OPINION: Changing the myths, mystery and mortification around menopause

One symptom that has historically been associated with menopause is hot flashes. Treatments have included medications approved by the FDA, unregulated medication and alternative therapies such as acupuncture. (Dreamstime/TNS)

Credit: TNS

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One symptom that has historically been associated with menopause is hot flashes. Treatments have included medications approved by the FDA, unregulated medication and alternative therapies such as acupuncture. (Dreamstime/TNS)

Credit: TNS

Readers, friends and colleagues often give me story ideas or suggestions for topics they want to read about in this column. Recently, I noticed, one topic of interest has been surfacing from each of those circles, at least among the 40-and-up women.

If the interaction is in person, the inquiry usually starts after someone wipes beads of sweat from her forehead while asking in a voice that is at once embarrassed and apologetic … “Are y’all hot?”

It doesn’t take long for someone to then say, “Hey, Nedra, you should really write a column about MENOPAUSE!”

In fairness, it does seem that a lot of people are talking about peri-, post- and plain old menopause, which is defined, by the medical community at least, as the period of hormonal chaos that signals a woman’s shift into her final reproductive years.

The changes usually begin in a woman’s mid-40s, alongside a buffet of symptoms ranging from hot flashes to brain fog. Menopause itself is official only when a woman has bid a final adieu to her menstrual period.

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By 2025, more than 1 billion women around the globe will be postmenopausal, according to the North American Menopause Society, and yet, while most women generally know what menopause is, the modern characterization of this transition as negative or mysterious has left them without a deeper understanding.

In some ways, that seems to be changing as conversation about menopause becomes more normalized. New products, books and communities are cropping up daily providing women with information and support through menopause. Dr. Jen Gunter, author of ”The Menopause Manifesto” (Kensington, $18.95), said in an essay for The New York Times the time has come for a feminist menopause that “rejects the patriarchal notion that a woman’s worth is tied to her ovarian function and that the end of her reproductive life represents the end of her productive life.”

The femtech industry — which refers to software and technology designed to address the health care needs of women — is expected to reach almost $50 billion by 2025 and menopause management has high market potential as indicated by the explosion in startup companies focusing on the area.

It’s hard to miss all the advertisements for products that claim to alleviate symptoms of menopause from the inside out. Supplements claiming to relieve hot flashes, sleep disturbances and mood swings are widely available but have little supporting evidence on their efficacy. Other products take a more general focus, such as skin creams or shampoos, specifically advertised to address the skin and hair concerns of women in perimenopause.

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In the 1960s, estrogen replacement became the dominant regimen for treating menopause, but estrogen is not the wonder drug everyone thought it was, writes Susan Mattern, distinguished research professor of history at the University of Georgia and author of “The Slow Moon Climbs” (Princeton, $19.95), and while hormone replacement therapy may help with hot flashes, studies have revealed that it also comes with elevated risk of stroke, breast cancer, heart disease and more.

Most doctors advise short-term hormone replacement and only for severe symptoms, Mattern said, but when women are hyper-focused on physical symptoms that we attribute to menopause, they could be missing the bigger point.

“Usually it is hard for me to listen to conversations about menopause because most of what people say about it is wrong,” she said. “We think of it as a medical condition and something you need to go to the doctor for. There has been an enormous amount of profit made off of menopause, selling drugs to women who think they are sick.”

Because menopause can impact so many different systems in the body, addressing any concerns requires a multidisciplinary approach, one that doesn’t place outsized importance on menopause as a physical transformation. “I wish doctors would become more educated about what other disciplines are saying about menopause,” said Mattern.

Menopause only became a subject of medical interest in Europe in the 18th century, said Mattern in her book, and our understanding of it rests on that most recent and somewhat faulty foundation. For most of human history, menopause has been seen as a developmental transition to an important stage of life — something we should consider a solution rather than a problem, Mattern writes.

Why would animals outlive a time when they can reproduce copies of themselves? “(Menopause) is something that has been important to the success of our species,” said Mattern. Because women have a long post-reproductive life stage, humans across time have been able to rapidly populate while also controlling population size and managing resources.

So why do so many women seem to be in the dark about the changes to their bodies?

“We don’t talk about it because it is a mortifying subject,” Mattern said. “There is no reason to fear menopause and there is no reason to be embarrassed about it.”

Part of changing the narrative means creating a space for women to talk about menopause in a more revolutionary manner than what has existed in the past.

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About five years ago, Licia Freeman, a marriage and family therapist in Atlanta, created a 12-week menopause therapy group when she began attracting clients that mirrored what was happening in her own life.

“It was not a group to just complain,” Freeman said. “It was about menopause but it merged into more existential topics … what is going on in their lives outside of their bodies.”

The women discuss careers and retirement, relationships, travel and how to manage it all during a perimenopausal and postmenopausal period that they are learning to reframe as a time and space for living life more passionately and freely. Freeman helps the women find skills to manage depression, anxiety and irrational thinking that may be exacerbated by the traditional messaging surrounding menopause.

“There are so many necessary losses in life. We are constantly grieving something,” said Freeman. “The aim is to reach acceptance. (Menopause) is a stage of life with no limitation really.”

Read more on the Real Life blog (www.ajc.com/opinion/real-life-blog/) and find Nedra on Facebook (www.facebook.com/AJCRealLifeColumn) and Twitter (@nrhoneajc) or email her at nedra.rhone@ajc.com