Forgotten women: tackling women's health in mid and later life

The menopause is a natural phenomenon that will affect roughly half the population. But for a long time, it’s been ignored, spoken about in hushed tones, and dealt with quietly behind closed doors. If women’s health in general has been sidelined, health issues affecting middle aged and older women have been even more shrouded in stigma and taboos.

Recent years though have seen growing public awareness, discussions and campaigns beginning to tackle those taboos, as Erica and Eileen talk about in the podcast. From celebrities speaking out, to campaigns like Make Menopause Matter – which resulted in the menopause being added to Personal, Sexual and Health Education (PSHE) syllabuses – more and more women are talking about their experiences with ‘the change’.

There is of course a long-standing health food market for menopause supplements – with products like red clover, black cohosh and evening primrose oil offering natural alternatives to hormone replacement therapy (HRT). However, these have typically been marketed at silver-haired grandmothers – an image that many women approaching the menopause no longer identify with.

Today, there’s a growing recognition that ‘menopausal’ doesn’t mean ‘old’ or ‘past it’, and a need for brands and products that reflect this. Although the average age for reaching the menopause is 51, women typically enter perimenopause – the transition period between regular menstruation and the menopause – during their 40s. Symptoms can last for up to a decade before the final period, and many also continue afterwards.

With a population that’s living longer than ever before, many women are now living full and active lives for three or more decades post-menopause. There’s also increased awareness of the younger women who experience early menopause – either as a result of premature ovarian insufficiency (POI) or treatment for conditions like cancer – but who don’t see themselves in ‘granny pants’ and Tena Lady.

‘Rebranding’ the menopause

With the broader explosion of interest in women’s health on platforms like Instagram, we’ve seen the emergence of many more sleek, visually appealing brands targeting women in perimenopause and beyond.

Many of these – like Meg’s Menopause, MPowder and Menopoised – succeed not by reinventing the wheel, but by repackaging traditional menopause treatments, such as supplements, magnetic devices and essential oils, in ways that wouldn’t look out of place on a wellness influencer’s Instagram grid.

There is still a wealth of opportunity for growth in this space, from affordable basics to more luxurious ‘self-care’ products, addressing the whole range of hormonal effects of the menopause. Much of what already exists typically focuses on hot flushes, and there is certainly space for innovation on the issue – with products emerging like cooling lingerie and nightwear, designed for (and often by) women who don’t see themselves in some of more dated looking options already on the market.

But there are also a host of menopause symptoms that tend to be overlooked, including (but not limited to) mood swings, headaches, UTIs, memory problems or ‘brain fog’, joint stiffness, heart palpitations, and sexual changes like vaginal dryness and reduced libido.

Beyond hot flushes

Research published in 2019 found that one in three women were being wrongly offered antidepressants when presenting to their GP with symptoms of the menopause. For women suffering with hormone-related anxiety, depression and cognitive issues, HRT may be a more appropriate option.

However, it’s clear that there’s still considerable interest in natural alternatives as well. There’s an opportunity here, within the consumer health sector, for developing products that allow women to both track and manage hormonal mental health and other symptoms.

The app balance, for example, was designed by menopause specialist Dr Louise Newson, and features tracking and journaling facilities, as well as expert advice on the whole range of treatment options available.

Sexual symptoms of the menopause are perhaps the most taboo, and for a long time have been brushed under the carpet, with older women expected to put up and shut up about changes to their sex lives. But, as a more empowered generation of women reach mid-life, they’re less willing to accept being seen as sexless and ‘past it’.

Brands like Yes Organics have successfully tapped into the mid-life market, serving up menopause-friendly digital content alongside their attractively packaged range of lubricants and vaginal moisturisers. Sex toy retailer Jo Divine also offers advice, products and resources tailored to women in the menopause, acknowledging their desire to remain sexually active well into later life.

Longer-term effects of reduced oestrogen

While we typically associate the menopause with these more immediate symptoms, it’s also worth remembering that there are long-term risks associated with depleting oestrogen levels – which, again, have historically been overlooked.

Urinary and faecal incontinence, for example, are more common post-menopause – particularly in women who have previously given birth vaginally. Incontinence is a major reason for women being admitted to residential care in later life, and is associated with an increased risk of falling while rushing to the toilet during the night.

However, for a long time this has simply been accepted as an inevitable consequence of ageing, and managed using continence pads rather than treating the underlying issues.

Today there’s growing innovation around pelvic floor health, both to prevent and treat continence issues. Alongside the more traditional kegel eggs, tech solutions now include pelvic floor ‘trainers’ like Elvie and Kegel8, and physio-designed pelvic floor app ‘Squeezy’.

As Eileen mentions in the podcast, Atlantic Therapeutics have also developed the Innovo – a pair of smart shorts that use Electrical Muscle Stimulation (EMS) to deliver contractions. These help to strengthen the pelvic floor muscles, improving both bladder control and sexual function.

Bone and cardiovascular health are also affected by the reduction in oestrogen. While the risk of osteoporosis is quite widely known, and can be protected against using HRT and/or bone health supplements, there are significant gender disparities when it comes to the heart.

Coronary heart disease kills twice as many women as breast cancer, yet research by the British Heart Foundation (BHF) shows women are 50% more likely than men to be misdiagnosed when having a heart attack.

One wearable innovation that could help – if women are prepared to wear it – is a bra with built-in ECG sensors to monitor cardiovascular health. There are a number of these currently in development and it’s an alternative, potentially more female-friendly, take on the growing trend for smart watches and fitness trackers with all-day heartrate monitoring technology.

Finally, a less well researched area is the role of oestrogen decline in the dementia risk. Women with dementia outnumber men by two to one, and leading theories about why this gender gap exists centre on women’s falling oestrogen levels at the menopause. Further research and development in this area could not only help to bridge the existing gap in knowledge and understanding, but also provide solutions.