South African Women Want Menopause Answers, Not Old Granny Labels

JOHANNESBURG, SOUTH AFRICA  — Many South African women go through menopause without information or care, and researchers and doctors say better access to menopause symptoms and treatment advice is overdue, Spotlight reported on 3 November.

The report describes women whose symptoms were brushed aside. “They’ll say ‘it’s just menopause, there’s nothing we can do’,” the report quotes, capturing a response many women say they hear.

Why menopause symptoms and treatment go unaddressed

A 2017 study of 450 Black women near Pretoria found that more than three quarters had never sought help for menopause symptoms, according to Spotlight. Researcher Sostina Matina, who has studied women’s experiences of menopause in South Africa, is among those quoted, and the report’s headline captures the stigma of being labelled an “old granny.”

Prof Lineo Matsela, president of the South African Menopause Society (SAMS), and Xoli Madlala are also quoted in the report, which looks at why so many women are left without answers.

Menopause is the point at which menstrual periods stop for good, confirmed after 12 months without a period. It usually occurs between the ages of 45 and 55. The years leading up to it, known as perimenopause, can bring irregular periods and the first symptoms, sometimes for several years.

What women experience

Common symptoms include hot flushes, night sweats, poor sleep, mood changes, anxiety, difficulty concentrating, joint aches, vaginal dryness and discomfort during sex, and urinary problems. Some women have few symptoms, while others find them severe enough to affect work, relationships and daily life.

Falling oestrogen levels also have long-term effects. Bone density declines faster after menopause, increasing the risk of osteoporosis and fractures, and the risk of heart disease rises.

These changes mean menopause is not only about short-term symptoms. Checking blood pressure, cholesterol, blood sugar and bone health around the time of menopause can help women and health workers spot risks early and plan care for later life.

Spotlight reported on a study in Soweto that examined bone density in women living with HIV during menopause. South Africa has a large population of women on long-term antiretroviral therapy who are now reaching menopause, which creates new questions about how HIV, its treatment and ageing interact.

The treatment options women are not told about

Hormone replacement therapy (HRT) is the most effective treatment for hot flushes, the report said. It replaces some of the oestrogen the body stops producing, often combined with progestogen for women who still have a uterus, and can be given as tablets, patches or gels. Local oestrogen creams can treat vaginal symptoms.

Concerns about HRT grew after a large US study in 2002 linked it to higher risks of breast cancer and blood clots. Later analyses found that for most healthy women who start treatment before the age of 60, or within 10 years of menopause, the benefits usually outweigh the risks. Decisions should be made with a health worker who can review a woman’s history, including any history of breast cancer, clots or stroke.

Women who cannot or do not want to use hormones have other options for menopause symptoms and treatment, including some non-hormonal prescription medicines, cognitive behavioural therapy for hot flushes and sleep problems, regular exercise, weight-bearing activity for bones, and reducing alcohol and smoking.

Calcium and vitamin D, through diet or supplements where needed, support bone health. Women should tell a health worker about any bleeding after menopause, because it needs to be checked.

What better menopause care could look like

Advocates say primary health care clinics could ask women in their 40s and 50s about symptoms during routine visits, such as checks for blood pressure, diabetes or HIV. Training nurses to discuss menopause and to offer or refer for treatment would bring care closer to women who cannot afford private gynaecologists.

Access to HRT in the public sector is limited, and supply and cost can be barriers in private pharmacies. Clear national guidance and inclusion of menopause in women’s health programmes would help standardise care.

Workplaces also have a role. Flexible arrangements, cooler working spaces and open conversation can help women manage symptoms while continuing to work.

Pharmacists can also help. Many women first ask about hot flushes, sleep problems or vaginal dryness at a pharmacy counter, and a trained pharmacist can explain the options, check for medicines that may interact, and refer women to a clinic when prescription treatment or further tests are needed.

The women quoted by Spotlight say they want to be heard. Wider knowledge of menopause symptoms and treatment, among women and health workers alike, could turn a stage often met with silence into one managed with information and support.

 

 

Why it matters: Millions of women reach menopause without advice, yet effective treatments exist and clinics already see them for other conditions.

 

 

Source: Spotlight (Joan van Dyk),  November 2026.