Traditionally, menopause has been discussed only by women approaching middle age, with few resources for partners and children. Experts say that’s a mistake, because the more openly menopause is talked about, the less stress menopausal people — women, gender-neutral people and transgender men with ovaries may experience symptoms of menopause — will feel as they traverse the physical and emotional changes they’re experiencing. That’s especially important now, with pandemic-associated depression and anxiety potentially exacerbating this difficult part of aging.
After I asked about experiences with menopause in an over-40 women’s Facebook group, Alex Thom, a mom from Toronto, shared her frustrations. She wrote: “These are rough times. We are aging and seeing the effects of that on our bodies — wrinkles, grey hairs, sagging, unexplained weight gain, and a lack of energy. Then we add hormonal changes — remember the teen years when everything felt confusing, awful and scary? Menopause is that, times 100. We question our own feelings, like ‘Am I justifiably upset, or is this just a hormone swing?’ ”
She went on to mention how menopausal symptoms can be compounded by partners who don’t understand, and concerns about jobs, aging parents, or kids whose hormones are also out of control. “How did we get to midlife knowing nothing about what’s next?” she wrote, adding, “And why are we not talking more about all this?”
Research has documented this lack of knowledge about and discussion of menopause, including a 2010 study published in the journal Women’s Health Issues that concluded that there was a gap for women in “information about symptoms and how to cope with/reduce them, how to communicate with providers about their experience, what to expect, and social support.” Ten years later, that gap seems to persist. Why is that, and how can we do better?
What is menopause?
The term “menopause” is commonly used to cover a hormonal process that usually has three phases. “Menopause occurs when a woman has not menstruated for 12 months,” said Dara N. Matseoane-Peterssen, an obstetrician, gynecologist and assistant professor at Columbia University’s Irving Medical Center in New York City. The transition period leading up to that point is called perimenopause and can last several years; symptoms associated with menopause can also occur during that time. Symptoms may be present after the year without periods, too, in the stage called postmenopause. The average age for Americans to reach menopause is 51, but few know that 1 percent of people reach menopause before age 40, according to Zaher Merhi, a gynecologist at New Hope Fertility Center in Manhattan.
When ovaries stop releasing eggs to the uterus, they produce and release less of the hormone estrogen, which is important to cholesterol levels and reproductive, bone and skin health. It can also affect the brain (including moods) and body tissues. Decreasing estrogen levels can result in hot flashes, mood swings, depression, anxiety and irregular periods during perimenopause, and those symptoms can continue into the rest of the menopausal process after periods end. The median number of years women experience vasomotor symptoms — hot flashes and night sweats — is 7 1/2 years, according to a study published in the Journal of the American Medical Association in 2015.
Maura C. Brennan, an obstetrician and gynecologist at Advocate Lutheran General Hospital in Park Ridge, Ill., said lesser-known symptoms of the menopausal process include migraines, insomnia, joint aches, stomach issues, fatigue and mental fogginess. Menopausal people may also experience a variety of symptoms recently collected under the name genitourinary syndrome of menopause, or GSM. These can include vaginal dryness, painful intercourse (due to thinning vaginal walls) and urinary urgency, discomfort or frequent urinary tract infections.
While there are prescription and over-the-counter medicines, treatments — including hormone-replacement therapy — and lifestyle changes to help manage menopausal symptoms, some medicines have risks or side effects, and not all people find relief, which is another reason family support is so important.
Why don't we know more?
How is it possible that even those who will go through it know so little about what to expect from menopause? It’s partly because the condition has been feared or misunderstood throughout the ages. “Society has a long history — from the ancient Egyptians through the Middle Ages and Renaissance — of women being treated as bewitched, or viewed as men if they had an inability to bear children, and being relegated to the periphery of society,” said Soma Mandal, an internal medicine specialist in Berkeley Heights, N.J., and the author of the book “Dear Menopause I Do Not Fear You!” “Society doesn’t look at aging as a good thing. Unfortunately, menopause is a part of that.”
It’s also no secret that previous generations considered the “change of life” strictly women’s territory — along with periods, pregnancy, giving birth and postpartum physical concerns — and some of that mystery around natural gynecological functions continues today.
The subject hasn’t received the attention it deserves. “The reason partners and kids have been left out of the educational loop about menopause is that menopausal people themselves have been left out of the loop,” Leslie Butterfield, a perinatal psychologist in Seattle, said via email. “There is no ‘information loop’ about menopause,” she added. “Despite the (thankfully) increasing information many women receive about the hormonal, physical, and emotional impacts of pregnancy and postpartum, that type of sharing of knowledge and understanding does not generally extend to include menopause.”
Why should we know more?
While most know that hot flashes and the end of menstrual periods signify the menopausal process, there are also associated mental and physical health risks that are critical to determining an overall health plan. About 30 to 66 percent of menopausal people will experience menopausal depression if they have experienced previous depression, postpartum depression, premenstrual syndrome or premenstrual dysphoric disorder before menopause. Ten to 20 percent of perimenopausal people will experience anxiety and/or depression for the first time.
There are also physical concerns associated with menopause, including increased cholesterol levels, a higher risk of heart disease, osteoporosis, a higher risk of stroke, weight gain and even oral issues.
For these reasons, Mandal and Merhi said, knowledgeable and compassionate families are a key component to a smoother menopausal transition. When family members are aware of both the emotional and physical problems associated with menopause, they can help watch for symptoms, encourage menopausal family members to seek treatment and help establish preventive measures, such as changes in diet and exercise, that are easier to stick to as a family.
A 2019 study published in the Journal of the North American Menopause Society concluded that “additional training and/or resources for men (e.g. brochures, websites, materials at doctors’ offices) could greatly benefit both menopausal women and their male partners in coping with menopause. Male partners may offer a unique opportunity to further disseminate information regarding menopause and treatment options for bothersome symptoms and improve midlife women’s health and well-being.”
Uchenna Umeh, a San Antonio pediatrician, said education shouldn’t stop with husbands. “If kids know what’s going on with their parents and have empathy for them, our next generation will understand better when it’s their turn,” she said. “It’s particularly important for boys to learn about menopause so they’re supportive to potential future mates.”
How can families help?
What does such support look like? It’s understanding that a menopausal partner or parent “is going through a life-changing experience in their physical body that also affects emotional health, which may also affect self-esteem,” Tola T’Sarumi, a psychiatrist in Boston, wrote in an email. “You cannot always resolve your partner’s issues, but understanding means you can provide physical and emotional support. The most important thing a partner can do is ensure that communication does not break down.”
Umeh says that both children and partners should understand that menopause can cause people to express negative emotions unpredictably, and that families should try not to take it personally. She suggested partners educate themselves, without expecting the menopausal person to be their only teacher, and recommended parents discuss menopause with children at their maturity level. Relating menopause to puberty and its physical and emotional hormonal challenges can help teens and tweens understand, along with answering questions openly and honestly. Doing so can sometimes bring empathy in unexpected ways, as Nina McCollum of Cleveland found out.
“I’ve been talking about my perimenopausal and menopausal journey with my partner and my son for a couple of years now,” McCollum said. “I have had tons of hot flashes, and they know all about them and understand my need to suddenly turn on a fan. My son will even get a magazine or book and fan me sometimes.”
Given how long this transition can last, attitude and lifestyle shifts are often required from the entire family. Whether it’s doing more around the house to help lower stress or giving a menopausal person time alone for quiet self-reflection, as Mandal suggested, dealing with menopause is less difficult as a team effort.
After three years of communication about menopause with my family, my husband recently stopped complaining when I blasted the air conditioning to soothe my hot flashes and instead simply kept a sweater handy. With communication, knowledge and understanding, I’m learning that menopause doesn’t have to be an exasperating process suffered alone.
Jackie Gillard is a freelance journalist in Toronto with a particular interest in women’s health. You can follow her on Twitter at @JackieLGillard.