For Meg Mathews, menopause looked like the Golden Girls—gray hair, elderly gentleman callers, chic but shapeless caftans. “Not me at 49,” Mathews says.
After coming back from a holiday, Mathews started experiencing some anxiety, brain fogginess and aching joints. She didn’t feel like herself. “But how do you explain that to the doctor?” she says. “So of course I went in going, ‘I just can’t cope with life.’ And of course they just gave me antidepressants and off I went. I had no idea that [those symptoms] were anything to do with menopause.” Many women don’t, thanks to the stigma attached to aging that’s made menopause either a punchline or kept it out of the conversation entirely.
Every woman (and some trans men) will go through menopause—that’s an estimated 1.3 million women in the U.S. alone who enter menopause every year. It is officially diagnosed after you’ve gone 12 consecutive months without a period, which happens at age 51 on average, according to the Mayo Clinic. (That’s the actual age of Jennifer Lopez, who could not look less like a cast member from The Golden Girls.) One percent of women enter early menopause (which can be triggered by chemotherapy or a hysterectomy) by age 40 and 5% are menopausal by age 45, explains Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University Medical School and a North American Menopause Society certified menopause clinician. “That’s not a huge number necessarily, but it’s hardly trivial,” she says.
Even for those who hit menopause at the average age, the “menopausal transition”—a period known as perimenopause—can last a decade or longer and start as young as your 30s. “It’s not weird for somebody in her late thirties or early forties to experience some hot flashes or night sweats or insomnia or vaginal dryness,” Dr. Minkin says.
Despite this, Mathews was certainly not the first woman in her 40s—or even mid- to late-30s—to walk into her doctor’s office experiencing disorienting symptoms and eventually discover, surprise, it’s perimenopause.
It’s Time to Start Talking About Menopause
Menopause may be the last great taboo in women’s health. While conversations around fertility and female pleasure are (finally) becoming more open, menopause still feels like a secret. And that leads to a lot of misinformation. “Myths are created because there’s so much ignorance and no conversation around it. Everybody just kind of makes up their own story about what they think menopause is based on the little bitty facts that they have,” says Arianna Sholes-Douglas, M.D. a board-certified ob-gyn and maternal-fetal medicine specialist, and author of The Menopause Myth: What Your Mother, Doctor, And Friends Haven’t Told You About Life After 35. “Part of the taboo is that menopause represents aging—and no one really wants to deal with that.”
Mathews, now 54 and the author of The New Hot: Cruising Through Menopause With Attitude and Style, was experiencing severe perimenopausal symptoms before anyone even mentioned the word “menopause.” “I’m a recovering alcoholic and I’m in AA. So I went to an AA meeting and I said, Why the hell am I staying sober?,” she says. “It’s like, I might as well have a drink because I am absolutely at the end of my tether: I’ve got anxiety, I haven’t left my house for three months.” As she was leaving, a woman tapped her on the shoulder. “She just said, ‘I think you’re going through menopause.’ And I was a bit like, God, that’s cheeky. You know, I’m imagining gray hair and a cane.”
That kind of it-can’t-be-me reaction is common among women, says Dr. Sholes-Douglas, largely because doctors aren’t talking about it. “There’s no training in medical school or residency around helping women after their reproductive years. Everything that we’re taught is mostly focused on the reproductive years,” she says. According to a study by researchers at Johns Hopkins, only 20% of residency programs have a formal menopause curriculum.
That hurts women in the exam room. “Not only are many women not aware of perimenopause, but unfortunately many physicians aren’t aware of it,” says Dr. Minkin. “They will take a woman who has come in and has skipped a couple of periods—maybe she’s a little hot, maybe she’s not sleeping so well—and they may think about hyperthyroidism or pregnancy, which are both very appropriate. But my goal in teaching medical students is to try to get them to think about including perimenopause as a possibility in making a diagnosis.”