Is It Becoming Less Taboo to Talk About Menopause?

Each day, an estimated 6,000 women reach menopause. The bevvy of symptoms — some of which can continue for 15 years or more — might, under any other circumstances, send them running to their physicians for help. These symptoms include hot flashes, mood swings, sleep disturbances, heart palpitations, vaginal changes and sexual dysfunction.

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Yet, why are women so hesitant to seek treatment for their menopause symptoms, which many admit to causing a major disruption in their physical and emotional lives? Many of the women who seek treatment remain dissatisfied and left feeling that they’ve not received adequate or quality care or education, according to the 2018 AARP magazine article, "What Doctors Don't Know About Menopause." Women are white-knuckling through a very tempestuous and confusing time, hungry for information and social support.

But we're beginning to see and hear more about menopause in the mainstream media, and several online businesses are trying to fill the the void of information and care to help women get through this profound life transition.

The true definition of menopause is the “ceasing of menstruation,” when a woman has been without a period for 12 consecutive months.

This definition might be accurate, and many women may be joyous at not dealing with their monthly flow. But the more nuanced connotations of menopause, which include aging and the loss of fertility, are anything but comforting in our youth-obsessed society.

While the beginning of menstruation is celebrated as a rite of passage and the arrival of a girl’s womanhood and fertility, menopause is mourned as a loss of youth — a shrinking not only of one’s ovaries, but of one’s self.

More of these negative feelings about menopause can be traced back to 2002, after the results of the hormone replacement therapy (HRT) study by National Institutes of Health’s Women’s Health Initiative were made public.

Once considered the gold standard of treatment for menopause symptoms, the Women’s Health Initiative linked HRT to a (later unfounded) increased risk of breast cancer, heart disease and stroke. Women panicked and abandoned their treatment, fearing for their health.

Later, the Women’s Health Initiative study was found to be flawed and much of its findings were discounted. HRT is now believed to be safe for women who are within 10 years of menopause or are younger than 60.

The position of The North American Menopause Society is that "hormone therapy remains the most effective treatment for vasomotor symptoms (hot flashes, night sweats) and the genitourinary syndrome (vaginal and sexual symptoms) of menopause and has been shown to prevent bone loss and fracture."

But the consequences of the Women’s Health Initiative study were profound, says Dr. Mary Jane Minkin, clinical professor in the Department of Obstetrics, Gynecology and Reproductive Services at Yale University School of Medicine. “Not only did women stop using hormone replacement therapy, but OB/GYN residency programs stopped teaching menopause education.”

By 2011, Minkin says, only 20% of the OB/GYN residencies in the U.S. and Canada had formal menopause education.

“We still had to teach residents to deliver babies, do hysterectomies, D and C’s (dilation and curettage), tubal ligations and contraception,” Minkin explains. So, it became convenient to “throw menopause education under the bus. Why waste time teaching menopause if women won’t use hormone therapy anyway?”

Today, much of the burden in managing menopause falls on the shoulders of the women going through it.

But there’s much evidence that women are pushing back.

JWT Intelligence, in its latest trend report, “Elastic Generation: The Female Edit,” finds that this once-invisible demographic is “now refusing to go quietly,” and is now out there “embracing change, celebrating life and flying in the face of stereotypes.”

This includes upending the taboo of menopause and bringing it out of the dark. Partly responsible are TV shows and celebrities, many of whom give a voice to once-shunned topics like mental health, childhood vaccines, breast cancer and now, menopause. For example:

• Gwyneth Paltrow publicly announced her trials with perimenopause (the transition to menopause which can last anywhere from four to eight years) and followed that up with a line of products.
• Actress Pamela Anderson admitted to feeling emotional and suffering from hot flashes and mood swings during perimenopause.
• A storyline in the Netflix show Grace and Frankie features a line of sex toys specifically tailored for the post-menopausal woman.

Menopause is even making it into art exhibits: One, created by an Indiana University School of Nursing expert, educates its viewers on the effects of hot flashes. Titled “Hot Flashes? Cool!” its aim, through art, music and film, is to educate the public, dispel myths and open a dialogue around menopausal hot flashes.

Gynecologist Dr. Lauren Streicher saw this unmet need for menopause care when she proposed opening a center dedicated to sexual medicine and menopause. In the new center, where she serves as director, “Everything is one-stop shopping,” she says. This Center for Sexual Medicine and Menopause at Northwestern Memorial Hospital in Chicago serves the comprehensive needs of women with a team of experts, including gynecologists, dermatologists, urologists, pelvic floor physical therapists and sex therapists.

“The majority of women in this age group don’t know who to turn to,” Streicher says. “Many don’t even see their own gynecologists anymore, unless there’s a problem. We pay attention to all the issues specifically secondary to the loss of estrogen that go way beyond just hot flashes.”

Perhaps educators in the U.S. will take a lesson from the U.K., where the government has recognized the far-reaching effects of menopause and decided to add menopause education to the sex education curriculum next year. “It is hoped the lessons will help pupils support their mothers, sisters and partners later in life,” according to an article in the Daily Mail. After all, with the average age of menopause at 51 and greater life expectancy, it’s estimated women will live one-third of their lives after menopause.

In their quest to make health care more accessible for menopausal women, online companies like Amwell, Genneve and Rory are cropping up, hoping to provide the vastly underserved population of women with medical attention, education and products they need to make the menopausal transition easier.

These websites offer online doctor visits, over-the-counter products and prescription treatment plans. Procter & Gamble has created the website Pepper & Wits, which offers information and products to deal with issues related to menopause (like vaginal dryness and insomnia). And a former Procter & Gamble executive has launched Better Not Younger, a company for women dealing with hair issues (like thinning and dryness) that frequently strike at midlife.

Minkin, in addition to treating patients and teaching menopause education to soon-to-be doctors, has a women’s health website and blog: MadameOvary.com. “Minkin laments that medical students typically “get a one one-hour lecture on menopause; maybe two!” That’s why she launched the blog.

“I knew that at least there, women could start a menopause education,” she says.

Minkin is also the online menopause adviser for other websites like WebMD and RedHot Mamas.

“As I tell my medical students: Being a menopause doc will never make you rich,” Minkin says. But the care she gives, and the opportunity to change and improve the lives of women and their families is priceless, she says.