We applauded HRT as progress. Then we quietly handed women a prescription and walked away.

Yes, HRT helped some but it was only for a minority and yet it became the headline cure, not the start of an honest conversation. The result: almost half of UK women never see a GP about menopause, and many who do lose roughly 10% of their earnings within four years because symptoms go unmanaged. Meanwhile the headlines cheer the next pill, HRT formula and the system still treats menopause like a tidy clinical problem rather than a whole-body transition.

Here’s the brutal fact: hot flushes, brain fog, sleep loss and persistent tiredness are tangled up with stress biology and metabolism. Cortisol spikes and insulin resistance show up in research as real drivers of symptom burden and long-term risk. A tablet that reduces a flush does not fix broken sleep, rising waistline, anxiety or cardiovascular risk. Treating the symptom but ignoring the system that created it is poor medicine.

We have tools that actually move the needle, diet plans that improve vasomotor symptoms, resistance training to protect bone and function, NICE-backed CBT to reduce bother and improve sleep, and service evaluations showing benefit from group auricular acupuncture for some women, including breast-cancer survivors. These are evidence-based, low-harm strategies that should be routine, not optional.

If we want genuine choice, we must stop using HRT as the default finish line. We need metabolic and stress screening in menopause pathways, funded brief CBT and lifestyle programmes in primary care, and employer action so women can stay working without losing health or income. New drugs belong on the menu but until the menu includes real, accessible holistic care, we’ve only rearranged the deckchairs. That’s not progress. It’s cosmetic medicine.