"I never had a conversation about it": Why can't our culture talk about menopause?

Journalist Jancee Dunn thought maybe it was her heart. She thought maybe she was pregnant. She thought, "I guess I'm just sweaty now." There she was, right on time and experiencing a variety of perfectly common indicators of a normal biological process, and yet, she says, "I was so clueless about symptoms of menopause. And I'm a health writer." 

That Dunn should have been so perplexed isn't so perplexing. Menopause, after all, is a double whammy of taboo topics: female aging and female fertility. To acknowledge either, let alone both, seems like an admission of defeat — even among the people we trust the most. "I had never had a conversation with my mother about menopause," Dunn says. "Never. I hadn't talked about it with some of my friends."

Fortunately, that silence is beginning to be broken. A new generation of celebrities and public figures have in the past few years started opening up about their own perimenopause and menopause experiences — while a host of savvy marketers have discovered a previously untapped consumer niche. But all that conversation doesn't necessarily provide any practical answers. And that's where Dunn comes back in with her trademark humor and common sense, and her new book "Hot and Bothered: What No One Tells You About Menopause." It's a guide that anyone who gets periods should read, a detailed and demystifying exploration of what happens as the childbearing years wind down and what experts say can make the transition time easier. It's also a frank and personal account of her own journey through menopause and a beacon of encouragement of what's on the other side. What it is not, however, is any kind of gentle nudge in the direction of the nearest ice floe. "I'm not saying it's so great to embrace your invisibility," Dunn said during a recent phone conversation about aging out loud and getting "Hot and Bothered." "It's not that at all," she says. "I'm fighting to be visible still."

This conversation has been edited and condensed for clarity.

Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter The Vulgar Scientist.

Menopause is so hot now. For most of our lives, it was this big dark secret. What's changed that now we're willing to talk about this thing that has been going on since the dawn of history, and that half of the human population experiences? 

It's a couple of things. I have to give Gwyneth Paltrow credit for talking about perimenopause and menopause a long time ago. I know these celebrities often have things that they're selling, but it still opens up the dialogue. Like it or not, it does, and it gives people permission to talk about it. 

Another thing is that marketers have woken up to the fact that this sector of the population has tons of symptoms, no solutions and lots of money. The reality is that marketers smell money and so they're starting to invest in these companies. From a consumer standpoint, I find it really interesting that menopause products now are kind of pitched as luxury products. This is new to me, because back in the day, there would be some round supplement bottle with like, a sunset on it.

The fact that now they're display-worthy, that's noteworthy. So money is driving some of it. I really loved that there was a movement to be more open about menstruation. Some of it is filtering down from the younger generations. We can really take a lesson from them and how open they are about so many different things,

And then at a grassroots level, women are starting to talk about it more. I really do hope that will drive it further out of the shadows. Even when I was writing this book, I had never had a conversation with my mother about menopause. Never. I hadn't talked about it with some of my friends who were obviously going through it, and we talk about everything. You and your friends, you talk about the most granular subjects, parents dying and chin hairs, all kinds of things. Yet we didn't talk about symptoms. It's even shocking to me because when I started shopping around the book, I thought, is this going to fly? 

How I pitched the book was that I went to my library. I noticed that there were shelves and shelves of pregnancy books. Then I thought, Okay, where's the menopause books? My library is a nice library. There are tons of books. There was one menopause book, one. Jen Gunter has a great book, but there was just nothing else. That's how I was able to pitch it — look at this hole in the market, and it's half the population. It's just heartening to see that even since the time that I shopped around the book, things have moved forward in the way that they have.

There are consequences for women of getting older in a way that is more visible. You tie that to how you look, the weight you gain, the way your hair changes. For a lot of professions, being young is synonymous with being successful and being relevant and having a voice and interesting opinions. What do we do about that? 

Yes, the fear is real. I cited a study in the book that happened over COVID, where women went gray. Then they felt like they had to counteract the gray hair just to reassure all their co-workers and get a bold lip going or interesting jewelry or vibrant colors just to telegraph to everyone, "Okay, I have gray hair, but don't worry, I'm not going to slump forward during a meeting. I'm actually still vibrant."

I certainly don't want to blithely tell everyone, "Be sure to come clean about your symptoms in the workplace," We have to work with the system, and it's biased against older women at this point, even though they make up a significant part of the workforce. It's a thorny question. I wish we were like the UK. Not that they're perfect, but at least they're aware of menopausal women's symptoms and put systems in place to support them. 

We have no systems in place to support us, and the onus is on women. I wish I could give you a different answer, but it's just, in ways that you feel safe, talk about it. You can form an ERG (employee research group) with people, but even that can be a little dicey. Start at the social level with people that you know, and start that movement of transparency as much as you can, where you feel safe, with whom you feel safe, and go from there. I've been in offices where I'm the only one who's having hot flashes. I remember I was in one office where another woman was going through it, and she didn't want to acknowledge it or talk about it. I get that too. Not everybody wants to be transparent about it yet. 

There are also issues of privacy. I don't necessarily want to tell everybody what's going on inside my body, particularly around my reproductive health. How do we normalize these processes in a way that is also respectful of our boundaries? 

I kept thinking of legal leverage. I can think about lactation and pregnancy issues and how it's made some employers scared to go against that or to not support that. How do we transfer that, to make them a little uneasy about not supporting us? I was digging into the research about if we have any legal legs in that area. I couldn't find any.

You talk in the book about how very often when you're Googling around menopause, everything is symptom-based and problem-based. Because there are symptoms and problems. So let's start with them. 

Allegedly, there are 34 symptoms. Some experts told me there were even more, and some of them are just kooky. But every expert that I talked to, and I talked to so many, all said, "Be sure and tell people that some women sail through menopause with nary a symptom. It is not always a given that you get symptoms." 

That's one semi-heartening message. Not everyone gets the symptoms. But if you don't know what the symptoms are, you cannot connect the dots. I see now that I'm through it, what would have helped tremendously is knowing what the symptoms were so that I could connect the dots or that my doctor could, but more likely I would. If you don't know, the surprise and shock really adds to the unpleasantness of the whole process. I wish I'd known. And I'm a health writer. 

The symptoms, the problems, often take people by surprise.

There's been research about this too, that women go to all these different specialists, I did. I saw a cardiologist because my heart was racing — one of the symptoms. So you waste time, you waste money on your co-pays if you're insured, and you're also uneasy because you can interpret these symptoms for something scarier. Brain fog, Alzheimer's. Heart racing, am I having heart attack? 

It's two problems. One is that if you're not aware of the symptoms, you can't connect the dots. The other is that in midlife, it can just be life stuff. You're tired? Who isn't? Perimenopause occurs most often in your forties. That's when so many people are raising kids, they have a job, they're dealing their elderly parents. They're tired anyway. Also, if you don't know the symptoms, you can rationalize them so many different ways.

When I started having night sweats, I was like, "I guess I'm just sweaty now." It never even occurred to me. When estrogen leaves your body it's often this really chaotic process. When I started reading about it, I thought it was a smooth transition. But no, it's all over the place. Your periods can be the Mighty Mississippi one month, and a trickle the next. I didn't get my period for a couple of months. Because I was so clueless about symptoms of menopause, I thought, "I'm pregnant." I was 45. I had my other kid at almost 43 so it wasn't out of the realm of possibility. Just being aware of the symptoms is such a good first step. Then you can go from there. 

My message is also, once you're through this, that most of them go away. It's not for life. Some people do have hot flashes until they're 80, but they are a rarity. Also, there are treatments for so much of this stuff. Topical estrogen — who knew it could make you stop peeing and sex could stop hurting? There are things that you can do so you're not trapped.

With all the woo-woo treatments and alternative remedies out there, you also don't have to go full Goop either. 

Some of that stuff is a big old waste of money. A doctor can help you. Menopause specialists can help you. If you go to the North American Menopause Society, they'll find people who are qualified to treat you and they will be in charge of your menopause care. You go one or two times to them, not forever, and then they refer you back to your doctor, and they can help you quickly pull together all the treatments that you need. I'm not being rah-rah about it. Sometimes, it's hellish for women, but there are treatments available. Unfortunately, you're going to be have to be the one to find them and to manage them.

Talk to me a little bit about the role of the fact that your body is going to change, which is still a very hard pill to swallow. How do we reckon with that in a way where we're aware of what's going on, rather than just trying to clench and fight those changes? 

It has to be about assessing the next stage in your life with your eyes open and accepting the reality that your body is going to change. There's no way around it. Yes, Jennifer Lopez was able to pole dance at the Super Bowl Halftime Show, and she looked amazing and she was 50. But most of us mortals, things are going to change. You gain weight around your middle, statistically about five to seven pounds, and your pants don't fit. I finally just donated a bunch of my pants — I just accepted the fact, as painful as it is, that my body has changed in shape.

Yes, the things that do hurt are your strength. It's not what it was. Your flexibility, you really have to work to maintain those things. Some of it is just depressing. I wish it were different. But I really do frame this as an opportunity, when you've been taking care of so many people and maybe neglected taking care of yourself, because there's just no time, to figure out what you can do to make this next stage in your life as healthy as it can be so that you're as strong mentally and physically as possible. 

Maybe start walking more, nothing crazy. Just lifestyle changes so that you feel like yourself. What was important for me is, how do I recognize myself? How do I recognize myself as it is now, because your body will change. Accept it, deal with it. It will change. Whatever makes you feel like yourself is okay with me, not that you need my endorsement. I just mean, it looks different for everybody. It's a strategic path that you have to take about, what is making me feel like myself?

For me, in terms of my body, it was about balance and flexibility and strength. Now I walk like a maniac every day. I do light weight sometimes because weight-bearing exercise helps your bones and your bones start to thin at this age. Prioritize what will make you feel good psychologically during this process and throw your energy into it. Its a good thing to know about your medical history as well as, what happened to the females in your family? What happened to their bones? When did they go through menopause? This is all so helpful to know and it can dictate your own care. 

I really appreciate it in the book that you were not going to talk about becoming the "wise, sage woman" like it's some kind of booby prize. But you do talk about the fact that there is something on the other side of this. There are things that are kind of great about the freedom of moving into this other point in your life. 

There's something that even rebirths you. I cannot stand the word "wise." Do we all automatically get wisdom? I think not. Experience, yes. You can't help having lived. But "wisdom" just feels so condescending somehow. Just because you're old doesn't mean you're wise.

I want to be fully, fully upfront about everything. And I am here to say that once you get through it, it's really kind of amazing. It's like that speech and "Fleabag," where she says it's glorious. You really are free of a lot of annoying processes of your body. And you almost return to pre-menstruation levels, where you're just kind of a weirdo. And you don't know not to be a weirdo, you don't have societal pressure not to be weird. I hope this doesn't sound like the wisdom trope, but you really don't care what people think, which is enormously freeing. 

I'm not saying it's so great to embrace your invisibility. It's not that at all, I'm fighting to be visible still, I'm doing it as I'm talking to you. But it's definitely a period of freedom where you can concentrate on yourself a little bit more like, "Okay, what do I want to do next? What can I do to maintain my sanity and my strength, mentally and physically?" It really can be an exciting time, and no one believes me until they're through it. 

And most of the symptoms go away. They really do. Brain fog goes away, statistically. You're mentally sharp again, which to me was the biggest fear of all — that my marbles were going to roll away and never roll back. They did. So now that I have a plan in place, I feel somewhat like myself, only a little bit more free. And that doesn't seem so bad, does it?