Unpacking the black box of menopause ⬛
Plus five other big takeaways I've learned in my brief foray into 'that stage' of a woman’s life.
Until recently, I associated menopause with two things: hot flashes and the end of periods. I never thought someone still having regular cycles could experience perimenopausal symptoms, which is why even at age 49, I didn’t think it applied to me.
But after struggling with bouts of brain fog and investigating potential causes, I stumbled upon research that showed the opposite: Some women experience perimenopausal symptoms even while they’re still in the late reproductive stage! It’s likely I had been feeling the effects of “the change” without even realizing it.
Since then, I’ve gone down the rabbit hole, immersing myself in menopause books, articles, and podcasts. One valuable resource has been Hit Play Not Pause, an active Facebook group with around 32,000 women navigating this transition together. It’s no replacement for medical advice, but I’m a big believer in the power of sharing our collective experiences. And while I’m still in the early stages of my menopause education, what’s been most clear—and frankly shocking—is how little we still know and understand about this stage of life.
You’d think something every woman on the planet who lives to a certain age experiences would be a little less mysterious. But for much of history, there hasn’t been adequate education or support around this rite of passage. Women have suffered in silence, embarrassed to discuss their symptoms, even with loved ones.
Because it marks the end of a woman’s childbearing years, in patriarchal societies, menopause is often viewed as the end of her perceived value, or the beginning of the end. The brain fog, anxiety, and irritability only reinforce this perception. We aren’t just losing our ability to bear children; we’re losing our minds on top of it! Aside from saying goodbye to periods, menopause is often a dreaded milestone—a symbol of loss rather than an opportunity for growth. This dismal, even oppressive view frames menopause as a problem to be solved, something we wouldn’t dream of ascribing to puberty or pregnancy.
Seriously, this is how far we’ve come
The discovery of hormones, and estrogen in particular, in the late 1920s began “our modern” understanding of menopause. Estrogen replacement was all the rage through the ‘60s and ‘70s, but it wasn’t well studied. Women had largely been left out of clinical research for fear of unwanted risks to pregnancies, leaving massive gaps in our understanding of the female body. The women’s health movement helped change that, and in 1993 the U.S. Congress passed a law requiring the inclusion of women and minorities in clinical research, which began to address this imbalance.
The Women’s Health Initiative—the largest study on menopause—was born out of that movement. But it sparked significant debate and controversy, especially around hormone therapy, that continues to this day. Initially, HT was believed to offer protective benefits against heart disease and other aging-related conditions. However, the WHI halted its study in 2002 when initial results showed an increased risk of breast cancer, heart disease, stroke, and blood clots for women using HT.
Almost overnight, healthcare providers stopped recommending it, and women were told to stop using it. But later analyses of the WHI showed the risks were overblown, especially for women who started HT near the onset of menopause. One analysis of the WHI reported just this year stated that for some women in early menopause, the benefits outweigh the risks.
Women and even many doctors, who already receive limited training on menopause, remain unsure about the safety and effectiveness of HT. With all the confusion, mixed messages, and lag between research findings and widespread adoption of best practices, change has been … slow, but it doesn’t look like it will stay that way.
My biggest menopause takeaways so far …
Menopause is complex, with multiple symptoms.
It’s not just hot flashes and night sweats. Menopause can affect nearly every part of life, with symptoms like mood changes, anxiety, depression, weight gain, joint pain, brain fog, and more. Nina Coslov, founder of Women Living Better, tracked 61 symptoms in a recent survey of women in the late reproductive stage (those still having regular periods) and menopausal transition, and there are probably more that haven’t been discovered!
Bottom line: If you’re experiencing a new symptom in midlife, it might be worth looking into whether it’s associated with menopause.
There’s still little consensus on menopause.
Even basic information, like the average age it begins and how long it lasts, varies. When it comes to HT—how long women should take it, who should take it, and in what combination—there's even less agreement.
Bottom line: Be proactive, check multiple sources, and don’t be afraid to question what you hear—even from experts.
Diet culture preys on menopausal women.
As soon as I started researching menopause, I was bombarded with ads for bioidentical hormone treatments, the majority of which were focused on—you guessed it—weight loss.
Women are vulnerable at any age, but even more so in menopause, as they are faced with changing bodies and a society that no longer sees their value. Diet culture preys on these natural changes to promote products, supplements, or hormone treatments with a focus on weight loss, most of them without research to support their claims.
Bottom line: Don’t let anyone profit off your insecurities. Prioritize health over appearance and be wary of quick fixes.
There is no one-size-fits-all solution to symptoms.
Every woman’s hormones are different, and every woman’s body is different. HRT is not a cure-all for everyone, and there are risks that should be considered.
Bottom line: Weigh the risks and benefits, and make the decision that’s right for you.
Many women still aren’t getting the care they need.
Lack of research and training means many women suffer needlessly. Some are misdiagnosed, outright dismissed, or insufficiently treated. Symptoms can start as early as the late 30s and last for years. If symptoms aren’t typical, women are often misdiagnosed or dismissed.
Bottom line: If you feel ignored or misunderstood by your doctor, don’t settle. Keep searching until you find someone who takes your concerns seriously.
What does this mean for women?
We have to advocate for ourselves. We know our bodies better than anyone else, and when something feels off, it’s up to us to push for answers. Sadly, because of the lack of research, we can often be more informed than our healthcare providers. It’s essential to do your own research, vet the experts you trust with your health, and ensure you're getting the care you deserve.
Now it’s your turn. What was the most surprising thing you discovered about menopause?
The fact that being awake right now could be a perimenopausal symptom. Ha! No but in all seriousness, the fact that only as recent as 1993 was there a law passed to include women and minorities in research. That was the most surprising takeaway for me.
Thank you for this, Kristi. I am one year into official menopause (no period for 12 consecutive months) and am just beginning to experience symptoms that I am learning are from my decreased estrogen levels. I had no idea my frozen shoulder is from a lack of estrogen and it explains why it is much more common in women over 40. I am also learning that despite having an active and healthy sex life and not having any issues with arousal and lubrication, my vagina can still tear from sex! This was beyond distressing and disturbing. And I could not help but think, "WHY DID NO ONE TELL ME THIS??!!" Women have been suffering in silence for eternity. My experience makes me deeply sad to think what my mother and her mother before her may have and probably endured and suffered-without women gynecologists to help them or the internet web of women to guide and inform them. Like you, I am rather dismayed and disappointed at how much we still need to learn about this stage of life. I am a researcher at heart though and am digging and diving into what is out there. Please keep sharing and writing on this topic.