When I first encountered Tania Elfersy online, something she said struck me as profoundly wise – and refreshingly different from the prevailing menopause narrative. Since then, I’ve admired her fearless clarity about how women are being manipulated into fearing a natural transition. So when I decided to run a special Menopause Matters season on my Magnificent Midlife podcast, I knew it was time to bring her back for another feisty conversation. You can listen to that conversation in full here.
A lot has changed since Tania and I last spoke. Back then, we were both uneasy about the tone of Davina McCall’s documentaries on menopause in the UK. They were undoubtedly well-intentioned, but felt worryingly fear-based – and we wondered whether that would spread. Unfortunately, it has.
“It did cross the Atlantic,” Tania said. “It did reach the States and Canada, and now is in Australia. So it does seem that the UK was the experiment. It was an experiment full of fear, full of getting women into a place where they’re going to fear not only menopause, if they’re in menopause, but before menopause – they’re going to fear approaching menopause, they’re going to fear the future of their health.”
She’s right. What started as an effort to raise awareness has snowballed into a global campaign to medicalize menopause, fuelled by marketing and selective science.
“Except that it’s not revolutionary to tell women that their bodies are designed to malfunction,” Tania said wryly.
The Misuse Of Research
Tania and I share a deep frustration at how scientific data is cherry-picked, misunderstood, or misapplied. The Women’s Health Initiative (WHI) study, halted in 2002 because of increased breast cancer risk among women taking hormone therapy, is still routinely misrepresented. And now by the US Government when it comes to hormone therapy.
“He [Dr Makary] used research that was carried out on women who had undergone a hysterectomy, often with ovary removal, and assumed relevance for all women who go through natural menopause,” Tania explained, referring to the head of the US FDA, who has been advocating HRT for disease prevention. “That’s a mistake, and that’s a manipulation of the data.”
This lack of nuance can have devastating effects. As she said, “Women are taking medicine that comes with risk. They’re not receiving the benefit that they’ve been told, but they are exposing themselves to risk.”
To illustrate how misleading statistics can be, I brought up the confusion between relative and absolute risk – one of my bugbears, which I have personally struggled to get to grips with. But it’s so important to understand this when confronted with big scary statistics. Professor Susan Davis has helped me do this.
I explain on the pod how the oft quoted statistic of HRT providing a 50% (relative) reduction in heart attack risk sounds impressive until you realise it’s a drop from 1.8% to 1.1% – a real reduction of just 0.7%. “It means that, you know, the real-world impact is minimal, even though the 50% sounds very impressive,” I said.
Tania pointed out that even that reduction statistic only relates to women who had estrogen-only hormone therapy, which is not recommended for any woman who still has a uterus. Nuance again.
Missing Context And Manufactured Fear
This selective storytelling has created an environment where women believe their bodies are broken and need lifelong medical correction.
“Women in the UK, in the US, now believe… they need to take HRT to protect their heart,” Tania said. “And the problem with that is that HRT, just like all medicines, comes with risks.”
Tania recently wrote an open letter to Dr. Makary, head of the US FDA, challenging his claims that HRT prevents heart disease, dementia, and osteoporosis. Her meticulous breakdown exposes how these ideas rest almost entirely on estrogen-only trials – studies that don’t apply to women in natural menopause.
“There is no large randomized control trial that shows disease can be prevented through combined HRT,” she said. “Yet, that narrative is still out there, and it’s still pushed on women.”
She pointed out that women are being told to take hormones not to manage severe symptoms but to stave off imagined future illness.
“Many women I’ve spoken to are taking HRT not because they have terrible symptoms, but because they fear that if they don’t take it, they’re going to get dementia,” she said. “There is no conclusive research that suggests that if you take HRT, you will lower your risk of dementia.”
Instead of looking at environmental, dietary, and lifestyle factors – like low-fat diets, ultra-processed foods, toxic products, stress or years of contraceptive pill use – menopause is being scapegoated for all women’s later-life health issues.
“We blame menopause,” Tania said. “And then we tell women, take HRT, when there is no research [proving it is effective for disease prevention].”
The Money Trail
When I try to challenge these narratives, I’m often told that pharmaceutical companies don’t make much money from hormones. But as I said to Tania, “If you can convince 50% of the world’s population that they will be unhealthy unless they take this drug from about the age of 45 every day for the rest of their lives – you are going to make a lot of money.”
“It’s interesting, this idea that drug companies aren’t making any money,” Tania replied. “Pfizer had to pay $1.2 billion in lawsuits regarding breast cancer – and they still sell the drugs, and they still make a profit.”
The system thrives not only on hormone sales but also on private clinics (because the NHS could never afford to give all women HRT for life), expensive consultations, and subscription-style accreditation of products or consultancy services. Often it’s a clever business model effectively disguised as empowerment.
Commercializing Menopause
In the UK, one Japanese pharmaceutical company even sponsored the UK Government All Party Parliamentary Group on Menopause to the tune of £66k – the same company whose new non-hormonal drug for hot flushes was conveniently approved quite rapidly in the UK. This same company also sponsored the US Super Bowl! Everyone thought, how great that menopause is being discussed at this major event. But did they know their drug was also being quite rapidly approved in the US?
I told Tania about a recent Australian study on what researchers call “the commercial determinants of health.” Women in that study reported feeling “targeted for profit under the guise of menopause support.” They described influencer-led empathy, fear-based marketing, and wellness products exploiting their insecurities.
“There’s this umbrella term of menopause awareness,” Tania said. “But this menopause awareness created by these organizations and charities is all about: let’s tell you how terrible it is, how it’s a medical condition, and how you need to fear disease. And here we have the pharmaceutical solution.”
The same pattern, she noted, can be seen in mental health – where “awareness” campaigns often lead to more medication, not less.
Misinformation And Conflicts Of Interest
The scale of misinformation is staggering. A recent British Medical Journal published research report found that out of 180 top social media posts about hormone therapy, 93% of content creators had conflicts of interest – selling private services, supplements, or products – and only one in three disclosed it. I wrote in detail about this here.
“It’s literally the Wild West out there,” I said. “Women are being bombarded with marketing dressed up as medical advice.”
“Doctors say, ‘I’ve carried out this survey among my patients, and we’ve found that HRT or testosterone does this,’” Tania added. “A survey among your patients is not considered gold standard science in any way whatsoever.”
A menopause doctor’s patients are a self-selecting audience! Yet these anecdotes circulate online as evidence, amplifying hype and contributing to placebo effects.
“When women say, ‘I started my HRT and within two days all my symptoms disappeared’ – that’s the placebo effect,” Tania said. “If it was your hormones, you’d be overdosing by week two.”
The Cost Of Credulity
Even supposedly benign products, like estrogen face creams, are being pushed without clinical trials and by influencers who appear to be objective commentators on menopause. “If we treat it like candy, maybe everyone will just think it’s harmless,” Tania warned. “And the history of HRT has shown to us that big promises are made before any trials are carried out – and then it’s a sort of oops moment. Oops. We’re sorry.”
Her frustration mirrors my own. “Anybody watching the video can see that I am just combusting over here,” I admitted during our chat. “I get very hot under the collar because I just hate this manipulation.”
What we both want is simple: truth and context. “That’s all we want,” I said. “We want women to have the full picture and understand exactly what’s going on. And when we don’t know stuff, the world needs to say, I don’t know. There’s nothing wrong with that.”
This isn’t about bashing hormone therapy. It’s about bashing the deliberate manipulation of women when it comes to potential treatment for menopause.
A Call for Curiosity, Not Fear
Despite the hype, Tania has noticed a quiet shift at least in the UK: “I’m beginning to see this sort of calming down after women rushed out to get HRT because they were told it was the answer for all problems,” she said. “Many are realizing, ‘Oh, it doesn’t really make me feel that great. I’m having side effects. It doesn’t have the protective effects I thought it did.’”
Maybe, just maybe, the tide is turning.
In a world that profits from our fear, the most radical thing we can do is stay curious. Ask questions. Trust our intuition. As Tania reminded us, “The best solution is for us to come back into balance – in a natural way, to rebalance and live a life of harmony.”
This article first appeared on The Mutton Club.
Wise words indeed.
MenoClarity – both Rachel and Tania are founders of this
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