I wonder... your school-aged children, teens, and 20-somethings - they probably know a bit about heart disease, dementia, and aging. They likely have heard about periods, puberty, sex, and childbirth. I would bet some of them even know about erectile dysfunction. But what do they know about menopause? Menopause is a natural process that happens to 100% of women who live long enough. It has happened to their living grandmothers and to many or most of their mothers (who may be reading this right now). Despite this, they are likely in the dark, perhaps having never even heard the word. What's worse is that it's not only the younger generation that is uninformed, but also the very women experiencing it, the men that support them, their workplaces, their community, and even the medical providers who are supposed to help them navigate this transition.
In recent history, the treatment of menopause and hormone therapy has been fraught with misunderstanding and fear. Back in 2002, media coverage of the Women's Health Initiative (WHI) trial led to widespread panic over HRT, focusing on an increased risk of breast cancer while failing to provide full context or nuance. This resulted in millions of women abruptly stopping their hormones, with little to no alternative support. Prior to the WHI, approximately 38-40% of women in menopause were taking hormone replacement therapy (HRT). As of 2020, a mere 7% of women were managing their symptoms with what is the considered gold standard therapy - MHT. Women stopped taking their hormones, and doctors stopped prescribing them—often without fully evaluating the data, driven by fear of litigation.
It has been over 20 years since that trial, and its impact is still clearly felt today. Once hormone therapy was "out," medical schools stopped teaching it and residencies stopped training with it. Today, most doctors receive little to no training on menopause - and OB/GYN's are no exception. What's more, menopause has profound effects on every part of a woman - the entirety of menopause care must not fall solely on the gynecologist.
Women approach their providers with menopausal symptoms, but when labs and other testing come back as "normal," they are often made to think that their symptoms are largely in their heads. Even when they are recognized as being symptoms of menopause, women are often told that hormones are too dangerous, or they are not good candidates (which I find is often not actually the case,) and are instead offered prescriptions for antidepressants or sleeping pills. (Don't get me wrong - antidepressants can be life-saving for many! But they are often not the best choice in these instances.) This dismissal, rooted in a lack of understanding, leaves women feeling unheard and alone during one of the most significant transitions of their lives.
The importance of educating healthcare providers cannot be overstated, but education needs to start even earlier than medical school. I believe that menopause should be part of the health and biology curriculums in our schools and should be openly spoken about in our culture. This way, women aren't blindsided by the symptoms and body changes when they come. Menopause affects every part of a woman's body—from her cardiovascular health to her bone density, from her mental health to her sexual well-being. The changes that occur during menopause are complex and multifaceted, and women deserve to have doctors, partners, friends, and family members who understand that. This isn't just about hot flashes; it's about maintaining quality of life.
Thankfully, there is hope on the horizon. A growing menopause movement is taking root, one that aims to destigmatize menopause and provide women with the tools and knowledge they need to thrive. From advocacy groups to specialized practitioners, more and more people are working to ensure that menopause is treated not as a shameful secret, but as a natural and important phase of life. Women are reclaiming the narrative, demanding better care, and insisting on being informed participants in their health decisions.
We need to continue to raise our voices and demand change. We need to push for changes in medical education and public school curriculum reform so that all doctors who treat women are well-versed in menopause, and the next generation grows up understanding it. We need to support research that addresses women's health holistically. And most importantly, we need to listen to and validate the experiences of women going through menopause. Only then can we ensure that every woman receives the care, respect, and support she deserves as she moves through this transformative time.
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This article was originally published in Port Washington Living - November 2024 Issue
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