Menopause Needs A New Narrative – Sponsor Content

As a primary care physician specializing in women’s health and the chief medical officer of a first-of-its-kind menopause care platform, even Dr. Nora Lansen admits her personal experience has felt both surprising and full of contrasts.

“I mean, I had night sweats starting five years ago, but I didn’t even think about it until much more recently,” she recalls. “It feels like something that should happen when you’re feeling old and tired and at the end of life. Not when you’re vibrant and functioning in a million different directions, and when also you’ve got a lot of demands—like taking care of family, maybe taking care of aging parents, a relationship. We’ve got a lot going on. But the menopause transition is also a big part of our lives. It’s not just a transition from being able to have babies to not being able to have babies. This is our life for quite some time.”

For some women experiencing menopause, it may feel like they’re living in a world of contrasts: Conversations about symptoms among friends may feel comforting, but those same symptoms may still feel difficult to bring up with a physician, potentially resulting in a lack of actionable information. While women between the ages of 45 and 54 make up about 20 percent of the female workforce in 2020,¹ there is still a growing need for more specialized menopause-related benefits in the workforce due to the impact of menopausal symptoms on women.²

Many women may be experiencing symptoms in the middle of very full, demanding lives, both personally and professionally. They may be experiencing menopause as they’re juggling the expectations of building careers, tending to family, and being actively involved in their communities. That may make it particularly challenging to handle the symptoms of menopause, especially without a robust understanding of what symptoms might emerge or when. “Even if you think you know what to expect, the symptoms of the menopause transition can sometimes feel frustrating,” Lansen says.

While the momentum around raising menopause awareness is heartening to see, there are gaps in knowledge and understanding of menopausal symptoms that may lead to challenges for those seeking help and relief. As is often the case, misinformation breeds misconceptions, which in turn perpetuate stigma—particularly about menopause symptoms like hot flashes as well as more unexpected issues like mood changes, fluctuating weight, and declining libido. We need to shift the narrative by tracing how we got here and chart out a better path forward.

Menopause, marked by the permanent cessation of menstrual periods for 12 months,³ most commonly occurs in women between their mid-40s and mid-50s. However, symptoms can start before onset of menopause and could last between 7 and 10 years.⁴ Women are expected to spend one third of their lives in menopause and postmenopause, assuming an 80-year average lifespan.⁵ Not all women have symptoms, but the majority do: Around 85 percent of women report experiencing at least one menopausal symptom by the time they reach menopause,⁶ which is quite a lot—considering that approximately 2 million women in the U.S. enter menopause each year.⁷ Why, then, does so much misunderstanding about the menopause experience persist?

Looking through a historic lens, one of the many reasons for this misunderstanding could be a lack of research. The word “menopause” was first coined by a French physician in 1821, and the role of the hormone estrogen, a decrease of which causes many of the symptoms associated with menopause, was first described in guinea pigs in 1917. Yet, for approximately 70 years after that, researchers didn’t invest much time or money into the investigation of female aging — that is until the ’90s. That’s when the United States began a project called the Women’s Health Initiative (WHI), which conducted studies on postmenopausal women.⁸ In 2020, the United States National Institutes of Health spent 11 percent of its funding on women’s health-specific research, such as gynecologic cancers and endometriosis.⁹ Though there is progress, there is still more that could be done, especially as greater advances in research related to women’s health care could be an opportunity to work towards closing the women’s health gap.¹⁰

Now, momentum is growing for more women’s health research, with a recent statement from the White House calling on Congress to create a transformative investment of $12 billion to create a Fund for Women’s Health Research at the National Institutes of Health. In the past, without knowledge and awareness about what was happening to their bodies, women in previous generations sometimes suffered in silence. Menopause was often discussed with negative euphemisms and quietly spoken about, sometimes perpetuating stigma. Even today, there is still persistent minimization of symptoms: In a 2022 published study conducted by Harper et. al, more than 60 percent of respondents, who were women aged 40 and older, reported that they didn’t feel informed about menopause before the age of 40.¹¹

“There are so many assumptions about the female experience after they go through menopause,” says Dr. Yesmean Wahdan, vice president of medical affairs at Bayer Women’s Healthcare. “She’s gone out to pasture, if you will. But that’s an outrageous—and insulting—myth. We should be thinking about menopause as a new journey that a woman’s going to go through, and we should provide information and resources to support her through it.”

As discussed earlier, menopause has been sometimes minimized or oversimplified in cultural references as an inconvenience for some women. While the oversimplification alone is a result of both historical and ongoing dismissal of women’s pain and health challenges, even the most straightforward symptoms of menopause can compromise a woman’s quality of life. Today, as some women start their families later¹² and continue working as they raise them, some rising into leadership roles, the journey of menopause may begin while women are at the height of their personal lives and careers—making it challenging to manage menopausal symptoms without having a negative impact on their life or work.¹³ For example, imagine having to navigate a high-pressure board meeting or a stressful parent-teacher conference when a wave of heat consumes you—excessive perspiration begins, potentially leaving you embarrassed and distracted. It’s a reality that some women experience.

Of course, sweating as a result of hot flashes is not the only symptom a woman may experience. Research shows that menopause can affect many parts of the body, potentially everything from bones to the heart to the brain,¹⁴ and the experience can be quite nuanced. Women may experience a range of other physical and emotional changes, sleep disturbances, mood changes, musculoskeletal pain, pain during sex, depression, anxiety, cognitive issues such as forgetfulness and impaired recall, and even changes in skin and hair.¹⁵

According to recent studies, almost two-thirds of women reported impacted work performance associated with some menopausal symptoms,¹⁶ 23 percent have considered quitting, and 10 percent were actively planning to quit.¹⁷ This research shows that menopausal symptoms can adversely affect work performance and reduce work satisfaction. For example, one recent study from the Mayo Clinic estimated that menopause symptoms led to $1.8 billion annually in lost working time.¹⁸

“We have to care for women, not just through the stages of their life where they’re childbearing, but through all stages of life, because it will contribute to a healthier society,” says Wahdan. And when women share their own experiences, it helps others overcome biases.¹⁹

As Candace Montgomery, executive vice president of AtlanticLIVE at The Atlantic, recently said at a roundtable event in San Francisco that she co-hosted with Bayer, which sponsored the event: “Whether it’s on social media or through events like these, as we continue to de-stigmatize menopause through open dialogue and discourse about what’s happening, more women and their families will gain access to tools that they can share with each other. High visibility makes it a safer space for us to be able to go through what we’re going through.”

With less stigma, and more visibility, women may increasingly feel more empowered to seek guidance and relief from health-care providers. Importantly, even if a new symptom arises that may not seem directly connected to menopause, it is worth asking a physician about the possible correlations.

Dr. Mindy Goldman, an ob-gyn at UCSF and chief clinical officer at a virtual care clinic focused on women navigating menopause and perimenopause, agrees and encourages women to be proactive about their health. “Women should be encouraged to bring up any symptoms with their doctor and ask if they think it could be related to hormonal disruption,” she says. “I think those conversations still aren’t happening often enough.”

One of the most common missteps made around menopause is that all women have a universal experience, marked by the same symptoms.²⁰ In reality, the experience of menopause can vary from person to person, depending on a range of factors. For example, Black women often have more frequent rates of early menopause than white women.²¹ They also report certain more bothersome symptoms, such as more intense hot flashes and other certain symptoms.²²

“There are stark disparities in how menopause symptoms are experienced and treated in Black women,” says Linda Goler Blount, M.P.H., president of the Black Women’s Health Imperative. “Symptoms like vaginal dryness, changes in libido, or anxiety also can be tough to discuss with a doctor, leading them to suffer in silence rather than seeking the help they need.”

Women’s comfort in talking about sensitive symptoms may depend on a range of cultural, religious, and community factors. In fact, some research shows that whether menopause is considered a medical problem or a natural process differs by self-identified race, culture, and ethnicity, as does the likelihood of consulting a doctor about symptoms.²³ But for women of color, racial biases can be particularly detrimental—for example, research has shown more negative descriptors of Black patients in electronic health records, noting that they are resistant or noncompliant. And Black women’s menopausal symptoms are often dismissed in clinical situations.²⁴

“Validation is critical to getting care,” says Lansen. “So first and foremost, find someone who understands and validates your concerns.”

As the dialogue around menopause continues to evolve and expand, experts emphasize the importance of women seeking out knowledgeable health-care providers who really listen and validate a patient’s menopausal symptoms. There are also online resources available for help. For example, The Menopause Society offers a range of educational materials and a database of providers who are certified in menopause care.²⁵

Looking to the future, advocates for menopause care hope to see increased funding for research, greater inclusion of diverse populations in longitudinal studies and clinical trials, and additional training in residency programs for health-care providers. By increasing access to valuable knowledge through education and offering more support to women, menopause care advocates like Lansen, Wahdan, Goldman, Goler Blount, and many others are hoping to transform menopause from a time that could be shrouded in mystery and confusion to a time of confidence and growth.

The good news? Momentum is building and will continue to do so as women themselves contribute to the conversation, share personal experiences, and advocate for themselves. Along with a recent wave of best-selling books, wellness startups, television shows, and social media influencers all focusing on menopause, ongoing peer-to-peer support and community-building will help make a positive difference.

Staying open to the breadth and depth of menopause experiences is important. We can try to challenge biases or misperceptions, and consider how this stage of life may be affecting ourselves or other people in our lives.

“Menopause can be another time for self-discovery,” says Goler Blount. “It’s an opportunity to invest in your health with the support of informed, culturally competent care. Do not be afraid to ask questions, and when you are not satisfied with the answers, ask again.”

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