Halle Berry is a well-known actress, but she also recently made headlines when she boldly shouted, “I’m in menopause!” outside the Capitol Building in Washington, D.C. She and others are challenging the silence that has long surrounded this inevitable life stage for women. According to researchers at Yale University, Berry’s declaration is a part of a broader cultural shift, where women are beginning to push back against the stigma and shame that has historically defined menopause.
The Yale researchers say menopause should be seen as a critical health stage, beyond merely a reproductive milestone. Further, they say it is time for medical professionals across all specialties to understand and address menopause’s far-reaching implications for women’s health.
Menopause begins for approximately 6,000 women each day or 1.3 million women annually in the U.S. Despite these numbers, long-lasting misconceptions about menopause abound. A simplistic view of menopause as a sudden, binary change has shaped decades of inadequate care, according to the Yale researchers. “You were supposed to go to bed one night premenopausal and wake up the next morning postmenopausal,” said Dr. Mary Jane Minkin, who is a gynecologist and clinical professor at Yale New Haven Health and Yale School of Medicine in Connecticut.
Menopause is defined by 12 consecutive months without a period. However, many people don’t realize that ovarian function begins to decline long before menopause. This transition time is called perimenopause and can last up to 10 years. The average age of menopause in the U.S. is 52. Perimenopause usually develops when a woman is in her 40s.
During perimenopause, the ovaries gradually produce less estrogen and progesterone. However, this decline is not steady. A perimenopausal woman’s hormones fluctuate unpredictably, making it both difficult to test for the occurrence of perimenopause and difficult to treat its possible symptoms. The researchers say one day, a woman’s hormones might appear completely normal on a blood test, and the next day they might show significant imbalances. This creates a diagnostic challenge that standard quantitative tests can’t reliably capture.
The classic symptoms of menopause include hot flashes, night sweats, and mood changes. However, the transition into menopause can manifest in various different symptoms and ones that often go unrecognized as having anything to do with menopause. The ovaries are involved in regulating a wide range of processes, far beyond reproductive function. The hormones produced by the ovaries promote the health of the entire female body. This includes everything from bone density to sexual desire to cardiovascular health to cognitive function.
To date, hormone replacement therapy (HRT) has been the most effective treatment for perimenopausal and postmenopausal women. HRT can alleviate symptoms by replenishing declining hormone levels. After initial popularization in the 1960s, HRT gained incredible traction in the ‘90s, with nearly 15 million women in the U.S. taking an estrogen-based menopausal treatment. However, in 2002, use plummeted after the Women’s Health Initiative (WHI) study found that HRT increased the risk of breast cancer, heart disease, and stroke.
The study concluded that the benefits associated with HRT did not outweigh the risks. In the decades since the WHI study, research has continuously refined a new understanding of HRT. Today, the literature suggests that HRT can be beneficial for women below the age of 60. Unlike the single delivery method tested in the WHI study, HRT may be tailored to each woman’s individual needs, considering factors such as symptoms, medical history, and risk profile.
Treatment options vary and include oral pills, transdermal patches, vaginal rings, and topical gels. There is concern that advancements in menopause care will remain limited if doctors and patients lack education about the stages of life for women. Health care providers may not connect symptoms to perimenopause, while patients often naturally seek help from specialists for individual symptoms without realizing their diverse health complaints could all stem from the same hormonal changes. For example, for mood changes, a woman might be sent to a psychiatrist, or for insomnia, she might be sent to a sleep specialist.
Unfortunately, many doctors are not receiving guidance in this area of medicine. This critical knowledge gap risks leaving many health care providers ill-equipped to address menopause causes and symptoms effectively.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com
