What we know, what's missing, and what we'd like to support.

What's thin or missing

The gaps we won't pretend aren't there.

When we say "the evidence base is thin here," this is what we mean. We'd rather name the gap than write past it.

• First Nations, Inuit, and Métis menopause

  A 2021 NCCIH scoping review found roughly thirteen peer-reviewed papers on Indigenous menopause in Canada, most small, qualitative, and community-led. Almost nothing Inuit-specific. Almost nothing Métis-specific. The medical-trauma history (residential schools, the Sixties Scoop, Inuit TB sanatorium era, Métis exclusion from coverage) shapes care-seeking at midlife in ways the literature has barely touched.

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• LGBTQ+ midlife and menopause

  Research on lesbian and bisexual women's midlife health exists but is sparse. Trans menopause is mostly endocrine-focused, with small samples. The Endocrine Society's 2017 trans guidelines acknowledge menopause data is "essentially absent."

• Trans women on long-term estrogen

  There is almost no longitudinal data on what happens to trans women if exogenous estrogen drops, is interrupted, or is reduced in midlife. The symptom picture (vasomotor, sleep, mood, bone) is biologically plausible from cis-menopause physiology, but the trials don't exist. We write about it on the trans-women hub because the silence isn't neutral, but we mark it as low-grade evidence on purpose.

• Bigger bodies and menopause

  Body size changes risk profiles (cardiometabolic, breast cancer, fracture, MHT dosing) in ways that matter clinically. Most trials either excluded higher-BMI participants or didn't stratify by them, and weight-stigma in clinical settings means symptoms get attributed to size rather than hormones. The honest picture for women in larger bodies is patchier than the textbook suggests.

• Premature and early menopause

  Premature ovarian insufficiency (before 40) and early menopause (40–45) are studied as endocrine events, but the long-arc questions, what does forty years of post-menopause look like for bone, brain and heart, and how should MHT be dosed across that span, sit on much thinner data than the average-age cohorts.

• Surgical menopause care and counselling

  There is almost no large-scale evidence on what women are actually told before an oophorectomy or how well surgical menopause is managed afterwards. The best current snapshot is Menopause Support's 2024 patient survey of 521 women in surgical menopause: 74.5% said they were not told about potential side effects of removing their ovaries, and most reported no menopause-trained follow-up. Patient-org data, not a peer-reviewed cohort — but it's currently the most cited number we have, which is itself a gap.

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• Menopause training in medical schools

  Menopause Support's FOI-based survey of UK medical schools showed extreme variation in how much (and whether) menopause is taught at undergraduate level — from a few hours to essentially nothing. Mandatory menopause teaching was committed to from 2024 onwards, but the back-catalogue of qualified doctors trained without it is the cohort most patients are still meeting. There is no equivalent published audit for Canadian or US medical schools that we've found.

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• Neurodivergent women through perimenopause

  ADHD and autism research in adult women is itself recent. The intersection with perimenopause (estrogen's effect on dopamine, late diagnosis at midlife, executive-function collapse during the transition) is almost entirely clinical observation and lived-experience writing, with primary research only just starting.

• Disability and menopause

  A 2023 BMJ scoping review concluded the field is "in its infancy." Almost no work on how chronic illness, mobility limitation, or sensory disability intersects with the menopause transition or treatment access.

• Intersectional symptom and access data

  Even SWAN doesn't break out Black + queer, Indigenous + disabled, racialized + neurodivergent. Treatment access disparities by race and sexuality together, not just one axis, are largely anecdotal.

• Sex and gender treated as one field

  Most menopause research, and most clinical intake forms, collapse sex-at-birth and gender identity into a single "female" checkbox. That erases trans women on estrogen, trans men post-oophorectomy, non-binary people on HRT, and intersex people whose hormone-and-symptom picture maps onto menopause physiology. It also makes it impossible to tell, after the fact, who a study's findings actually apply to. The physiology is what drives symptoms and treatment; the identity is what shapes access and how symptoms get heard. Both matter, and they need separate fields.

• Menopause stage and cause, standardized

  STRAW+10 (the Stages of Reproductive Aging Workshop) is the closest thing to a shared vocabulary for perimenopause, menopause, and postmenopause, and it's barely used outside academic papers. Cause of menopause — natural, surgical, medical/chemo, iatrogenic, POI, gender-affirming — is even patchier. When those categories aren't captured consistently, surgical menopause and POI keep getting folded into "postmenopausal women" in trials, and the lived reality (younger onset, abrupter drop, longer treatment horizon) disappears into the average.

• Symptom scales built on a narrow sample

  The Menopause Rating Scale, the Greene Climacteric Scale, and MENQoL are the questionnaires most doctors and researchers reach for. They were built and validated on largely white, cisgender, neurotypical cohorts in their early 50s. They under-weight the symptoms readers tell us matter most (executive function, sensory overwhelm, joint and muscle pain, GSM), and they don't translate cleanly for people whose menopause was surgical, medical, early, or on exogenous hormones. Useful, but not the whole picture.

• Cycle and symptom data locked in consumer apps

  Most people entering perimenopause already have years of cycle and symptom data in a tracker app. Almost none of it moves cleanly to a clinician, a specialist, or another app. The absence of a shared export format means the person with the longest, richest record of their own transition can't easily hand it over when they finally get an appointment. Data portability is a menopause-care issue, not just a privacy one.