Women largely suffer in silence when it comes to reproductive health. Discussions about this fundamental and far-reaching system of the body tend to happen behind closed doors, in whispers. And despite causing half the population debilitating symptoms that can last for years, open conversation about menopause and perimenopause has lagged even behind topics like pregnancy, fertility and menstruation.
Menopause is defined as occurring 12 months after the final menstrual cycle, and perimenopause can begin anywhere from three to 10 years prior. “It affects every aspect of women’s mid-life period; their health, sex lives, relationships with family, and how they feel about themselves,” wrote Deborah M. Merrill, professor of sociology at Clark University, in her book, “Mastering Menopause: Women’s Voices on Taking Charge of the Change.” With that in mind, it should be shocking that the conversation surrounding menopause has been almost nonexistent. But it’s not.
Lately, though, the conversation has gotten a bit louder. A-list celebrities, who stand to lose a lot in youth-obsessed Hollywood, have raised their voices: Halle Berry shouted, “I’m in menopause!” on Capitol Hill this May, to push for U.S. legislation that would fund research and education; Naomi Watts declared Sept. 9 National Hot Flash Day, on behalf of her new pro-aging wellness brand, Stripes Beauty. On “The Today Show” in September, Alanis Morissette wryly described her current phase of life as “this beautiful perimenopausal unravelling,” calling it “the second puberty that gets less less less attention.”
Gen-X women aren’t going to be quiet as they wade into this phase of life. While they’re making the most noise currently, we can thank Baby Boomer women for setting the stage for this movement. The cultural conversation about reproductive health tends to stay in lockstep with their needs and experiences: when most Boomers were entering their reproductive years, the pill became widely available (starting in 1960 in Canada) and the process of legalizing abortion began (in 1969).
Now, their interest in healthspan and longevity is coming into play. Baby boomers are living much longer than past generations (life expectancy is 79 today, up from 63 when the first boomers were born), making quality of life in post-childbearing years a much more pressing concern.
Menopause is often thought of as an isolated event that happens around age 55, but perimenopause can occasionally begin as early as the thirties, and some continue to experience hot flashes into their eighties. It spans generations. “Sometimes menopause is framed as a problem to be solved as opposed to a universal experience,” said sexologist Jess O’Reilly. “Half of us will experience menopause, so it’s not an exception — it’s the norm.”
Most are familiar with the concept of hot flashes, but symptoms can also include fatigue, sleep disturbances, decreased libido, muscle and joint pain, weight gain, mood changes and brain fog. Many of these can be brushed off or ignored, not unlike PMS or postpartum issues. “Folks have been expected to grin and bear it, oftentimes with no support or empathy,” said O’Reilly. “I’d like to see more education on perimenopause, so we understand what to expect and we’re able to recognize symptoms from the onset. We also need more training for health professionals. I’ve heard countless stories from women in their thirties whose symptoms were dismissed.”
Growing awareness of what women go through during these years has meant we’ve seen a surge in offerings dedicated to symptom relief. Tech executive Sheryl Sandberg and fashion designer Tory Burch recently invested in Midi Health, a U.S. telehealth startup focused on prescribing treatments for perimenopause and menopause symptoms. And a new clinic named Lume will open in Toronto this fall, where “menopause-specialized physicians” will address salient concerns like pelvic health, sexual health and emotional wellness.
There are products for this, too. Take The Galveston Diet, developed by Dr. Mary Claire Haver, a nutritional guide for women in menopause, and Epiphany, a Canadian brand addressing sexual health concerns during this time with items including an arousal serum. In September, Watts launched her brand Stripes Beauty at Hudson’s Bay, which addresses skin-related symptoms of menopause with products like a cooling mist for overheated skin and a vaginal moisturizer to alleviate dryness.
More resources and support equals progress — and profit. “Brands now see that we’re living a good proportion of our lives post-menopause,” said O’Reilly. “They simply need to pay attention to this market and its spending power.”
That is happening because more people are beginning to share their stories. “Wherever a conversation doesn’t exist, or is unavailable, the community needs to come together and unlock it,” said Watts, 56, who was told that she was in early menopause in her mid-thirties. “By sharing stories, you’re instantly halfway to solving the issue just by being honest and addressing it — it’s a sense of self-preservation.”
Merrill talked with multiple generations of women for her book and found that increasingly, they are more comfortable asking their mothers, sisters and friends about menopause, instead of just their doctors. Notably, she found these discussions are still mostly between women. “I think that women are talking more to their partners in heterosexual relationships, but they aren’t as likely to talk to their brothers, their fathers, their male friends,” Merrill said.
Decades of shame surrounding women’s bodies have prevented us from speaking openly about menopause. In 2023, 82.7% of respondents in a national U.S. survey said they felt stigma associated with their menopausal symptoms. And if you feel embarrassed, you’re less likely to seek help and health care.
When it comes to health care, openness to hormone replacement therapy (HRT) to treat symptoms is ramping up, thanks to new research giving context to its long misunderstood risks.
But there are some menopause topics we’ve only just begun to explore, like the connection between hormones and the brain. Many women report new or emerging mental health struggles during perimenopause, including brain fog, depression and anxiety. Brain scans show significant change in brain structure, connectivity and energy metabolism, though the research is still preliminary.
Research on women’s health in general is still pretty preliminary, in fact — women were excluded from clinical trials until the 1990s and the study of women’s health didn’t exist until 30 years ago, according to the Society for Women’s Health Research.
In early September, a clip from a PBS documentary called “The M Factor: Shredding the Silence on Menopause” went viral on social media — we were collectively drawn in by an OB-GYN saying she got less than a month’s training about menopause.
As younger generations are increasingly online, this conversation is widening, spread by doctors, influencers and celebrities with millions of followers like Haver (@drmaryclaire, 2M followers on Instagram), an OB-GYN and author of The New Menopause. Menopause educator Carol King (@aunticarols50s, 162K followers on TikTok) offers tips to manage symptoms and has an upcoming book called “Are You There, God? It’s Me, In Menopause.” On Instagram, there are 1.9 million posts with the tag #menopause, and on TikTok over 350,000, a number that will surely grow along with the age of its users.
Unfortunately, a wave of misinformation has accompanied the rising awareness. “Predictably, as the legitimate discussion on menopause has grown, there has been a parallel flood of scammy supplements from celebrities and doctors alike,” wrote OB-GYN Dr. Jen Gunter, author of “The Menopause Manifesto,” in a recent newsletter. She cited “false claims about so-called bioidentical hormones, unstudied meno-diets, and the promotion of useless tests and unproven hormone coaching services.”
Ideally, we’ll come to see menopause as an inevitable phase of life to be understood — and even enjoyed. “There’s a lot that comes with seniority that women don’t often think about as being positive because we’re such a youth-oriented society,” said Merrill. “But there really are a lot of benefits.” Not having a period and its associated PMS and cramping, and not worrying about unplanned pregnancy can be a relief, though Merrill found many women mourn these changes too.
However it manifests, this can be a confusing and overwhelming time of transition. As we begin to talk about our experiences, we begin to take them more seriously — and more of us will gain access to support and treatment where needed. “How heartening it is to see women share, because we shared at every point: our first kiss, when we got our periods, when we first had sex, we shared about love and babies,” said Watts. “But the fact that we’re all out there alone in menopause is mind boggling.”
