I was shocked to learn that the average life expectancy for a woman in the U.S. was under 50 until 1900. (It’s important to note that it was 33 for non-white women, which meant primarily Black at that time, and 47.8 for white*.) That means that until a little over a hundred years ago, most women didn’t live long enough to go through menopause at all. Living a life after menopause is essentially a modern phenomenon.
Today the average woman can expect to live an entire third of her life post-menopause.
And yet, there are almost no reliable maps for negotiating this stage of life.
Though at 54 I’m an outlier and haven’t yet crossed over into full menopause, for nearly 20 years the bulk of my client base has been women from peri-through-post menopausal age.
Over the decades I’ve been witness to the broad range of reactions to dealing with menopause – from delight through desperation. But in the last year or so since I rebranded and restarted my business, what I’ve been hearing overwhelmingly are questions.
“Why, when I haven’t changed my habits, do so many things feel like they’re changing – fast?”
“Why have aliens suddenly invaded my body and what exactly is their mission?”
“Why on earth isn’t anybody talking about this stuff…?”
Something is not quite right and the x-gen-ers are asking why.
Menopause is, of course, a completely natural human transition and the lucky woman with good health and a balanced endocrine system will pass through the stages with mild, manageable symptoms and step regally into her middle age.
But for women who have struggled with trauma issues, weight issues, emotional issues, auto-immune issues, metabolic issues, PMS, thyroid stuff, environmental or food-based endocrine disruptors – and the list goes on – menopause has become a big hairy bear of a problem, sometimes starting in its earliest stage of pre-menopause – which for some women can kick off in their late 30’s!
Some of the most challenging “lifestyle health” issues that contemporary women have struggled with for most of their adult life are getting hijacked by the “normal” changes of menopause and generating symptoms that can deeply sabotage the quality of daily life – sometimes for many years.
And this whole problem is complicated by the fact that most women don’t talk much about menopause at all. The general consensus has been that it’s something you just have to endure and eventually the worst of it will “go away”.
Or you’ll get used to not sleeping at night…
Despite the fact that female hormones are essentially communal in nature – the menstrual cycles of women who work or live together will often synchronize over time, especially if they have close relationships, and pregnant women naturally seek out the company of other pregnant women – this charged hormonal time is often experienced in isolation, “behind closed doors”.
But if you look at today’s media culture, it’s not hard to understand why that is.
In our society menopause is like a signpost for the start of the “age of invisibility” for women.
Would you advertise that you’re about to become insignificant…?
Especially when, for many of us, our experience is the opposite – when we’re living longer, when we feel more engaged and might be living better lives than ever before.
We’ve got this perfect storm brewing where many of us are starting to feel and live our true power and potential, but we’re weighed down by inordinately high levels of pressure and stress – both at work and at home, and we were already struggling with health issues without good solutions – when suddenly our hormones start surging and crashing -!
Male bodies age hormonally and chronologically at roughly the same pace. But hormonally, female bodies age radically over just a few years while chronologically at about the same rate as male bodies.
And many of us are penalized socially for that by largely being ignored after The Change.
As a result, many women go into denial about the early symptoms of menopause. Some ignore it and hope it will go away. Others attack it as if it were something to be defeated – with intense dieting or punishing exercise.
But that backfires big-time. No popularized “healthy eating” fads take a woman’s changing hormones into account. And nearly all fitness research is done by – and based on – 30 year old white men. So if you try to go that route you’ll end up increasing your stress load and using hormone-blind programs to “fix” hormonal issues. Not surprising if the problems get worse.
And never mind getting help from your doctor.
According to a terrific AARP article, “’three out of four women who seek help for menopause symptoms don’t receive it”.
There are a number of reasons for this – a deep gender bias in medical research and training, a deep racial bias in medical access and quality of care, the sheer complexity and individuality of each women’s menopause process, the fact that almost half of all women in some stage of menopause don’t even bring up their symptoms with their doctors, and the fact that almost 80% of medical residents “admit that they feel ‘barely comfortable’ discussing or treating menopause”.
I’ve also got a personal theory about why we’re experiencing such a dearth of support right now – at a time when many seem to be stepping into their personal power in so many other ways.
In 1991 the largest ever women’s preventive health study, the Women’s Health Initiative (WHI), was launched by the National Institutes of Health to study, among other things, the effects of Hormone Replacement Therapy on menopausal women. In an unprecedented move, the study was halted 3 years early in 2002 after the initial results came through.
There’s some confusion about the media storm that surrounded the release of the early findings, but at the time sensational stats were released that the women taking a combination of Premarin (estrogen made from PREgnant-MAre’s-urINe) and progestin (synthetic progesterone) for menopause symptoms suffered a significant increase in the incidence of breast cancer, heart disease, stroke, blood clots and urinary incontinence.
As a result, tens of thousands of women were immediately pulled off the hormones. Some suffered the side effects of the HRT, and others experienced the side effects of total withdrawal. It was basically a disaster.
The release of the information was somewhat skewed by the participating doctors and sensationalized by the media with the end result that it was popularly and medically deemed that all HRT was “dangerous” – and the baby got thrown out with the bathwater.
My theory is that this terrible mess shot HRT research right out of the sky for a while. Can you imagine trying to get funding for a menopause study in 2003….??
I think large-scale and high-level research simply ground to a temporary halt and as a result we’ve been experiencing a unique kind of information “gap” for the past decade and a half.
As the dust settled and the results were sifted through and released more objectively, it became clear that the average age of the women in the study was well past menopause onset – 63, in fact. We’ve since learned that HRT can be protective for some significant health issues for younger women – in smaller doses over shorter periods. We’ve also seen improvements in hormone quality – bio-identical vs synthetic, and method of administration – skin patches or subcutaneous pellets that bypass the digestive system seem to cause less blood clotting, for example.
But in the decade plus after 2002, women shunned HRT in droves. The current generation of women watched our mothers struggle through that time – getting sick from HRT later, or getting sick at the time from radical withdrawal. Horror stories abounded and we were listening.
At the same time many women were also leaning more and more heavily into the workforce, some adopting the role of “supermom”, and some caring for aging parents. For women suffering from the effects trauma or PTSD, aging increased the cumulative physiological toll.
Our cortisol levels soared.
Progesterone is one of the first hormones to start to diminish in peri-menopause, and guess what? It’s a precursor for cortisol.
Is it possible we’re “sucking up” our dwindling progesterone in cortisol production to keep pace with the out-of-balance demands of our lives?
Could this be part of the rise of estrogen dominance symptoms – at an age when we’d expect to see estrogen levels decreasing?
One further complicating factor in the menopause sh*tstorm in which we find ourselves is racial disparities. While race has no real genetic significance, it turns out there are some pretty significant differences in commonly reported peri- and menopause symptoms. For example – the most frequently reported symptom among African-American women is difficulty sleeping. Among Asian-American women it’s vision changes. Among Hispanic women, it’s allergy symptoms. Among white women, it’s feeling hot or cold. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670463/
As there are already terrible race-based inequities in our healthcare system, this does not bode well for intersectional improvements in menopause health care.
But I don’t want to just up your cortisol levels with an article like this. The call for more help and better support is going out and being heard. As more and more women learn about these problems, as more of us speak out about the inequities in the healthcare system and choose to speak more openly about our own experiences, as stand-out women doctors and neurologists and other pioneers of “menopause medicine” advocate for more broad-reaching approaches to education and support – our knowledge base and resources grow.
Yes, we are in a gap right now, but we’re also revolutionizing the way women’s health at mid-life and beyond is being viewed and managed. In many ways, we’re finding our way as we go. My hope is that the fight for women’s equity – for the safety and care of ALL women’s bodies, not just those of straight white cis women – will have a penetrating impact on the medical world. Pretty much every aging body with ovaries is the subject of a global experiment right now. Whether we choose to try some form of HRT or avoid that and use diet and complementary care practices like meditation and rest-based HIIT, we’re finding our way and laying down our own trail markers for our circles.
Let’s keep talking.
Let’s make a new map.
It’s time for a revolution.
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