As menopause wars rage, social media skirmishes erupt over new approaches to hormone therapy – and Sydney is about to be a flashpoint

The Guardian

22-02-2025

A menopause and hormone treatment conference in Sydney in March has ignited a passionate debate among medical doctors and researchers about women's empowerment, social media advice, big business and even how doctors communicate with their patients.
The So Hot Right Now conference, being held on 1 and 2 March in Sydney, has become a flashpoint over the science of menopause hormone therapy, or MHT – formerly known as hormone replacement therapy – just as it has in the UK and the US.
At the heart of the conflict is the dosage of hormones being prescribed by a new breed of mainly female doctors, and whether evidence supports the claims being made on social media, especially about the benefits of testosterone therapy in perimenopausal and menopausal people.
'The menopause wars are alive and well,' says Prof Jayashri Kulkarni, a professor of psychiatry at the Alfred hospital in Melbourne, who will appear on the panel at the Opera House event on 1 March.
'Millions of women go through menopause without any problems, but for others the experience is horrendous,' she says. 'I believe they deserve to live their lives as they wish.
'The conference is a good one,' she says; it will present important information about treatments available to menopausal women.
But other experts in the field of menopause beg to differ. Prof Susan Davis, an endocrinologist at Monash University and one of Australia's leading experts on menopause, says the conference is not supported by the Australasian Menopause Society and accuses some of the overseas speakers, at least in their social media feeds, of straying beyond the harmonised guidance on treatments.
'I can't pre-empt what they are going to talk about,' Davis says, 'but based on the track records of their posts, it's concerning.
'What motivates these women? I don't know … Are they believing that they see the light where other people don't see it? Have they had an experience that they have become evangelical about? I really don't know.'
The Australasian Menopause Society is a charity for Australian and New Zealand medical professionals who are working in treating menopause. It is an evidence-based organisation that provides education and resources for doctors and, while it is considered to be a specialist authority, it does not offer formal accreditation, unlike the various specialist colleges. Similar societies exist in the UK and US.
The conference kicks off with a public session at the Opera House followed the next day by a second session for medical professionals at the Hyatt Regency.
But it's the headlining of three international speakers, each with huge internet profiles and flourishing businesses, that is coming under fire from local experts: they are the UK general practitioner Louise Newson, the US obstetrician/gynaecologist Mary Claire Haver and the US urologist Kelly Casperson.
Newson, an Instagrammer with more than 640,000 followers, presented to the Australian Senate's 2024 inquiry into menopause. She runs a chain of clinics in the UK and has created an education program for healthcare professionals which she says has been downloaded by 33,000 clinicians, as well as an app for menopausal people called Balance.
Newson advocates prescribing large doses of menopause hormone therapy – beyond the maximum doses in guidelines provided by the Australasian or British menopause societies – because she says some women don't absorb the hormones efficiently.
She defends her practice, saying that while manufacturers usually state a recommended maximum dose for a medication, this does not mean that prescribing over that level is dangerous nor that clinicians cannot or should not do so, as higher doses may be essential for an individual patient's needs.
Newson lost British Menopause Society accreditation as a menopause specialist late last year after the BBC's Panorama program investigated women's physical and mental health ailments that they claimed arose from high doses of hormone prescription at her clinics.
The UK's health watchdog, the Care Quality Commission, initiated a 'review of quality' at Newson Health after the program aired.
Newson said the British Menopause Society was a charity, not a regulatory body, and that she had not received a satisfactory explanation from it about why her accreditation had been removed more than a year ago, despite her completing all required training and exceeding other requirements.
'Newson Health is confident in the quality of care it provides and maintains a CQC Good rating,' she says.
'In recognition that menopause and wider hormone health is under-researched and underfunded, a portion of Newson Health's profits fund much-needed research and education, as well as financing the [Balance] app and numerous free resources available to people globally.'
She said she did not undertake paid work with pharmaceutical companies, nor with any organisations that engaged in 'menowashing'.
Davis says: 'Louise Newson advocates for doses of oestrogen that have not been tested. The biggest dose on the market is a 100mg patch. There are clinical trials looking at that dose; there is a GP database that has data regarding the risk of breast cancer and thrombosis [at that dose].'
Giving standard doses means patients can be given accurate information about the risk of breast cancer associated with MHT, she says.
She says if doctors are going to prescribe doses higher than that, 'it should be in a clinical trial. And if you put them on these doses, they need more progesterone to avoid endometrial thickening.'
Newson defends her practices, saying decisions about whether to prescribe MHT and its dosage was made on an individualised basis after discussing the benefits and risks with each patient.
'Every woman is different so a 'one size fits all' approach to HRT is not the best for women,' she says. 'Some women need higher doses of oestradiol than other women to achieve the same benefits, especially as oestradiol can often be absorbed differently through the skin.'
She says Newson Health has published audit data showing that some women need higher doses of oestradiol for adequate absorption.
Haver sells menopause supplements under the brand The 'Pause Life as well as diet plans. She has a combined Instagram and TikTok following of more than 4.6 million.
She is recognised as an influential menopause educator but has drawn criticism from other menopause doctors 'for recommending hormones for uses that stray from official medical guidelines and, they say, risk harming women', according to the New York Times.
Haver told the NYT that she heard the concerns of critical doctors but that she discusses risks and benefits with all her patients and is primarily interested in helping women. She has argued that the medical establishment has been too conservative in its recommendations for hormone therapy and that women deserve treatment based on promising evidence.
Casperson, with more than 200,000 Instagram followers, advocates strongly for MHT, particularly the use of testosterone. The disputes between her and Davis have become pointed.
Davis has been at the forefront of studying testosterone, which was initially thought to be a major breakthrough in treating low libido, mood and energy levels in menopausal women.
She accuses Casperson of saying things about her research 'that [are] completely inappropriate'.
Casperson regularly cites a 2003 study, in which Davis was the lead author, as proof that testosterone therapy improves wellbeing, mood and sexual function in premenopausal women with low libido and low testosterone.
Davis says the study was a pilot and the findings were never able to be replicated.
The two have engaged in a terse exchange of posts in which Davis has become increasingly frustrated by the use – or as she sees it, the misuse – of her research.
Casperson did not respond to several requests for comment.
The public conference is being organised by the Australian GPs Ceri Cashell and Emma Harvey, who run the website Healthy Hormones, and two consultants and patient advocates, Krystal Barter and Alex Isaac, who have a consultancy, Humanise Health. The medical conference is being organised by Healthy Hormones.
'Healthy Hormones was created to improve menopause education for both women and healthcare professionals,' says Cashell, who created the site.
She says it began as a small peer support group for doctors discussing menopause cases and grew in response to demand from other healthcare professionals and women seeking menopause information. It is now Australia's largest online community for healthcare professionals interested in menopause care, with 2,500 members.
'Menopause affects every woman who lives long enough, yet most doctors receive little or no formal training,' Cashell says. 'Healthy Hormones provides medically curated resources, expert discussion, and the latest research to support healthcare professionals in delivering better care.
Kulkarni says: 'I don't understand why there is so much hatred toward Louise [Newson].
'Maybe it's because she runs a private clinic outside the NHS. She's just trying to work out individual dosing. Of course it makes sense that some people need one type of dose, while another will need just a sniff.'
The public event will be hosted by the media presenter Shelly Horton, who runs a business with Dr Ginni Mansberg called Don't Sweat It. It offers training packages to businesses to help them make their workplaces more menopause-friendly. Horton is also a brand ambassador for at least two pharmaceutical companies.
The Opera House website states the event is 'Presented by Healthy Hormones, Humanise Health & Alex Isaac'. The business interests of the speakers are not stated on the Opera House event's webpage, although they are outlined in the medical conference literature.
Horton says she does not see any conflict and that she is chairing the conference pro bono, motivated by her longtime advocacy about menopause and as a person with lived experience.
'I am so proud of the speaker lineup,' she says. 'I think the old guard of the menopause experts in Australia need to modernise and I wish that they would come to the conference.
'The speakers have not just experience, but the empathy and art of communicating with patients.
'I understand that we have people like Professor Davis, who is very by-the-book, but [our speakers] have thousands of patients and years of experience.
'It's offensive that these speakers are referred to as 'influencers' when they are highly qualified. They are gynaecologists, urologists, psychiatrists and menopause experts.'
There is also the question of who is paying for the speakers to come to Australia and the cost of staging the two events.
While the medical event at the Hyatt has a list of six sponsors including several pharmaceutical companies such as Besins, an Australian manufacturer of hormones, and Aspen Medical, as well as Cashell's Healthy Hormones website, none are listed on the Opera House site.
Cashell says: 'The So Hot Right Now Opera House event has received a small amount of sponsorship, none of which is from the pharmaceutical industry.'
Asked about who is paying for the international speakers' costs and travel, she says the arrangements are 'confidential'.
'Their presence at this event is an invaluable opportunity for Australian women.'
Magdalena Simonis, an associate professor and the chair of the Royal Australian College of General Practitioners' specific interest sexual health medicine group, says: 'We have had a fairly rapid influx of information about menopause and perimenopause over the last four to five years, and this is happening globally.
'Now that there is consensus that [menopause hormone therapy] is relatively safe, women want to have relief for their symptoms: hot flushes, sleeplessness, fatigue and vaginal dryness.
'We want to steer women away from situations where a rather opportunistic market might be taking advantage of their vulnerability,' she says, adding that she was not talking specifically about the doctors presenting at this conference.
Tickets to the public event range in price from $99 to $350. The organisers say it is sold out and will now include a live stream.
The Australasian Menopause Society says advice and treatments for menopause should be evidence-based and consensus-based.
Simonis says: 'We also need to keep in mind that not everyone's menopause experience is going to be the same. I think this emphasises the need for a doctor-patient relationship that is going to be one where the woman is listened to. And this is important – being listened to.'
Cashell says menopause care has been neglected in medical training for decades, leaving many women without the treatment they deserve.
'This conference brings together leading experts to provide the latest, evidence-based education across a range of topics for healthcare professionals looking after women. We welcome open discussion and differing opinions, but the goal is simple – better education leads to better care for women.'