What we know, what's missing, and what we'd like to fund.

What's thin or missing

The gaps we won't pretend aren't there.

When we say "the evidence base is thin here," this is what we mean. We'd rather name the gap than write past it.

• First Nations, Inuit, and Métis menopause

  A 2021 NCCIH scoping review found roughly thirteen peer-reviewed papers on Indigenous menopause in Canada, most small, qualitative, and community-led. Almost nothing Inuit-specific. Almost nothing Métis-specific. The medical-trauma history (residential schools, the Sixties Scoop, Inuit TB sanatorium era, Métis exclusion from coverage) shapes care-seeking at midlife in ways the literature has barely touched.

  Source

• LGBTQ+ midlife and menopause

  Research on lesbian and bisexual women's midlife health exists but is sparse. Trans menopause is mostly endocrine-focused, with small samples. The Endocrine Society's 2017 trans guidelines acknowledge menopause data is "essentially absent."

• Trans women on long-term estrogen

  There is almost no longitudinal data on what happens to trans women if exogenous estrogen drops, is interrupted, or is reduced in midlife. The symptom picture (vasomotor, sleep, mood, bone) is biologically plausible from cis-menopause physiology, but the trials don't exist. We write about it on the trans-women hub because the silence isn't neutral, but we mark it as low-grade evidence on purpose.

• Bigger bodies and menopause

  Body size changes risk profiles (cardiometabolic, breast cancer, fracture, MHT dosing) in ways that matter clinically. Most trials either excluded higher-BMI participants or didn't stratify by them, and weight-stigma in clinical settings means symptoms get attributed to size rather than hormones. The honest picture for women in larger bodies is patchier than the textbook suggests.

• Premature and early menopause

  Premature ovarian insufficiency (before 40) and early menopause (40–45) are studied as endocrine events, but the long-arc questions, what does forty years of post-menopause look like for bone, brain and heart, and how should MHT be dosed across that span, sit on much thinner data than the average-age cohorts.

• Neurodivergent women through perimenopause

  ADHD and autism research in adult women is itself recent. The intersection with perimenopause (estrogen's effect on dopamine, late diagnosis at midlife, executive-function collapse during the transition) is almost entirely clinical observation and lived-experience writing, with primary research only just starting.

• Disability and menopause

  A 2023 BMJ scoping review concluded the field is "in its infancy." Almost no work on how chronic illness, mobility limitation, or sensory disability intersects with the menopause transition or treatment access.

• Intersectional symptom and access data

  Even SWAN doesn't break out Black + queer, Indigenous + disabled, racialized + neurodivergent. Treatment access disparities by race and sexuality together, not just one axis, are largely anecdotal.