For Meg Mathews, menopause looked like The Golden Girls—gray hair, elderly gentleman callers, chic but shapeless caftans. “Not me at 49,” Mathews says.
After coming back from a holiday, Mathews started experiencing some anxiety, brain fogginess, and aching joints. She didn’t feel like herself. “But how do you explain that to the doctor?” she says. “So of course I went in going, ‘I just can't cope with life.’ And of course they just gave me antidepressants and off I went. I had no idea that [those symptoms] were anything to do with menopause.” Many women don’t, thanks to the stigma attached to aging that’s either made menopause a punch line or kept it out of the conversation entirely.
Every woman (and some trans men) will go through menopause—that’s an estimated 1.3 million women in the U.S. alone who enter menopause every year. It is officially diagnosed after you’ve gone 12 consecutive months without a period, which happens at age 51 on average, according to the Mayo Clinic. (That’s the actual age of Jennifer Lopez, who could not look less like a cast member from The Golden Girls.) One percent of women enter early menopause (which can be triggered by chemotherapy or a hysterectomy) by age 40, and 5% are menopausal by age 45, explains Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University Medical School and a North American Menopause Society certified menopause clinician. “That's not a huge number necessarily, but it's hardly trivial,” she says.
Even for those who hit menopause at the average age, the “menopausal transition”—a period known as perimenopause—can last a decade or longer and start as young as your 30s. “It's not weird for somebody in her late thirties or early forties to experience some hot flashes or night sweats or insomnia or vaginal dryness,” Minkin says.
“Menopause represents aging—and no one really wants to deal with that.”
Despite this, Mathews was certainly not the first woman in her 40s—or even mid to late 30s—to walk into her doctor’s office experiencing disorienting symptoms and eventually discover—surprise—it’s perimenopause.
It’s time to start talking about menopause.
Menopause may be the last great taboo in women’s health. While conversations around fertility and female pleasure are (finally) becoming more open, menopause still feels like a secret. And that leads to a lot of misinformation. “Myths are created because there's so much ignorance and no conversation around it,” says Arianna Sholes-Douglas, M.D., a board-certified ob-gyn and maternal-fetal medicine specialist, and author of The Menopause Myth: What Your Mother, Doctor, and Friends Haven’t Told You About Life After 35. “Everybody just kind of makes up their own story about what they think menopause is based on the little-bitty facts that they have. Part of the taboo is that menopause represents aging—and no one really wants to deal with that.”
Mathews, now 54 and the author of The New Hot: Cruising Through Menopause With Attitude and Style, was experiencing severe perimenopausal symptoms before anyone even mentioned the word menopause. “I'm a recovering alcoholic and I'm in AA. So I went to an AA meeting and I said, Why the hell am I staying sober?” she says. “It's like, I might as well have a drink because I am absolutely at the end of my tether: I've got anxiety, I haven't left my house for three months.” As she was leaving, a woman tapped her on the shoulder. “She just said, ‘I think you're going through menopause.’ And I was a bit like, God, that’s cheeky. You know, I’m imagining gray hair and a cane.”
That kind of it-can’t-be-me reaction is common among women, says Sholes-Douglas, largely because doctors aren’t talking about it. “There's no training in medical school or residency around helping women after their reproductive years,” she says. “Everything that we're taught is mostly focused on the reproductive years.” According to a study by researchers at Johns Hopkins, only 20% of residency programs have a formal menopause curriculum.
“Menopause is not an old woman’s thing.”
That hurts women in the exam room. “Not only are many women not aware of perimenopause, but unfortunately many physicians aren't aware of it,” says Minkin. “They will take a woman who has come in and has skipped a couple of periods—maybe she's a little hot, maybe she's not sleeping so well—and they may think about hyperthyroidism or pregnancy, which are both very appropriate. But my goal in teaching medical students is to try to get them to think about including perimenopause as a possibility in making a diagnosis.”
Instead, women are often told to just suck it up, says Sholes-Douglas, to stay silent. “A big part of the problem is doctors just aren't prepared to talk about it either,” she says.
What happens when women stay silent
“Menopause is not an old woman’s thing,” says Jill Angelo, CEO and cofounder of Gennev, an online menopause clinic. Millennials are the largest generation in the workforce, and the oldest of us, at 39, are entering the perimenopausal period. By 2024, the Bureau of Labor Statistics estimates that there will be more than 55 million women over the age of 55 in the labor force. In the U.K., menopausal women are already the fastest growing demographic in the job market.
Before founding Gennev, Angelo spent 15 years at Microsoft, where she ran a networking group for senior-level women at the company. “The dialogue started to change among them from talking about kids and babies, to the changes they were experiencing in their bodies,” she says. “I’m 46 now, so I am in perimenopause—I realized this was such an underserved space.”
Women who are going through menopause at work report hot flashes, fatigue, depression, poor memory, and concentration—all things that can impact performance and cause job stress. But despite this, 47% of women in one survey who needed to take a day off, said they didn’t feel comfortable telling their bosses or employees why.
In an era when the coronavirus is already predicted to have a generational impact on women’s careers, the stigma surrounding a perfectly normal part of life shouldn’t be an added burden. “At the end of every talk I give about menopause, one or two fairly young women come up to me at the end of the lecture in tears and they will tell me the same thing that I've heard from many, many other women,” says Minkin. “They’ll say, ‘I was told I was crazy. I was sent from one psychiatrist to another psychiatrist. But really I was just perimenopausal.’”
The great menopause myth
Menopause is still saddled with a lot of myths: It’s the end of your professional life, or the end of your sex life, it will make you go crazy, or turn you into a parody of Samantha Jones having a hot flash while rubbing yams on her skin. But the greatest menopause myth might be that, whatever symptoms you’re experiencing, there are no solutions.
“For so many generations, we’ve just had this assumption that you just have to suck it up,” says Angelo. “We need to change that mode of thinking because there are real solutions to what women are experiencing.” From a medical perspective, many of the symptoms of perimenopause and menopause are treatable. Hormone replacement therapy (though not right for everyone) can treat hot flashes and lower your risk of health conditions associated with declines in estrogen, including heart disease, stroke, osteoporosis, and dementia. For vaginal dryness, “we’ve got lots of stuff,” says Minkin, from over-the-counter remedies to prescriptions and treatments. “Women could be feeling so much better than they're feeling through this phase of life if they knew that there is help available to them,” says Angelo.
Knowing how to address the changes of the menopause years starts with talking about them—something the women I spoke with were all optimistic about. “We're seeing more 50-plus women in Hollywood kicking major ass and looking amazing, whether it's Jennifer Aniston or J.Lo,” says Angelo. More high-profile women are starting to open up about going through menopause—including Michelle Obama and Gwyneth Paltrow. “That gives women hope, it starts a conversation,” Angelo says.
That can help drive change in medicine, says Sholes-Douglas. “I have always been of the mindset that patients can drive whatever outcome they want to see,” she says. “Because once there are enough patients that are expecting their doctors to have conversations with them, it will happen. I think that it starts as a grassroots [campaign].”
The good news is that once women do start opening up about it, menopause isn’t a punch line or a decade spent in living hell. Gennev surveyed 1,500 women in perimenopause and postmenopause and found that the majority of women felt better about life now than they did 10 years ago. “They have more hope, they have more happiness with their bodies, they had more optimism around their career, they had more excitement about their family,” Angelo says. “As we move into menopause, it’s that notion of being more independent and more competent—that's often a totally positive thing.”
For Mathews, the day she got treatment for menopause was the most empowered she’d ever felt. “Throughout my 20s and 30s, I was never thin enough, or I was wanting to have longer hair or I wanted to have longer legs. In menopause I’m comfortable in my skin,” she says. “That was like, wow, I've accepted I'm here now.”
Originally Appeared on Glamour