The problem with menopause information online
Search almost any perimenopause question — "is HRT safe," "best supplement for hot flashes," "why can't I sleep" — and you get an overwhelming, contradictory pile of results: clinical guidelines, supplement-company product pages, wellness influencers, forum threads, and news coverage that's sometimes years out of date, all stated with the same tone of certainty. Almost none of it tells you how it knows what it claims to know.
That's not really anyone's fault in particular. Menopause was under-researched for decades, guidance has genuinely changed more than once as better evidence arrived, and there's now a large commercial market — supplements, telehealth, wearables — with a direct financial interest in you believing a specific claim. Put those together and a well-designed clinical trial and a supplement company's blog post can look, at a glance, exactly the same.
This page has two purposes: first, to walk through how to evaluate a claim you encounter yourself; second, to describe honestly what one part of Ripple, the Evidence Engine, does and doesn't do — so you're not guessing about that either.
What the Evidence Engine actually does
Inside the Ripple app, once you've logged at least three days of symptoms, the Evidence Engine turns that tracked data into a structured brief you can print or hand to a clinician. Once you're tracking, Ripple can turn that data into a structured brief: your Greene Climacteric Scale scores, computed from your own logs, assembled into a document with the same clinical references discussed below. It's not a lookup tool — it's a formatter for your own data, not a text field where you ask it questions.
The Greene Climacteric Scale itself is a validated, published research instrument (Greene, 1998), used in menopause research for over two decades. Ripple's part is the arithmetic on your own answers and the formatting — not new clinical judgment.
How to read evidence quality
You don't need a research degree to evaluate a health claim. A handful of questions gets you most of the way there — the same six the checklist above walks through.
Where did the claim actually come from? A news article, an influencer's caption, or a supplement label is a retelling — often several steps removed from the original research, and retellings lose nuance every time they're repeated. Trace a claim back to the original study or guideline where you can. If you can't find that source at all, that's information too.
What kind of study is it? Not all evidence carries equal weight. A randomized controlled trial — where participants are randomly assigned to a treatment or comparison group — is generally more reliable than an observational study, where researchers watch outcomes in people who already made their own choices, and both outrank a single case report or personal account, however compelling. None of these are worthless; they answer different questions. But "this worked for me" and "a controlled trial of thousands of people found this" are different kinds of evidence, and a responsible source tells you which one it's making.
How big was it? A study of 20 people finding an effect is a reason to look further, not a reason to be convinced. Small samples are more likely to produce results that don't hold up when someone repeats the experiment at scale.
Has it been replicated? One study is a data point, not a verdict. A finding repeated by independent researchers in different populations is much sturdier than a single paper, however well-designed. If a claim rests on exactly one study, that's worth knowing.
Who paid for it, and who benefits from you believing it? A study funded by the company selling the product isn't automatically wrong, but it's a reason to check the details and see whether independent researchers found the same thing. The same question applies to whoever is telling you about the study.
Is it actually current? Guidance changes as better evidence arrives. Menopause research is a good example of exactly that happening — twice, in fact.
Hormone therapy is the clearest case, and it's worth walking through, because the real story is more useful than either side of it usually gets credit for. In 2002, a large randomized trial called the Women's Health Initiative published results suggesting combined hormone therapy increased the risk of breast cancer, stroke, and heart disease in the postmenopausal women studied (Rossouw et al., 2002). Hormone therapy use dropped sharply almost overnight. But the original trial enrolled women across a wide age range, many starting treatment years after menopause began — and later, more detailed analysis by age and time since menopause found a different picture for women who started treatment earlier (Manson et al., 2013). That distinction is reflected in current guidance: the position statement from The Menopause Society (published under the organization's former name, NAMS, in 2022) states that for women under 60 or within 10 years of their final period, the benefit-risk balance for treating symptoms is generally favorable; for women starting later, the calculation is different (The Menopause Society, 2022). Neither the 2002 headline nor "it's fine for everyone" is the honest summary — the honest summary is that the answer depends on who's asking and when.
That history is also a reason to check whether what you're reading reflects current guidance. The UK's NICE guideline on menopause, for instance, was substantially updated as recently as November 2024 (NICE, NG23) — a page written even a year or two earlier could describe an outdated version of the same official guidance without saying so.
None of this tells you what to do about your own symptoms — that's a conversation for you and a clinician who knows your history. What it should do is make a claim you encounter online easier to weigh on its own terms.
What the Evidence Engine will not do
To be direct about the limits of the feature this page is named after: the Evidence Engine does not diagnose perimenopause or menopause, does not prescribe or recommend a specific treatment, and does not generate new clinical findings — it computes your Greene Climacteric Scale scores from data you've already logged and formats them alongside a fixed set of published references. It does not claim certainty where the evidence itself is unsettled, and referencing a guideline from NICE, The Menopause Society, or the British Menopause Society is not the same as being endorsed by them. Ripple isn't endorsed by, recommended by, or affiliated with any of these organizations. Nothing here replaces a clinician's examination, and nothing here is medical advice.
Frequently asked questions
What is the Evidence Engine?
The Evidence Engine is a feature inside the Ripple app that turns your own tracked symptom data into a structured, printable brief for a doctor's appointment, including your Greene Climacteric Scale scores and a set of clinical references. It requires at least three days of tracked symptoms, and a Pro subscription, to generate.
Where does the Evidence Engine get its information from?
Your scores come from arithmetic performed on the symptom data you've logged yourself, using the published Greene Climacteric Scale. The clinical references included alongside your brief are a fixed set of publicly available guidelines and studies, not a live database query or an AI-generated answer — the Evidence Engine doesn't search the internet or generate new findings on your behalf.
Is the Evidence Engine the same as an AI chatbot for my symptoms?
No. It doesn't accept open-ended questions and doesn't generate free-form answers about your health. It performs a fixed calculation on data you've already tracked and lays the result out as a document.
Does the Evidence Quality Checklist tell me whether a claim is true?
No. It gives you a rough read on how traceable and well-supported the sourcing behind a claim looks — not a verdict on whether the claim is true or a treatment is safe, and it doesn't evaluate anything a clinician has told you personally. A low result is a reason to ask more questions, not a reason to reject the claim outright.
Is HRT safe?
This isn't a question with a single yes-or-no answer. A large 2002 trial found real risks in the population it studied; later analysis by age and time since menopause found a more favorable picture for women who start treatment earlier. Current guidance from The Menopause Society reflects that nuance rather than either extreme. Whether hormone therapy is right for you depends on your own health history — a conversation for you and a clinician, not something a page like this can answer.
Why has menopause treatment guidance changed so much over the years?
Because the evidence itself has developed. Early trial results are sometimes revised by later, more detailed analysis, as happened with hormone therapy research. That's evidence working as intended — a reason to check you're reading current guidance, not a reason to distrust it.
Do I need a hormone test to know if I'm in perimenopause?
Generally, no. Current NICE guidance (updated November 2024) recommends diagnosing perimenopause and menopause based on symptoms and age rather than a hormone blood test in most women over 45, since hormone levels fluctuate significantly during this transition.
Does Ripple endorse specific treatments, or is Ripple endorsed by NICE, The Menopause Society, or any other body?
Neither. Ripple references publicly available clinical guidelines for context. Referencing a guideline isn't an endorsement in either direction — Ripple is not endorsed, recommended, or vetted by NICE, The Menopause Society, the British Menopause Society, or any other clinical organization.
Sources
- Rossouw JE, Anderson GL, Prentice RL, et al. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial. JAMA. 2002;288(3):321–333.
- Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women's Health Initiative Randomized Trials. JAMA. 2013;310(13):1353–1368.
- The North American Menopause Society. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. doi:10.1097/GME.0000000000002028. The organisation is now named The Menopause Society.
- NICE guideline NG23, Menopause: identification and management. Published November 2015, updated November 2024. National Institute for Health and Care Excellence.
- Greene JG. Constructing a Standard Climacteric Scale. Maturitas. 1998;29(1):25–31.
Related
If you're preparing for an appointment, the free Appointment Prep sheet builder helps you describe symptoms clearly and know what to say if you're not heard. If a symptom hasn't been taken seriously, the free Dismissal Tracker helps you keep a dated record to bring with you. If you want a structured way to describe your overall symptom severity in the same appointment, try the free Greene Climacteric Scale self-assessment — another private, no-account tool that scores 21 common perimenopause and menopause symptoms in your browser. If you're on HRT, the free HRT tracking log builder helps you organize symptoms and regimen notes for your next review. If you're comparing tracking apps, see Balance app alternative or the Ripple vs Balance feature comparison.