Menopause Supplements

Part
01
of two
Part
01

Menopausal Supplements - What Women Think: United States

Women choose supplements over conventional methods in treating menopause because they believe these are safer, they prefer a more natural approach, and sometimes, refusal to use medical treatment is due to distrust and disappointment with the medical system.

Women and Menopause: Overview

  • Only 35% of participants in a study conducted to assess health and lifestyle behavior of women going through menopause felt prepared for menopause.
  • The same study shown that women rated weight loss as the main reason to join a lifestyle program during menopause and would consider a lifestyle modification program targeting weight loss and mitigation of metabolic impairments and symptoms as a potential alternative to Hormone Replacement Therapy (HRT), also known as hormone therapy (HT).
  • Women often feel confused about their options and rely on the internet as their primary source of information.
  • A Yale University study discovered that while 60% of women with significant menopausal symptoms seek medical attention, nearly three-quarters are left untreated.
  • A survey conducted in Europe shown that women avoid treatment for menopausal symptoms for a variety of reasons including discomfort discussing vaginal symptoms and safety concerns regarding HRT.

Hormone Replacement Therapy (HRT)

  • Two large studies during 2002 and 2003 raised concerns regarding HRT, revolving around an increase in breast cancer and heart diseases. These results created panic among some users and new guidance for doctors prescribing it. Even though the results of those studies are now viewed differently by doctors, the conversation is still driven by fear, while more “natural” methods are considered to be safer.
  • Even though HRT is still the most effective way to fight menopause symptoms, a relevant percentage of women express several safety concerns.
  • In an online survey from a British menopause-focused website, 70% of 1464 respondents were in favor of HRT, and 40% believed that the risks of HRT had been exaggerated in the media. On the other hand, 41% of perimenopausal women reported that they would never use HRT, and 77% said they would try alternative therapies before taking HRT.
  • A recent study with 1,611 women showed that 585 (37%) have tried HRT against 1,014 (63%) who haven’t.
  • As for the reasons they did not try, 35% said they never considered, 12% were not suitable candidates, 47% prefer not to take it, and 6% said that other remedies helped.
  • Negative impressions of HRT generally stem from the Women’s Health Initiative (WHI) study in the United States, and from the Million Women Study in the United Kingdom (UK). The use of HRT for the treatment of menopausal symptoms was widespread in the 1990s, but abruptly plummeted globally following the release of these study data.
  • Current consensus recommendations include HRT as an option for many women, and state that treatment decisions for menopausal symptoms should be individualized based on an analysis of each patient’s health status, age, symptoms, and personal preferences.

Alternative Therapies (Including supplements) and why women prefer them

  • Some women are expressing an overarching distrust of a medical system that they perceived to be dismissive of their concerns and overly reliant on pharmaceuticals in place of greater clinical attention.
  • Others expressed the perception that many clinicians were too ready to prescribe conventional HRT, rather than work more collaboratively with patients to identify a treatment approach that would effectively manage their symptoms in ways aligned with their overall approach to health and wellness.
  • A study conducted on women using CHBT showed that many participants suggested that clinicians’ dismissal of women’s concerns and their reliance on pharmaceuticals should be understood as implicit gender-bias or racial-/ethnic-bias in health care.
  • Other studies have shown that doctors are not really prepared to deal with menopause, as also shown by the Yale study previously mentioned.
  • In a recent survey by Women’s Health, 95% of women said they would try alternative therapies before HRT because they think they are more natural and because they are worried about health risks of HRT.
  • Most women using those alternative methods do not discuss it with their health care providers.
  • A survey conducted in the UK discovered that 20% of the participants tried alternative and complementary treatments such as herbal remedies and "natural" hormones. About 15% classified it as very effective, 44% fairly effective, 22% not very effective, and 14% not at all effective.
  • A study shown that approximately 51% of women use some sort of alternative relief and more than 60% perceive it to be effective for menopausal symptoms.

Research Strategy:

We started our research by looking for polls and surveys that could give us some insights as to why women choose supplements to treat menopause. We looked for that information in health-related sites like NCBI, Harvard Health, Women’s Health, MedScape among others. We also checked specific sites like Menopause, NIH, MenopauseWhispers, etc. We were not able to locate research about supplements, but we did find some studies about alternative therapies that were used in this report (supplements are mentioned as alternative therapies in most studies).

We then broadened our research outside of the US in order to find more relevant results. Due to cultural and ethnic differences, we excluded any study from Asia and Africa, but we decided to include some studies with European women, especially in the UK, that provided interesting insights.

Next, we inverted our research, instead of looking for reasons why women choose alternative methods such as supplements, we looked for reasons why they stay away from more conventional ones, like hormone replacement therapy. With this approach we found some new information, such as the distrust and disappointment with the medical system. It is important to note that we found some sources with testimonials of women and reviews of products, however, these sources are not used due to the obvious bias. We decided to focus our research in more reliable sources and controlled studies.

As for the reasons, since we could not find sources detailing exactly why women choose the supplements, we used the information that was available to make connections and understand the way they think. Different studies mentioned the safety concerns and how alternatives (like supplements) are viewed as safer, so we included “safety” as one of the reasons (even though some doctors alert to potential harm those supplements could cause, they also mentioned that women in general are unaware of them, we included a Forbes story about this). Several reports noted that the medical system is not ready to deal with menopause and women are not feeling like doctors take their symptoms seriously, so we included “distrust of the medical field” as another reason. “Natural” is also a word that came up in different sources when referring to alternative therapy and supplements preferences, so we included that as one of the reasons as well. “Convenience” could be used as one of the reasons, since a lot of women are reportedly taking their information from the internet and friends and some studies pointed out that they don’t feel comfortable discussing menopause symptoms, which could lead to more online purchases, however, since this reason is a judgment call, we excluded it from the final answer.

Part
02
of two
Part
02

Menopausal Supplements in the United States

The top seven menopausal supplements on the market in the United States, according to various market reports, are split into hormonal products that are based on Estrogen (Premarin, Vivelle or Vivelle-Dot, Estrace), hormonal products that are based on Progesterone (Prometrium), combination products (Prempro, Duavee), and non-hormonal products (Brisdelle).

premarin

  • Premarin's revenue in 2017 was $956 million with the total menopausal supplements market expected to reach $5.28 billion by 2023 at a CAGR of 3.7%.
  • Premarin has an average rating of 8 out of 10 stars on the Everyday Health website, with one review stating: "I take 0.625mg daily for hot flashes and night sweats. Within weeks my symptoms were under control, and I was sleeping better throughout the night. I worked with my doctor to find the best treatment for me."
  • On Drugs.com, Premarin has a score of 7.7 out of 10 based on 55 reviews. One reviewer stated: "I had problems with painful intercourse and Premarin improved it and increased my libido."

vivelle

  • Vivelle's revenue in 2018 was $31 million or 3.4 billion YEN as 1 Japanese Yen equals 0.0092 United States Dollar.
  • Vivelle has a rating of 3.92 stars out of 5 based on 244 user reviews.
  • A reviewer wrote: "I've been on this since my hysterectomy in 2000. I get frequent migraines, and I'm not sure if these patches are the cause. One doctor said I might get more without the patch. But I asked my pharmacist who said 50% on this drug get headaches and migraines. I had a big weight gain since on it. I have no hot flashes by day, but still have them at night."
  • Another reviewer wrote: "Very easy to use. No side effects DO NOT accept the generic form from Mylan, Their patch made my ears ring so loud they would wake me from sleep. I used their patch for three months never realizing that was causing it. Nearly drove me crazy."

Estrace

  • Estrace's revenue in 2018 was $486 million.
  • The supplement has a rating of 6.9 out of 10 based on ‎57 reviews on Drugs.com.
  • A reviewer stated: "I have been using Estrace for 5 yrs -a complete hysterectomy at age 42-can't live without it-no more nightmares, nerves are calm normally according to my husband-HA! & don't have hot flashes."

prometrium

  • Prometrium generated a revenue of $153 million in 2018.
  • The supplement has a rating of 7.8 out of 10 based on 22 reviews on Drugs.com.
  • A reviewer wrote: "Helps bleeding. Makes asthma worse. Helps me sleep," while another wrote: "I was diagnosed with hyperplasia. I was experiencing very heavy, clotty periods for YEARS. I thought this was normal until I had a month long period. This pill is heaven sent. I have not had a period for about 8 months, have lost a tone of weight, have more energy than I have had in years and I would say the only side effect is tender breasts. I cannot guarantee this result for everyone but clearly I was no producing my own progesterone."

prempro

  • Prempro's revenue was reported to be slightly under $1 billion for 2018.
  • The supplement has a rating of 8 out of 10 on RXList based on 30 reviews.
  • A reviewer who has been using the supplement for 10 years wrote: "I am 65 yrs old. Have been taking Prempro for approximatelt 12 – 15 yrs and hope to continue forever. I look and feel great. No side effects that I'm aware of. My Dr. encourages me to stop taking, but I keep telling her, "why fix something that isn't broken." I started out on the highest dose and 3 or 4 yrs ago switched to the lowest dosage. I have no history of breast cancer in my family, it's kept my bones strong and skin looking good, no weight gain (I'm 5'6, 140 lbs.) I'm a believer that our bodies need estrogen at this age. I have researched a lot and have found many articles as to the advantages of HRT. That old study was done incorrectly. I'll take my chances. At the time the study was done, 1 out of 100 women got cancer. Small %. However, it may be right for me (good genes) and not for someone else. I have yearly checkups, important to do. Good luck ladies and God's blessings be about you."

duavee

  • Duavee generated a revenue of $161 million in 2018.
  • The supplement has a rating of 8.8 out of 10 based on 12 reviews.
  • A reviewer wrote: "On Duavee I had strange dreams and nausea. I wish there was a transdermal application and lower dose option," while another stated: "After two doses the horrible hot flashes I was having have gone. I have only been on the duavee for 1 month, but I feel it has changed my life for the better, I am no longer depressed and hate to go places afraid I will have a hot flash and melt down, hair and all. To me it has been wonderful so far."

brisdelle

  • Brisdelle's sales was around $1 billion in 2018.
  • The supplement has an average score of 6.5 out of 10 based on ‎35 reviews.
  • A reviewer wrote: "I have been on this for 2 months. It has worked very well for my hot flashes and night sweats. I have noticed dry mouth and some headaches and some joint pain in my fingers, but that pain goes away during the day. It's worth it though so I can sleep at night without being hot and cold all night and day long. I just drink more water."

RESEARCH STRATEGY

To locate the top menopausal supplements on the United States market, your research team looked at various market reports from business consulting firms such as PR Newswire, MarketWatch, Grand View Research, Inc., and Statista which usually provide such research reports and statistics. Through this search, the team found a precompiled list of the top menopausal supplements globally, categorized according to hormonal, combination, and non-hormonal products. On subsequent search, the team also found mention of the identified supplement brands as being major contributors to the revenue of the supplement market by category. Next, the team searched for the revenue breakdown of these brands from sites such as Statista and BusinessWire and obtained the figures for each one. The revenue information for Vivelle was provided in Japanese Yen. Thus, your research team used a currency converter to provide the value in USD. Your research team, thus selected the top menopausal supplements in the US market based on the revenue generated.
Finally, to obtain product reviews, the team visited medical and drug review sites such as WebMD, Drugs.com, and Everyday Health, and there, obtained reviews for the supplements.

Sources
Sources

From Part 01
Quotes
  • "Women do not feel prepared for menopause and report interest in a structured lifestyle program containing weight loss and weight maintenance strategies to combat menopause symptoms."
Quotes
  • "Negative impressions of HT generally stem from the Women’s Health Initiative (WHI) study in the United States,15 and from the Million Women Study in the United Kingdom (UK)"
From Part 02