Bloating
• Nausea
• Breast tenderness
• Headaches
• Bleeding.

Common progestogen side effects:

• Mood swings
• Pre-menstrual symptoms (PMS) like symptoms
• Acne
• Fluid retention
• Breast tenderness.

She recommended that nurses avoid or defer HRT in cases of unexplained vaginal bleeding, untreated endometrial hyperplasia, active liver disease, oestrogen-dependent cancers or current or past breast cancer.

Ms Wheeler also highlighted how tirzepatide (Mounjaro) can reduce the absorption of oral micronised progesterone. For nurses supporting patients on weight loss medication, she said clinicians should consider dose adjustments or switching to a transdermal option or coil.

Ms Wheeler explained that GLP-1/GIP receptor agonists such as tirzepatide can slow gastric emptying, which may reduce the absorption of orally administered medicines. Consequently, clinicians should be aware that the effectiveness of oral micronised progesterone ‘may be reduced’ in women using these agents.

She noted that the BMS advises ‘considering alternative routes of progestogen delivery’, including transdermal preparations or a levonorgestrel-releasing intrauterine system, or adjusting the oral dose where clinically appropriate, alongside ‘careful review of bleeding patterns and symptom control’.

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PMS, PMDD and the risk of misdiagnosis

Ms Wheeler also warned that perimenopause can be misdiagnosed as anxiety or depression because of severe mood changes.

Both pre-menstrual syndrome (PMS) and pre-menstrual dysphoric disorder (PMDD), a severe form of PMS, which include psychological symptoms such as mood swings, irritability and anxiety and depressive symptoms, can develop or worsen around the time of perimenopause. PMDD can significantly impair work and relationships and carries increased risk of suicidal thoughts, she said. Symptom diaries remain essential, as there is no specific diagnostic test.

Ms Wheeler stressed that healthcare professionals should use ‘validated daily symptom charting tools’ to support patients in tracking their symptoms, alongside using NICE menopause guidelines and the National Association of Premenstrual Syndromes (NAPS) and Royal College of Psychologists guidance on PMDD.

Lifestyle and menopause management

Beyond HRT, Ms Wheeler stressed the importance of healthy living  and said lifestyle changes can ‘modestly but meaningfully’ improve individual’s menopause transition.

‘Lifestyle is fundamental in management of perimenopause and menopause,’ she said.

Patients on HRT can gain better symptom control and can feel more motivated to make lifestyle changes that may support weight management, she suggested.

What could lifestyle changes include?

• Build strength-based exercise to combat muscle loss and support bone density
• Improve sleep and reduce stress
• Limit alcohol and caffeine
• Stop smoking
• Focus on a diet higher in fibre and protein to support metabolism and satiety – think Mediterranean diet
• Emphasise achievable, sustainable changes

Tailoring care to each patient

Ultimately, Ms Wheeler urged clinicians to work collaboratively with patients, offering choices that suit their lifestyle.

‘Give women choice. Some may not remember to change a patch twice a week; others may not have time to wait for gels to dry. Absorption varies for everyone, skin type, alcohol, caffeine, stress, smoking and heat can all play a role, hence treatment options may change and women should be informed,’ she added.

‘Remember other tools we have available to us to support our patients such as CBT, relaxation, yoga, SSRIs, beta blockers.’

She encouraged signposting of psychological therapies where appropriate and ensured clear follow-up support.

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‘Review at three months, and sooner if you’re concerned,’ she said.

The latest episode of the Nursing in Practice Podcast explores the planned introduction of menopause questions into routine health checks and takes a deeper look at how nurses can provide more inclusive practice across the UK.

In another session at the event, nurses were encouraged to consider how sensory needs, executive function and communication differences affect care, and were urged to explore how consultation styles could be improved to create ‘calmer, more inclusive’ experiences.

Nursing in Practice has previously published advice for practice nurses on managing menopause symptoms at work.