Why Informed Consent Fails at Menopause

(and how to fix it)

Summary: How well women feel during menopause depends less on their symptoms and more on their belief that they can manage those symptoms—thus it matters a lot whether doctors help or hurt that belief. Doctors fail women in two ways: using old, outdated information or distrusting good science. Both result in women getting the wrong advice. The fix: women need to build confidence in managing their health and spot good medical care, while doctors need to learn how to tell solid research from weak research. Right now, the system creates a difficult situation, where poor care impairs women's confidence, women’s symptoms get more severe, and leave women with fewer options in life, which makes it harder to design a satisfying life after menopause.

Quick Takes

#1: The Self-Efficacy Multiplier

Women with high self-efficacy (confidence that they can successfully manage a specific challenge) cope better with menopausal symptoms regardless of severity. But this means that women who struggle the most with self-efficacy will often find themselves seeking help. When they encounter poor medical care, two harms occur: self-efficacy erodes further AND symptoms constrain life more (work, relationships, functioning). Both worsen symptoms. Physicians aren’t just failing to help—they may cause harm by weakening the resource women need most.

#2: Two Paths to Wrong Information

Physicians fail women by: (1) getting stuck on outdated warnings from old hormone formulations, OR (2) rejecting rigorous trials as untrustworthy while focusing on observational studies and animal models as equally valid. Both betray trust. Example: observational studies suggest MHT clearly protects heart and brain, but randomized trials (which remove selection bias) only prove bone benefits. Being "pro-woman" requires engaging with best science, not abandoning rigor.

#3: Informed Consent Needs Both

True informed consent requires scientific accuracy AND respect for autonomy. 

• Accuracy without respect = paternalism = no informed consent. 

• Respect without accuracy = informed consent also becomes impossible. 

Women must build self-efficacy and learn to spot quality care. Physicians must develop research literacy, update knowledge regularly, and individualize recommendations. We have work to do.

Favorite Finds

Building Self-Efficacy

There are evidence‑based ways to increase self‑efficacy, including in peri‑ and postmenopausal women. Some interventions have used counseling (Karimlou et al, 2017) or educational sessions (Khandehroo et al, 2025) (Magistro et al, 2025).

Bandura (1977) postulated the existence of 4 sources of self-efficacy, including mastery experiences (choosing a small goal and succeeding), vicarious experiences, verbal persuasion with concrete support, and managing physiological and emotional arousal.

Programs are available in many communities, for example in the Bay Area through Stanford Medicine and Kaiser Permanente’s virtual Navigating Menopause program, and on the more integrative side, Oakland’s Menopause Wellness Circle, and the Menopausitive Workshop. I am not familiar with the details of these programs but they may be worth exploring.

Science Literacy

Anyone can learn research literacy, for example by taking this beginner “massive open online course” from Coursera: Science Literacy.

Getting what you need from a physician visit (or other provider)

• What Patients Say, What Doctors Hear – Danielle Ofri’s book gets 4/5 stars on GoodReads.​

• Doctors Talking with Patients/Patients Talking with Doctors – A classic text on medical communication written mainly for clinicians.

• SHE+ Patient Advocacy guide — A totally free, very useful toolkit especially addressed to patientswho have experienced dismissal

• Self‑Advocacy Guide for Women’s Health (Ms.Medicine) – A free (they request your email) women‑specific downloadable guide

• My Menoplan: menopause‑focused resource that coaches women to set an agenda, prepare a symptom and question list, state visit goals clearly, and use decision tools to guide the discussion

• Healthline has some good free advice as well.

Deep Dive

Click through for more details: still free!

REFERENCES

Bandura A. Self‑efficacy: Toward a unifying theory of behavioral change. Psychological Review. 1977

Bień A, Niewiadomska I, Korżyńska-Piętas M, Rzońca E, Zarajczyk M, Pięta B, Jurek K. General self-efficacy as a moderator between severity of menopausal symptoms and satisfaction with life in menopausal women. Front Public Health. 2024

Karimlou V, Mohammad-Alizadeh Charandabi S, Malakouti J, and Mirghafourvand M; Effect of Counseling on Self-Efficacy in Iranian Middle-Aged Women: A Randomized Controlled Clinical Trial; Iran Red Crescent Med J. 2017

Khandehroo M, Peyman N, Gholian-Aval M, Tehrani H. Self-efficacy intervention on health literacy and quality of life in menopausal women of suburban areas. Sci Rep. 2025

Magistro D, Vagnetti R, Ansdell P, Piasecki J. Self-efficacy, quality of life, physical activity and educational interventions in menopausal women: A cross-sectional and pre-post study using Bayesian structural equation modelling. Maturitas. 2025