The Menowashing Problem
There is a lot of money in making menopause a special category. Some of it is legitimate. A lot of it isn’t.
In part 4 of our conversation Dr Carrie Pagliano and I got into the nitty gritty of menopause. She is not dismissive of the menopause wellness movement, or the need for this topic to be brought front and centre in public discourse. The cultural shift has been real and necessary. Women who spent decades being told their symptoms were psychosomatic or inevitable, who felt invisible in their forties, are now seen. Stigma costs health outcomes and visibility matters.
But there has undoubtedly been a wave in consumer health and wellness that has moved faster than the evidence. Products and programmes labelled “menopause” have opportunistically seized this moment, and a lot of them don’t have the clinical validation to justify what they’re claiming. Pagliano, who has spent 26 years in this field, is careful about how she says this. But when it comes to menopause-specific fitness programmes and products marketed at women without robust evidence behind them, she says it plainly:
“When you actually get in the nuts and bolts and the research, it just doesn’t have legs to stand on. But again, that’s all marketing.”
She is talking specifically about the proliferation of branded systems built on the premise that hormonal change requires a fundamentally different approach to exercise, one that only this programme, this coach, this supplement stack has cracked. The premise feels intuitive. It has the texture of personalised medicine. It speaks directly to the experience of women who tried generic fitness advice and found it didn’t fit, who felt unseen by an industry built around male physiology and young female bodies.
The problem is that the evidence does not support the central claim.
The Muscle Loss Myth
The claim you’ll encounter most often in menopause fitness content: oestrogen decline causes accelerated muscle loss, and you need a specific programme to address it.
The evidence doesn’t support it.
“We actually don’t have any evidence to say that muscle mass loss is because of menopause. It’s at the same rate as men.”
Age-related muscle loss begins in the fourth decade and progresses at roughly the same rate regardless of sex. What changes during the menopause transition is not the biology of muscle loss but the context around it. Women in perimenopause are sleeping badly, managing vasomotor symptoms, dealing with joint pain. They move less. They train less consistently. The muscle loss that follows is real. Its primary driver is reduced activity, not oestrogen.
“Do you need a menopause-specific strength programme? No. Is it menopause why you’re losing muscle mass? No. It’s because you’re getting older and you’re getting less active.”
A clinician who works in this space every day is telling you the boring answer is correct. Lift heavy. Eat enough protein. Sleep better. Address the symptoms making those things harder. The intervention doesn’t need a brand name.
To be clear: Pagliano is not arguing that hormones are irrelevant. Oestrogen affects connective tissue integrity, pelvic floor function, urethral health, and bone density, all covered in Parts 2 and 3. These are real, and they matter for how active women train and recover in midlife. But none of them require a proprietary twelve-week programme to address.
People Mistake Testing for Caring
Dr Jen Gunter, OB/GYN and author of The Menopause Manifesto, has been making this argument for years. She describes what she calls the “wellness industrial complex,” an industry that has learned to exploit the historical underfunding of women’s medical research by stepping into the gap it created. Her phrase stays with me: “people mistake testing for caring.” It applies beyond diagnostics. Women mistake the feeling of being understood for being well-treated. A supplement brand that names your symptoms and validates your experience has done something your GP probably didn’t, which is make you feel seen. That emotional transaction is real. It just isn’t the same as effective care.
The menopause wellness industry, at its most cynical, has learned to perform the first while selling you the second.
The Validation Economy
Here is what actually happened. Women in their forties and fifties were failed, systematically, by mainstream medicine. Symptoms dismissed. Appointments too short. HRT conversations shut down by fears that were never adequately corrected after the Women’s Health Initiative study derailed the field in 2002. Women left without diagnoses, without treatment plans, without information.
Into that void came coaches, clinicians, influencers, supplement brands. Some excellent. Some opportunistic. Most somewhere in between, doing genuine good while running a business that requires them to sustain your belief that you need them specifically.
“We love to be validated and we want somebody who understands us. And you’ve got to see what the motivation is behind that, unfortunately.”
A fitness programme with monthly subscriptions has a structural incentive to frame generic evidence-based advice as proprietary insight. A supplement brand has a structural incentive to overstate the ways hormonal change creates needs that standard nutrition can’t meet. No individual bad faith required. The incentive structure does the work.
And critically: the wellness industry exists partly because the healthcare system created the conditions for it. “Ours is just so broken,” she says of the US. Pagliano runs a private practice. The wait to see a pelvic health physiotherapist through the US system is now six to eight months. The NHS wait is similarly grim.
The women spending money on wellness programmes are not being irrational. They are responding to a genuine absence of care with the resources available to them. Fix the access. Train more pelvic health physiotherapists. Treat menopause as a medical condition rather than a life stage to be self-managed with adaptogens. The market for proprietary solutions to questions that already have evidence-based answers would shrink considerably.
How to Tell the Difference
Before you buy in, ask three things.
Does the claim have evidence behind it, and is that evidence in the population it’s claiming to address? Postmenopausal research doesn’t automatically apply to perimenopausal women. Research in sedentary older women doesn’t automatically apply to active women in their forties.
Is this intervention actually menopause-specific, or is it good general advice wearing a menopause label? If the menopause version is materially different from the general version, ask why.
Is the person offering it making money from your continued belief that you need them specifically? Not disqualifying, everyone in a service profession makes money from clients. But it’s worth knowing which side of that relationship you’re on.
This 🙌🏻
It’s why evidence and regulation so important in women’s health.