Menopause needs a societal rethink

Menstruation has been stigmatized for millennia. The Old Testament refers to menstruation as the ‘infectious time,' while Hinduism calls it ‘asaucha,' which has connotations of impurity or shame.

"You'd think this means we'd have a big celebration when menopause comes, as we're not unclean anymore. But this isn't the case," said Rachel Weiss, a psychosocial counselor in the UK, told DW.

Menopause is still a taboo subject today. Weiss said the first time she saw it mentioned on TV was in 2017 in a BBC documentary called "The Menopause and Me," and it taught her a lot about the many ways menopause can affect people.

Modern science has fueled the stigma. Scientists in the 20th century (predominantly male) discovered that the hormone estrogen could be used as a hormone treatment for symptoms of menopause. The research led menopause, a normal life event, to be turned into a hormone deficiency disease which requires diagnosis and treatment. 

Hormonal replacement therapy (HRT) was later advertised as a ‘cure' for menopause. The hormone pills Premarin, men were told in the 1950s, make a woman "pleasant to live with once again". The stigma is still around today and leads many women to feel unable to talk about their experiences with menopause.

"Imagine if you medicalized puberty and told kids that going through puberty will be horrendous, and then tell them there's a pill that would stop it happening. This is how menopause is often presented," said Weiss.

What is menopause?

"I think when you get into perimenopause, you notice a lot of changes. I can feel the hormonal shifts happening, the sweating, the moods — you're all of a sudden furious for no reason," Gwyneth Paltrow said in an interview in 2018.

Menopause marks the end of menstrual cycles and fertility in women. It stems from the gradual decline of reproductive hormones, primarily estrogen and progesterone, produced by the ovaries.

Menopause lasts seven years on average and typically occurs in women in their late forties to early fifties.

This hormonal shift triggers a wide range menopausal symptoms like hot flushes, night sweats, and mood swings. 38% of women describe these symptoms as moderate to severe.

Lancet studies

A new series of studies published on Tuesday in the Lancet argues for a new approach to managing menopause. 

The studies urge societies to move away from the medicalized view of menopause in favor of a broader model that supports women transitioning this life stage.

"The experience of menopause differs for every person. Our series calls for an individualized approach where women are empowered with accurate, consistent and impartial information to make informed decisions which are right for them over the menopause transition," study series co-author Martha Hickey, University of Melbourne, told reporters.

One of the studies highlighted that early menopause needs to be taken more seriously. Women who go through early menopause have a higher chance of cardiovascular disease and osteoporosis.

Around 8-12% of women globally experience early or premature menopause, but it's higher in some countries like India, where one in five women go through early menopause in their early thirties or early forties. Diagnosis of early menopause is often delayed and poorly managed, according to the study.

Another study challenged the widely held belief that menopause is associated with poor mental health. It found no compelling evidence that menopause increases the risk of anxiety, bipolar disorder, or psychosis. Depressive symptoms can be common, but predominantly in people with previous depressive disorders.

"It's not that the lack of estrogen causes depression. It's just that all the other social and cultural factors around menopause add to people feeling worthless. For many it happens when their teenagers are going through hormonal changes and being horrible, or elderly parents getting ill. It can be a big storm," said Weiss. 

Tackling menopause stigma

A major theme of the Lancet study series is the need to tackle the shame and stigma around menopause.

One study says that normalizing menopause and providing easy access to unbiased, credible information can be empowering for women and help them make decisions about its management.

"More broadly, challenging widespread stigma about menopause as a period of decline and decay and creating a more menopause-friendly work environment might help to empower women," the study authors write.

In 2017 Weiss founded the charity menopause café, which runs events where anyone can discuss, and listen to, people's experiences with menopause. The studies credit menopause café as an effective way to empower women going through menopause and create a less medicalized narrative of it. 

"One of the reasons our charity exists is to help people talk through their experiences with menopause and see if it might need medical attention or not. There is a place for HRT, especially for the 20% of people who have horrendous menopause symptoms, where it is primarily a medical problem. Medication (not only HRT) can also be useful for others if their physical symptoms significantly affect their quality of life," said Weiss.

The Lancet studies highlight how deep in society stigma around menopause goes. Many women report feeling shamed for menstruating as girls, then feeling shamed for not menstruating as older women, one study says.

"Women have been socialized not to mention our periods. But a deeper aspect is gendered ageism. I've heard women saying they can't tell their boss they're going through menopause because it will mean they're past it. Age in our society means worthless as a woman," said Weiss.

Growing discourse about menopause in some countries like the UK is raising awareness and helping to reduce shame and stigma, but the Lancet studies hope to make deeper changes in how menopause is viewed as a life experience rather than a disease that needs to be feared.

Edited by: Andreas Illmer