Menopause Advice Online: How to Tell Good Information From Noise
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Show Notes
It's two in the morning and you can't sleep, so you pick up your phone. One doctor with letters after her name is completely sure. Another doctor says the exact opposite, and he sounds kind of annoyed. Then a woman with no letters at all is nicer than both of them, and about thirty seconds in she gives you a discount code.
Dr. Siân West, board-certified OB-GYN and Menopause Society Certified Practitioner, explains why menopause information online feels like a fight, and gives you four questions you can use on anybody, including her. She doesn't name anyone in this episode. This one is about how it all works, so you can stop trying to be the referee.
Doctors who disagree used to argue at conferences where you'd never see it. Now those arguments show up on your phone in ninety-second videos, on apps that make money when you keep watching, so the careful details get cut. When two doctors both have credentials, credentials stop helping you decide, and it starts to make sense to go with whoever sounds most sure. Being the referee was never your job. What you need is a few good questions, and one clinician who'll talk through their thinking with you, out loud.
What you'll learn
Why credentials stop helping you once two doctors disagree in public
When doctors' disagreements turn into name-calling online, and what that costs you
The real difference between a clinician and a health influencer: who has to answer for it when they're wrong
Why sounding sure sells, and why a loud argument doesn't mean the research is unsettled
Four questions to ask about any health advice, on any app, including this show
Where Dr. Siân's own certainty stops: how long to stay on MHT, pills versus patches, testosterone, and the brain
Two common claims to practice on: whether compounded bioidentical hormones are really safer, and whether progesterone cream protects your uterus
Three questions to ask at your next appointment
One thing to do this week: apply the four questions to the next piece of menopause advice you see, including anything you hear on this show.
Questions this episode answers
Why do menopause experts disagree with each other so much?
Doctors arguing with each other is a normal part of how medicine works. It's how advice gets checked and changed over time. Most of the arguing happens in the areas where there isn't much research yet. It looks worse than it is online, because short videos cut the careful details and reward sharp, angry clips.
How can I tell good menopause information from bad information?
Ask four questions. Are they arguing about the research, or about the person? Does how sure they sound match how good the research is? Where does the advice end up, with your doctor or at a checkout page? Can you find the same claim somewhere that has nothing to do with them?
If someone sounds completely sure, does that mean they know what they're talking about?
Usually it's the opposite. People who really know a subject tell you where the solid research stops, without being asked. Someone who sounds just as sure about every single question either hasn't looked closely enough, or has figured out that sounding sure sells.
What's the difference between a doctor and a health influencer?
The biggest difference is who has to answer for it when they're wrong. A doctor's medical license, malpractice insurance and patient chart are all on the line, and the patient comes back to say whether it worked. Someone selling advice online usually answers to nobody, and you can't see that in a video.
If experts are arguing, does that mean the science isn't settled?
No. How loud an argument is tells you almost nothing about how sure the research is. Arguments happen in the small areas where research is still thin. The basics everyone agrees on rarely get talked about online, because there's nothing to fight about.
Are compounded bioidentical hormones safer than FDA-approved hormone therapy?
According to The Menopause Society's current guidance, claims that compounded or bioidentical hormones are safer than FDA-approved ones have not been backed up by well-designed clinical trials. A compounding pharmacy mixes the medication itself, and oversight of compounding pharmacies varies. There's also evidence they can be more dangerous: compounded products have been found contaminated, including with mold, and testing has found that what's on the label isn't always what's in the bottle, which matters a lot when the progesterone dose is what protects your uterus. These products are legal and the right choice for some women, but they haven't been through FDA testing and don't come with a standard package insert listing the risks.
Does progesterone cream protect my uterus if I'm taking estrogen?
Progesterone cream on the skin has not been shown to reach blood levels high enough to protect the lining of the uterus from estrogen. Estrogen without enough progesterone builds up the uterine lining, and over time that raises the risk of uterine cancer. If you're using a cream for this, bring it up at your next appointment rather than stopping anything on your own.
Should I wait until the experts agree before I start treatment?
Waiting is a decision too, and it has consequences. Medicine has never had complete agreement on everything. What helps more is finding a clinician who'll explain their thinking, tell you what would change their mind, and look at the decision again with you over time.
What should I ask my doctor about menopause treatment?
Three questions work in almost any appointment. What do you think is going on, and why? When are we going to look at this again together? If this doesn't work, what's next? Anyone worth your time will answer those.
Resources and research mentioned
Menopause Practice: A Clinician's Guide, 6th Edition, The Menopause Society, section on custom-compounded hormone drugs (compounded bioidentical hormones and topical progesterone)
Davis et al., 2019, Global Consensus Position Statement on the Use of Testosterone Therapy for Women
The Women's Health Initiative
Find a menopause-trained clinician: The Menopause Society's Find a Menopause Practitioner directory (look for the MSCP credential)
Related episodes
About Dr. Siân West
Dr. Siân West is a board-certified OB-GYN and menopause specialist. She hosts This Meno Life, a weekly podcast for women in midlife that covers perimenopause, menopause and MHT with the evidence first and no fear tactics.
Follow This Meno Life on Apple Podcasts, Spotify or YouTube so the next episode finds you.
I'm a doctor, but not your doctor. Everything here is for education, not medical advice. Stay curious, stay evidence-based, and always talk to your clinician before making changes.
