Early menopause: Why better research and global guidance matter for women’s health

Physician and scientist Priya Satalkar-Götz experienced her first symptoms of menopause in her mid-twenties, but it took several years for her to receive a diagnosis. In this conversation, she reflects on the physical and personal impact of early menopause, the limits of medical knowledge without strong evidence and how greater investment in research and global guidance could transform care for future generations.  

You have a unique experience with menopause. Tell us. 

I experienced my first hot flush at the age of 26, while returning from a work trip in India. It happened in the middle of a flight and was so intense that as a physician, I immediately recognized what it could be. But I could not believe it because I was so young. 

Over the following years, the hot flushes became more frequent, particularly at night, and my menstrual cycle became increasingly irregular. I consulted several doctors, but my symptoms were repeatedly attributed to stress, changes in lifestyle or weight loss. I was prescribed oral contraceptives to regulate my cycle, but they did not stop the hot flushes or the disruption to my sleep.  

After moving to Switzerland for my doctoral research, I consulted another gynaecologist. By then, I had carefully documented my symptoms including menstrual cycles for several years. The new doctor ordered blood tests, and the results showed that at 33, I was already at the far end of menopause.  

The consultation focused immediately on the clinical consequences, including the possible effects of prolonged low estrogen on my bone health and my (in)fertility. Although I understood the medical information, I was not given much space to process it as a patient. I left the appointment overwhelmed. When I reached home, I asked my landlady, who spoke very little English, for a hug. She did not need an explanation. She simply held me while I cried.  

What were some of your symptoms and what forms of support made the greatest difference?

Menopause can affect temperature regulation, sleep, skin, the eyes and other mucous membranes, as well as mood, memory and cognitive function. I had persistent sleep disruption over several years due to hot flushes, very dry, fragile skin, increased emotional vulnerabilities and moments when I would forget what I was saying in the middle of a sentence. 

These symptoms may not affect every woman in the same way or with the same intensity, but they are real. Women need to be taken seriously when they seek support for these symptoms. 

In the absence of clear evidence and guidance on management of early menopause, making an informed decision about my treatment options was extremely difficult, even for me as a doctor and scientist. When I reviewed the literature between 2012 and 2015, I found very little evidence that directly addressed the needs of women experiencing menopause at a younger age. Most menopause research involved women reaching menopause at the more typical age (around 51 years in European context). 

I was fortunate to find a reproductive endocrinologist who listened, understood my concerns and actively involved me in planning my care in a holistic manner. She helped me recognize that I needed to step out of the role of medical expert and allow myself to be a patient, process the grief and sense of loss. Under her competent and empathetic guidance, I finally started my combined estrogen and progesterone replacement therapy 1.5 years after the diagnosis. It led to a significant positive change in my physical and emotional wellbeing.  

Good clinical care was essential, but support extended far beyond the health system. My partner helped me see that my identity and value were not defined by whether I could have a child. My friends gave me space to grieve and invited me to play a meaningful role in their children’s lives. My brother informed himself about menopause and women’s health so that he could support me and other women in his life. 

Peer support also matters enormously. Other people with similar experiences can offer practical advice that may never arise in a short medical appointment. Simply being able to talk, exchange tips and sometimes laugh about the difficulties makes the experience less isolating.  

Why is menopause under-studied and what is needed? 

Menopause does not usually cause a sudden, highly visible crisis/death. Instead, its effects may emerge gradually through poorer health, reduced function and a lower quality of life. These effects can also be dismissed as an inevitable part of ageing. 

We need high-quality, long-term research on the safety and effectiveness of different interventions. This includes following women over many years to understand what works, for whom and with what long-term consequences. 

We also need evidence that reflects the experiences of different populations. If early menopause appears to affect some groups more often, researchers and health professionals need to understand why. Research could help identify who is most at risk, whether earlier detection is possible and how women can then be better supported in making decisions about their health and fertility. 

Research should also examine positive experiences. What can we learn from women who experience fewer symptoms or better outcomes? Understanding protective factors may help improve support for others. 

Finally, health policy requires more than clinical evidence. We need research on the economic and social effects of better menopause care, including improvements in quality of life, reductions in morbidity and potential savings for healthcare systems.  

What is the importance of a global guideline? 

An evidence-based guideline gives health professionals confidence that the available research has been systematically reviewed, that the quality of the evidence has been assessed and that recommendations have emerged from a rigorous, consultative process. 

Without guidance, individual clinicians may take very different approaches. Some may be understandably cautious, particularly when the evidence is weak. But for patients, this can mean inconsistent care and uncertainty about their options. 

A global guideline on menopause would provide a trusted foundation for care while recognizing that populations and individual circumstances differ. It could set out what is supported by strong evidence, where recommendations remain conditional and where further research is urgently needed. 

Research and guidelines therefore have to develop together. Guidelines depend on good evidence, while the guideline development process helps reveal the most important evidence gaps.  

How could better evidence change women’s lives

At the individual level, accessible evidence can help women understand their symptoms, prepare for consultations with healthcare professionals and ask informed questions about their care. This access to knowledge is an advocacy tool for women.  

For health professionals, stronger evidence and guidelines built on that evidence can improve recognition of menopause even when it might be earlier than expected, support more confident clinical decisions, and guide both treatment and long-term monitoring. At the health-system level, it could lead to more consistent treatment protocols and policies. 

Evidence can also help workplaces respond more effectively. Women may need flexibility to attend appointments, obtain treatment or manage symptoms that affect sleep, mobility, concentration and emotional well-being. Supportive working arrangements can help women continue contributing fully without forcing them to choose between their health and their work.  

My hope is that future generations will not have to struggle to make informed choices about managing their menopause like I did. The evidence should be clear, care should be supported by standardized protocols across countries, and every woman should be able to choose among safe, appropriate options. I also hope that they will receive support from their family including men in their lives. Many cultures have a saying that it takes a village to raise a child. We could have similar communities to support women to transition through their menopause so they can lead a healthy and active life for decades ahead.  

Better menopause care would improve quality of life not only for women but also for the people around them. When women are properly supported, families, workplaces, communities and health systems all benefit. 

Priya leads the work of HRP, the UN's Special Programme on Human Reproduction, on research governance, overseeing methodological strength and quality. She is a medical doctor by training with a background in public health, medical ethics and medical anthropology.