Let’s start by getting our small piece of constructive criticism, the title, out of the way. We wish the title had been something like, “The Guide to Dealing with the Many-years Menopause Transition” or “All You Need to Know about the Lead up to Your Final Menstrual Period”. Because, well, menopause is technically just one day — the day when you’ve been without a period for 12 months. And the term is correctly defined within the article. But, hey, we get it, “menopause” is shorter and it’s the term that most people use to refer to the whole shebang — the changes in cycle length and amount of flow, the disrupted sleep, the mood changes, the physical changes, aches and pains, weight gain and changes in libido. To be clear though, it’s all perimenopause.
We try to be precise about terminology because, without a set of clearly defined terms, it’s pretty tough to know what’s what. As this article and many others have pointed out, there is not enough anticipatory guidance to prepare women for what they may face as the reproductive system makes this many-years shift from active to inactive.
But, back to what we loved about this article because there is really so much.
“Here’s the truth: You probably will sweat the physical stuff. And possibly the mood stuff. Maybe a lot. Perhaps a ton. You will likely—sometimes astonishingly—encounter bodily changes no one ever told you about. You might be frustrated and, yes, enraged by modern medicine’s incomplete understanding of what is happening to you and by the cultural sexism that underlies that failure.
But. You may also make a significant discovery—something grand and important. You might even call it the discovery of a lifetime: that menopause, far from being the tragic end of the best part of a woman’s existence, can actually be a threshold, a gateway, the passage to the you you’ve been waiting your whole life to become.”
“Yet when it comes to navigating that process, women are, to a stunning degree, left to their own devices. “Every girl gets the period talk, but almost no woman gets a talk about what’s happening on the other end,” says Stephanie S. Faubion, MD, medical director of NAMS and director of the Mayo Clinic Center for Women’s Health. “That’s really a shame. And as a result, we have women coming to the clinic in a panic. They can’t sleep, they’re having heart palpitations, they’re forgetting things, their hair is thinning, they’re anxious—and they literally think they’re dying when, in fact, they’re just in perimenopause.”
Some examples; Dr. Rebecca Thurston who studies links between hot flashes and cardiovascular health and Dr. Pauline Maki who studies mood and cognitive changes.
Note the date here: 1990s!!!
“Back in the 1990s, Sherry Sherman, an endocrinologist with the National Institute on Aging then in her 40s, suspected a serious lack of scientific knowledge about midlife women.”
She points out that the Study of Women Across the Nation (SWAN) is filling this gap. There have been other important studies too: The Seattle Midlife Women’s Study and The Penn Ovarian Aging Study. These both started with women at 35, which we think is important. From our experience and what we hear from women, changes and symptoms start early for many of us.
“That same lesson was borne out by a groundbreaking 2016 study from Johns Hopkins—the work of two female Hopkins ob-gyns, Wen Shen, MD, and Mindy Christianson, MD, who, a few years earlier, had surveyed hundreds of ob-gyn residents across the U.S. to see whether they’d had adequate instruction on menopause, and, finding that they hadn’t, devised a two-year menopause-medicine curriculum to see if it made a difference.”
“And in 1966, a Brooklyn gynecologist named Robert Wilson published a runaway bestseller, Feminine Forever, whose sexist attitudes linger today. Wilson was the Pied Piper of plying menopausal women with estrogen—for the rest of their lives.
With estrogen, he promised, they could look forward to eternal youth and attractiveness (and menstruation!—on Wilson’s plan, women could expect to have five to seven periods per year, indefinitely). Without estrogen, they were fated to live as “sexual neuters” suffering from a “serious, painful, and often crippling disease” that made long life “an unnatural burden.” Wilson wasn’t speaking metaphorically when he said menopause could and should be cured.”
