Weight gain, brain fog and anxiety: Is it menopause, or just clever marketing?

Preventative hormone replacement therapy can feel a bit like preventative Botox – it’s often based on fear rather than need. And there is, according to social media at least, plenty to fear.

For the seven million Australian women aged over 40 who are looking down the barrel of perimenopause and menopause, the list of possible symptoms includes brain fog, weight gain, insomnia, osteoporosis, thinning hair, low sex drive, depression and anxiety.

And while we have greater awareness about perimenopause and menopause than we did 20 years ago, we are also more confused than ever, thanks to mixed information and misinformation. Much of the confusion is being driven by alarmist social media menopause “experts” selling the cure, which is often a bevy of supplements and menopausal hormone therapy (MHT).

According to experts, there’s a lot of fearmongering around both perimenopause and menopause.Credit: Getty Images/iStockphoto

When Melbourne-based perimenopause and menopause specialist Dr Fatima Khan first opened her clinic, her clients were primarily women over 50. Today, her clinic is full of women in their 40s, who have often spent hundreds of dollars on herbs and supplements and want to pre-empt any nasty changes.

“There’s a lot of fearmongering about the symptoms that women experience and how it’s the end of everything,” says Khan. “The problem now is it’s becoming an industry where MHT is going to solve all your problems and then there are tons of supplements coming out.”

Professor Susan Davis, director of Monash University Women’s Health Research Program, doubles down on this idea: “Menopause has become the number-one target for exploitation for women’s health. There are people catastrophising it because they’re offering services … they are pushing agendas to monetise it.”

Professor Susan Davis says some groups are pushing agendas to monetise menopause and perimenopause.Credit: Photos by MMP - Michelle McFarla

The ‘brutal’ reality

About 30 per cent of women experience severe symptoms during perimenopause, which typically occurs during our 40s when hormones are in flux and menstrual cycles start to become erratic, and during menopause, when a woman stops menstruating, typically around 51 years old.

When she was in her late 30s, comedian and presenter Em Rusciano, now 45, started to feel she had lost control of her body.

The mother of three says her brain “felt like pea soup”, her joints ached, her emotions were “cranked up to 11,” and she was exhausted but couldn’t sleep.

It was “f---ing brutal”, she admits.

“I felt unmoored – like I was losing parts of myself that I relied on, like my sharpness, confidence, and ability to juggle multiple things,” she says. “It impacted every aspect of my life, including my work, relationships, ability to show up for my family, and most of all, my sense of self.”

For a long time, Rusciano felt alone in her experience and as if she were failing at life.

Just over a year ago, she went to her doctor, who checked her hormone and follicle-stimulating hormone (FSH) levels – they were “all over the shop”.

A follow-up appointment with an endocrinologist confirmed that she was in early menopause – defined as happening between 40 and 45 – and also had low bone density.

“Once I realised that what was happening to me was biological, not a personal failing, I was able to reframe it and concentrate on getting better,” Rusciano says. She then began MHT.

Em Rusciano found MHT effective in dealing with early menopause and low bone density.Credit: James Brickwood

“[It] isn’t suitable for everyone, but for me, it’s been life-changing. I’ve also completely overhauled my lifestyle. I lift heavy weights, prioritise my health, and most importantly, I put myself first.”

Once women reach menopause, those with moderate to severe symptoms should get treatment, says Davis, who also advocates its use to prevent osteoporosis and for women going through premature menopause, before the age of 40.

No magic bullet

MHT is an important piece of the puzzle for women experiencing disruptive symptoms, but as Khan puts it, “hormone therapy is not a magic bullet”.

According to Dr Mary Claire Haver, an American obstetrician and gynaecologist with more than 4.5 million followers on social media, taking MHT can not only help with symptoms, but also help prevent cardiovascular disease and dementia and contribute to long-term health and happiness.

Davis disagrees. The evidence that it will prevent heart disease or dementia does not exist for transdermal oestrogen, she says, and the safety of giving postmenopausal doses to perimenopausal women is uncertain.

“Perimenopausal women can have terrible symptoms. But if you’ve got regular menstrual cycles, or they’re starting to change, you’re still making a lot of oestrogen or progesterone,” Davis explains. “If we start throwing standard MHT at those women, we don’t know what we’re doing. We need treatments designed specifically for perimenopause.”

As for herbs and supplements, Davis sees no place for them. “Unless you are deficient,” she adds. “We don’t even know they get past gastric acid half the time.”

Another issue is that – as they have become such a hot topic – it is easy to pin everything from depression and anxiety, brain fog and exhaustion on perimenopause and menopause. And there is good money to be made from doing so.

A 2024 McKinsey report found that women spend more on menopause and pregnancy-related products than any other health product, while a 2025 report from Women’s Health Access Matters and KPMG found the global menopause market was valued at nearly US$18 billion ($28.5 billion) and is forecast to reach $US27 billion by 2030.

Yet statistics around perimenopausal anxiety and depression and the role of supplements and MHT in treating it may be overblown.

Haver, who sells a line of menopause supplements, recently told Andrew Huberman that there was a 40 per cent increase in mental health disorders during perimenopause. She added that data suggests that oestrogen is more effective at preventing and treating it than antidepressants.

This contrasts with the findings of a new study Davis conducted of more than 10,000 women, due to be published this week. In her research, depression scores declined with age. At 30 years old, about 30 per cent of premenopausal women had moderate to severe depressive symptoms.

By their 40s, that figure dropped to about 14 per cent, spiking slightly to 17 per cent among those going through perimenopause.

It’s not the bleak picture that is being painted. It is also difficult to tease out whether symptoms such as brain fog, anxiety and exhaustion are hormonal or because of other factors, such as being a carer, having a demanding career, or experiencing financial or family stress.

“Women are coming to me because there’s no space to breathe, or stop, or self-care, and then because they can’t change anything else, the only thing is, ‘OK, what can I do to optimise my hormones?’ ” says Khan.

Dr Fatima Khan says there is much fearmongering about the symptoms of menopause and perimenopause.

Stress and a reliance on alcohol – one in five middle-aged Australian women “binge-drink” to manage stress – exacerbates sleep issues, anxiety and symptoms that are directly the result of hormonal changes.

“Of course menopause matters, but to just say everything is perimenopause is naive,” agrees Davis. “If we get too lost in perimenopause we might miss the big-ticket items that are putting women under tremendous stress.”

‘It’s about evolution’: A new start in life

With all the confusion, what is the best evidence for how to deal with a transition that all women will go through?

MHT, for symptomatic menopausal women and those with low bone density, can be life-changing, as Rusciano attests. For perimenopausal women experiencing symptoms, switching off their cycle and giving a low dose of oestrogen can help, while those experiencing vaginal discomfort can benefit from vaginal oestrogen.

“I support MHT for menopause and I support treatment of perimenopause, but we have to look at the whole woman and her situation,” Davis says.

To truly be well, women also need to address nutrition, movement, stress management, boundaries, sleep hygiene, and social connection, Khan adds.

And they need to be reassured that after menopause, “everything tends to calm down”.

In fact, the portrayal of life beyond perimenopause from the “misery perspective” which suggests life only gets worse as we age, is untrue.

Many women in their 50s are having the best sex of their lives and older age can be a time of transcendence and greater life satisfaction.

For Rusciano, it’s been a period of growth. “I’ve realised that this transition isn’t just about loss, it’s about evolution,” she says.

“For so long, we’ve been taught that menopause is the beginning of the end, but in reality, it can be the start of a new, clearer, more empowered version of ourselves.”

Em Rusciano, Dr Fatima Khan and Professor Susan Davis will appear at the Sydney Opera House on Sunday, March 9 as part of All About Women’s Feeling the Heat. Tickets to view the event as a livestream are also available.

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