Don't fear the hot flash: Menopause isn't a disease — but it is a health issue we need to talk about

There's a glaring void of accurate information and resources aimed at helping American women navigate menopause

By Mary Elizabeth Williams

Senior Writer

Published November 13, 2022 7:30PM (EST)

Woman fanning herself (Getty Images/Jose Miguel Sanchez)
Woman fanning herself (Getty Images/Jose Miguel Sanchez)

My friend Sheila was in tears. She'd texted me a few days earlier to say that her most recent pap smear had revealed some suspicious cells. She'd been experiencing serious pain — especially during sex — and erratic bleeding. Now, she told me that when she'd talked to her doctor on her follow up appointment, he'd shrugged it all off as "normal aging" and hustled her out the door.

I wish I could say that Sheila's story was unusual.

There are roughly 30 million women in America between the ages of 45 and 59. A whole lot of them are facing the biggest health challenges of their lives largely in the dark, stuck in a culture in which aging can be personally and professionally costly and in a medical system that often lacks the resources or curiosity to care for them. Do you want to know why a recent study on "stereotype incongruity perceptions for middle-aged professional women" found that in work interactions, women of a certain age are often perceived as "not fulfilling feminine niceness prescriptions"? It's sexism, sure. But it's probably also because they're all on their last good nerve.

I was thinking of Sheila while reading Dr. Suzanne Gilberg-Lenz's new book, "Menopause Bootcamp: Optimize Your Health, Empower your Self, and Flourish As You Age." The time of life in which menstrual cycles slow down and stop — and the changes that go along with it — are still rarely well-managed, or even acknowledged. How's 58-year-old Kamala Harris doing? Or 52-year-old Melania Trump? Or 53-year-old Jennifer Lopez? Are they having hot flashes in the middle of their meetings? Are they afraid of a breakthrough gush of bleeding in public? Are they not sleeping at night? I don't know, because growing older for many women means figuring out how much to go along with what Gilberg-Lenz calls "the ruse of youth." 

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In her book, Gilberg-Lenz talks about what's actually going on inside the menopausal body and brain, why there are no one-size-fits-all solutions, how to "build your team" of mutual support and information and why she doesn't love the term "perimenopause." 

"Here's my issue with the term," she said during a recent phone conversation. "I feel like it was very important at a certain point because it did validate by naming a set of symptoms that women were having. For instance, instead of getting dismissed, they might hear, 'This is perimenopause.'"

"It's turning something that is not a disease into a disease."

But, she said, "'Peri' just means the time around menopause. Your entire life is pre-menopause."

She added, "I think the term also pathologized it. When really nobody was talking about it, this was a way of reclaiming a real experience and giving some sense of control and agency. Now it's turned into yet another marketing term, and I feel like it's turning something that is not a disease into a disease. That's my concern. I'm not against it per se. But I would like people to be a lot more careful about their language, because they could be inadvertently feeding into something that's not what they want. Do we want to now consider aging in women a disease? Because it's not. This is a state of being alive. Let's just make sure we're discussing it, acknowledging it, and creating opportunities for people to make decisions about how they want to live their most healthy life." 

"We don't say a goddamn thing to women our age."

The confounding thing for many people facing menopause is the glaring void of accurate information and resources.

"We give adolescents whole sex ed courses," said my friend Deborah Copaken, who wrote the scorching memoir of her own health odyssey, "Ladyparts." "We say, 'Here's what's going to happen to your body. You're going to get breasts; you're going to get pubic hair; you're going to have sexy dreams, all that stuff. We don't say a goddamn thing to women our age. What?" 

So what should someone be on alert for? I ask Dr. Gilberg-Lenz what her patients come in concerned about, and she rattled off a lengthy list.

"Menstrual changes, changes in their cycle," she said. "How often they're bleeding, how much they're bleeding, what that feels like. PMS becoming just intolerable. Or they have breast tenderness. The mood stuff — more panic and anxiety, and very quick to lose their temper. Irritability. Difficulties sleeping, maybe falling asleep, or waking up a bunch of times not able to fall back asleep. Gaining weight out of what appears to be nowhere in their midsection. And then sexual complaints — vaginal dryness, sexual pain, libido loss, change in the quality of their orgasms."

Of course, not everyone experiences the same symptoms or the same intensity of them, but it would be nice if we could at least do better at educating each other about them and helping women manage them. 

One resource Dr. Gilberg-Lenz recommends is the North American Menopause Society.

"They're really serious about taking care of people transitioning into entering menopause," she said. "They really do care, they're committed, and they're educated." 

Copaken added, "Go online to your insurance and search for these words: 'menopause, menopause treatment, menopause health.' You're not just looking for a gynecologist, because, by the way, many gynecologists have no idea. You're looking for a gynecologist who specifically specializes in menopausal medicine."

Fortunately, more and more of the walls of silence around menopause are starting to crack. Just this past fall, the skincare brand Boots introduced a "menopause-friendly" line. And more celebrities are starting to come forward about their experiences. "When I was going through menopause myself, I wondered," Salma Hayek told AARP last year, "how come nobody talks about this in the movies?"

Menopause can suck, but nobody should suffer in silence. And this time of life doesn't have to be grim.

"Not to contribute to the 'spiritual bypass' or 'toxic positivity,'" said Dr. Gilberg-Lenz, "but there are so many great things about menopause. There's the growing confidence in our own sensibilities and less reliance on the opinion of others: the 'no f**ks to give fifties' is definitely real. Sex is decoupled from pregnancy! Sure, you may need to work at it, re-discover what sex can be for you alone or with a partner and invest in understanding how to improve sexual health as we age. But it can be a source of satisfaction, creativity, intimacy and vulnerability that can reinvigorate a long-term relationship or motivate a new one."

"Even though a lot of us are in the sandwich generation, caring for kids and aging relatives, just as many of us are liberated from daily family obligations," she added. "Although we need to re-explore and re-invest in what we actually want or what our actual personal preferences are, that in and of itself can be amazingly fun and joyful. You get to focus on you, not everyone else."

And that sounds really liberating. Speaking from her own apparent "no f**ks to give fifties" this week, Jennifer Aniston revealed that she had tried for years to become pregnant, and now "The ship has sailed." Then she added, "I have zero regrets. I actually feel a little relief now because there is no more, 'Can I? Maybe. Maybe. Maybe.' I don't have to think about that anymore."

By Mary Elizabeth Williams

Mary Elizabeth Williams is a senior writer for Salon and author of "A Series of Catastrophes & Miracles."

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Aging Commentary Menopause Women's Health