Viewed from Washington, where the Endocrine Society’s annual conference just concluded, the menopause moment is increasingly a tale of two therapies. On one hand, fresh data confirm that hormone replacement therapy (HRT) dramatically reduces bone loss: a study of 387 postmenopausal women found those on HRT had a 69 per cent lower risk of low bone density in the spine and hip. On the other, a Stanford-led analysis of nearly 59,000 adults with diabetes revealed that those taking semaglutide — the GLP-1 agonist already famed for weight loss — also suffered fewer fractures compared to patients on alternative medications. These findings arrive as the American College of Physicians issues a landmark guideline making semaglutide and tirzepatide first-line pharmacotherapy for obesity, a condition that often intensifies during the menopausal transition.

Yet for millions of women, the promise of hormone therapy remains out of reach. Across the United States, patients like Cybele Maylone, a 46-year-old whose breast cancer is fuelled by oestrogen, describe a deep frustration: they hear constant success stories of HRT lifting brain fog and quelling hot flushes, but their oncologists forbid it. The result is a growing cohort of women left to navigate a fragmented landscape of non-hormonal medications, cognitive behavioural therapy, and hypnosis — interventions that, while helpful for some, lack the sweeping efficacy of oestrogen. Viewed from Europe, the picture is similarly patchy. In Switzerland, women such as Sylvie, a 53-year-old architect, report being blindsided by the intensity of menopause despite voracious reading and podcast listening, then turning to dietary supplements whose benefits remain scientifically thin. French-language medical commentary underscores that while phytoestrogens and vitamins are widely marketed, rigorous evidence for their effectiveness is scarce, and unsupervised use can pose risks.

In Latin America, the conversation is taking a different turn. Brazilian media highlight a new international obesity guideline that positions semaglutide and tirzepatide as first-line drugs, a shift that could reshape menopause care given the weight gain and metabolic changes many women experience. Yet the same digital ecosystem that amplifies these evidence-based treatments also fuels a parallel market of unproven remedies. Influencers on Brazilian social platforms are aggressively promoting creatine — a supplement long associated with bodybuilders — as a menopause panacea, claiming it counters muscle loss and hot flushes without any robust clinical backing. Experts caution that while creatine may aid muscle mass in older adults, its specific benefits for menopause symptoms remain unstudied, and the hype risks diverting women from validated therapies.

Taken together, these developments expose a globalised but uneven landscape. The new obesity guidelines and the fracture data on semaglutide suggest that GLP-1 drugs could eventually serve a dual purpose for menopausal women: managing weight and protecting bone health. However, the research remains preliminary, and the drugs’ high cost and supply constraints limit access, particularly in middle-income countries. Meanwhile, the millions of women for whom HRT is contraindicated — breast cancer survivors, those with a history of blood clots — are still waiting for a breakthrough that matches hormone therapy’s broad benefits. Until rigorous trials fill that void, the gap between evidence and anecdote will continue to define the menopause experience for a substantial and often overlooked population.