Dr. Herman Weiss
Oct 9, 2026
Welcome to Issue 7. Four papers this time. One asks why menopause medicine still runs on guesswork. One tells doctors how to prescribe hormone therapy to women with heart risk. One looks at an overlooked group, women with type 1 diabetes. And one, for my PMOS readers, asks whether it is how much fat you carry or where it sits. As always: I read the science so you don't have to, and I tell you where each study runs out of road.
PAPER 1. MENOPAUSE RESEARCH HAS BEEN STARVED, AND "HORMONE THERAPY" IS NOT ONE THING
Gravelsins LL, Perovic M, and colleagues including Wood Alexander M, McGovern AJ, Rabin JS, and Galea LAM. Reframing menopause and menopause hormone therapy as opportunities for healthy aging. Science, October 1, 2026. doi:10.1126/science.aeg5004
What it is. A review article in Science - not a new experiment. The authors pull together what is known about menopause as a turning point in aging.
What it says. Menopause covers up to about 40% of a woman's life, and up to 72 symptoms have been reported with it. Hot flashes and night sweats hit about 80% of women in the transition, and the average woman has seven symptoms at once. Yet the authors cite analyses showing that just 0.2% of federal health research funding in North America over 15 years went to menopause questions. Their other point is about hormone therapy: it comes in more than 200 varieties, differing by dose, type of estrogen and progestogen, and timing, and each has its own risk-benefit profile. They argue the research often lumps these together, and that this lumping changes what we conclude. Their answer is precision care: match treatment to your symptoms, your genetics, and your earlier hormone exposures. They also note that menopause type (natural versus surgical), timing, and symptom burden shape later-life disease risk.
What it means for you. When a headline says "hormone therapy raises risk" or "hormone therapy protects you," ask which hormone therapy. Oral or patch? Which progestogen? Started when? That question is the whole story, and it is why I keep telling you to bring the paper, not the headline, to your doctor.
Limits. A review is only as good as the studies it gathers, and the authors say themselves that the evidence on individual differences is thin. This is a framework for better research, not a new treatment rule.
For my PMOS readers: women with a PMOS history reach menopause with their own pattern - metabolic and androgen differences, and a different timeline of symptoms. A one-size menopause story was never written for you either. Under the same precision logic, your history belongs in the conversation with your doctor. (Cross-reference: the blood-protein aging work from this research group was in Issue 5.)
PAPER 2. HORMONE THERAPY WHEN YOU HAVE HEART RISK: A JOINT FIGO AND WORLD HEART FEDERATION POSITION
Benedetto C, Gulati M, Khadilkar SS, Maas AHEM, Frezet F, de Oliveira GMM, Genazzani AR, Divakar H, Poppas A, for FIGO and the World Heart Federation. Menopause Hormone Therapy in Women With Cardiovascular Risk Factors or Established Ischemic Heart Disease: A Joint FIGO and WHF Position Paper. Global Heart, September 22, 2026. doi:10.5334/gh.1576
What it is. A position paper - a consensus statement from gynecology and cardiology bodies, written to help both kinds of doctors counsel the same woman. No new patients were studied.
What it says. Systemic hormone therapy started early - ideally soon after symptoms begin and at most within 10 years of the final period - relieves symptoms and is associated with long-term benefits. Women with cardiovascular risk factors need a proper risk assessment first, so the type, dose, and route can be tailored. For women at high risk of blood clots, transdermal estrogen (the patch or gel), with micronized progesterone or dydrogesterone when a progestogen is needed, is considered the safest option. Women with established ischemic heart disease may still use systemic therapy for symptom relief if the risks and benefits are carefully reviewed; low-dose transdermal estrogen is the preferred choice. All other heart-protective care, including statins, should continue. The hardest cases call for cardiologists, gynecologists, and primary care working together.
What it means for you. Having high blood pressure, high cholesterol, or even heart disease is not an automatic "no" to hormone therapy - but it moves the decision into a tailored conversation, and it points toward the patch over the pill. This lines up with the Danish BMJ study we covered in Issue 5 on oral versus transdermal clot risk.
Limits. This is expert consensus, not a trial. It tells doctors how to reason; it cannot promise an outcome for any one woman. Your own history decides.
For my PMOS readers: PMOS carries metabolic and cardiovascular risk factors in many women. That is my reading, not a claim in this paper - the paper does not discuss PMOS. But if you have PMOS and are approaching perimenopause, your metabolic history is exactly the kind of risk-factor information this position paper says should be assessed before choosing a regimen.
PAPER 3. MENOPAUSE AND TYPE 1 DIABETES: THE GROUP THAT RESEARCH FORGOT
Bonhoure A, Yardley JE, Boudreau V, Lepine L, Moisan JM, Messier V, Brazeau AS, Rabasa-Lhoret R. Physical and psychosocial complications faced by postmenopausal women with type 1 diabetes: a cross-sectional BETTER analysis. Diabetes Research and Clinical Practice, 2026. doi:10.1016/j.diabres.2026.113484 (press coverage this week, Canadian Press, October 1)
What they studied. Records of 211 women with type 1 diabetes, aged 40 to 60, from the BETTER registry: 121 before menopause and 90 after. They compared physical complications, diabetes management, and mental health, adjusting the groups so they were comparable on other factors.
What they found. After menopause, the women had higher risks of cardiovascular disease (risk ratio 3.31), neuropathy (2.22), retinopathy (2.20), falls (2.64), and moderate-to-severe depressive symptoms (1.48). They were also less likely to be prescribed blood pressure medication (0.57) or cholesterol-lowering medication (0.68). Insulin doses, HbA1c, and low-blood-sugar frequency did not differ between the groups. Diabetes distress was lower after menopause (0.80).
What it means for you. If you have type 1 diabetes, menopause may be a point to re-check your eyes, nerves, heart risk, balance, and mood - and to ask whether your blood pressure and cholesterol are being treated as actively as they should be. Notice that blood sugar numbers did not explain the gap, which is exactly why it is easy to miss.
Limits. This is a snapshot, not a follow-up over time, so it cannot show that menopause caused any of these. Women who are older also have had diabetes longer, and the statistical adjustment cannot fully remove that. The group is small - the cardiovascular result had a wide margin (the confidence interval ran from 1.07 to 10.23), so treat the size of that number loosely. The authors themselves call for prospective studies.
PAPER 4. FOR MY PMOS COMMUNITY: IT MAY BE WHERE FAT SETTLES, NOT JUST HOW MUCH
Zhao G, Jin Y, Yang A, Yu X, Yan Z, Zhu S, Yang S, Wang W, Gao B, and colleagues. Causal adiposity and clinical validation of regional fat distribution in PMOS: a multi-modal analysis integrating GBD 2021, Mendelian randomization, and machine learning. International Journal of Obesity, published online September 7, 2026 (media coverage September 30). doi and abstract: https://www.nature.com/articles/s41366-026-02208-x
What they studied. Three things at once. First, global numbers from the Global Burden of Disease 2021 database. Second, a genetic method called Mendelian randomization, which uses inherited gene variants as a natural experiment to ask whether something causes a condition rather than just travels with it. Third, a machine-learning model in a clinical group with detailed body-composition scans.
What they found. In 2021, PMOS affected about 69.5 million women worldwide (1,757.8 per 100,000), the highest modeled incidence was at ages 10 to 14, and about 12.5 million infertility cases were attributed to it. In the genetic analysis, higher genetically predicted body mass index was linked to higher odds of PMOS (odds ratio 2.60), and so were body fat percentage (3.32), trunk fat mass (2.54), and left-leg fat mass (3.44). Fat-free mass - lean tissue - showed no significant link. The machine-learning model reached an AUC of 0.701, which is moderate, and the most influential features were left-leg fat, trunk fat, percent body fat, and protein mass.
What it means. The study supports the idea that body fat is a driver of PMOS, not just a bystander, and that body composition tells you more than BMI alone. It does not say fat is your fault, and it does not say weight loss is the only lever. Muscle was not the problem in this analysis.
Limits. I read the abstract; the full text is behind a paywall, so I could not check the methods in detail. Mendelian randomization depends on assumptions that are hard to prove. The numbers for different fat depots overlap heavily, because the genes that raise one raise the others - so "left leg" versus "trunk" should not be over-read. An AUC of 0.70 is not a diagnostic test. And global burden figures are modeled estimates.
For women heading into perimenopause: body composition shifts during the transition, and fat tends to move toward the abdomen. That is general physiology, not a finding of this paper, but it is why a PMOS history and the menopause transition deserve to be discussed together. Keeping muscle is a sensible goal either way, and lean mass was not linked to PMOS here.
WHAT'S TRENDING
What I can ground in coverage, and what I am inferring. I could not browse TikTok or Reddit directly this week, so what follows rests on news reporting about those platforms. Where I am reading between the lines, I say so.
1. The supplement price tag. Which?, the UK consumer group, published an audit on September 30 of 26 supplements marketed to perimenopausal and menopausal women, checking 78 active ingredients. It found many were close to a basic multivitamin with botanicals sprinkled in, often at doses too low to matter. Daily cost ran from 22p to 1.33 pounds, close to 500 pounds a year, versus 6p a day for a basic multivitamin - Which? puts the markup at about 20 times. One low-scoring product had no calcium or vitamin D. How it fits: this backs up the warnings I gave in Issue 1. Where the chatter and the evidence part ways: the marketing says "formulated for menopause"; the audit says the word "menopause" was often a price tag, not a formula. Note that this is a UK audit; check your own local products.
2. "Male menopause" on TikTok. SWNS reported September 30 that influencers claim all men go through "andropause," starting in the mid-thirties. A doctor quoted there says it does not exist as a predictable event, and that true late-onset low testosterone appears in about 2% of middle-aged men. That doctor runs a hormone-therapy clinic, so weigh the source. My inference: this is the same wave as the testosterone chatter I covered last week, now aimed at men. The evidence-based message is the same - low testosterone is a diagnosis made by a doctor, not a vibe.
3. The "meno-boom." Newsweek (September 30) describes menopause as a major social-media topic, citing insurer data of a roughly 200% one-day jump in TikTok searches on fertility and menopause on August 12. Doctors quoted say patients now arrive asking about oral versus transdermal estradiol and testosterone. That is a real shift: better-informed women. The gap: knowing the vocabulary is not the same as knowing the evidence, as this week's papers show.
4. A training gap. The Menopause Society announced September 30 a survey study in its journal Menopause finding that menopause education in US family-medicine residencies is broadly present but uneven, with no formal competency assessment (press release only; I did not read the paper). It is a plain reason many women feel dismissed. It is also a reason to arrive prepared.
5. PMOS after the awareness month. AJMC (October 1) reports the renaming consensus drew 56 organizations and 14,360 respondents, and quotes experts on persistent diagnostic delays. Its summary notes exercise, nutrient-dense eating, and metformin as first-line, and limited evidence for inositol supplements. Where it matches the evidence: the delay is real. Where I would stay careful: anything sold as a one-supplement fix.
That's the cycle. Bring your doctor the papers, not just the headlines.
Dr. Herman Weiss
Medical Disclaimer
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