Menopause has long been stigmatized as an awkward chapter in a woman’s life. For decades, discussions about “the change” were kept to whispers.
But talk to Mary Jane Minkin, an OB-GYN and professor at Yale Medical School, and she’ll tell you about menopause, loud and clear.
“Menopausal symptoms, perimenopausal symptoms can be extraordinarily disruptive to women,” she said.
Menopause symptoms can include hot flashes, migraines and anxiety and can last as long as 10 years. And although treatments, such as hormone replacement therapy, are available, Minkin says they are underused.
“We have some great therapies for them so that people can leave totally normal lives,” Minkin said. “There’s a huge amount of unnecessary suffering, and it drives me crazy.”
‘The only one I wasn’t mad at was the dog’
Artist Tanya Glover said she was 45 when she began to notice symptoms she was unable to explain.
“It was rage for no reason,” she said. “I felt bile coming out of my mouth and didn’t feel any way to control it.
“The only one I wasn’t mad at was the dog.”
Glover also experienced night sweats, hot flashes, irregular periods, and intense depression and anxiety. After a conversation with a friend, Glover realized that she was experiencing perimenopause, the turbulent years leading up to a woman’s last period.
Glover’s doctor prescribed her anti-anxiety medication, which Glover says only partially relieved her symptoms. Glover considered hormone replacement therapy, a traditional treatment for menopause symptoms, but had reservations about the cost, and safety.
“You hear about the cancer risks, and I don’t know who to believe,” she said.
The Women’s Health Initiative was paused
Hormone replacement therapy has been used since the 1940s to successfully treat menopause symptoms. But in 2002, a study called the Women’s Health Initiative (WHI) was paused because of a statistical link between hormone use and cancer risk.
“That study made it onto the front page of The New York Times. It was the topic of talk shows on major news networks,” said Dr. Renee Eger, the director of the menopause program at Women & Infants Hospital in Providence.
Dr. Minkin remembered the day the news broke. Many of her patients called her, panicked that taking hormones was putting their health at risk.
“And they went to their toilets and promptly threw down all their estrogen,” said Minkin.
The numnber of prescriptions for hormone treatments dropped precipitously. 22% of women over 50 were on hormone treatments between 1990 and 2000, according to one study. Come 2009, the prevalence was a fraction of that, at about 5%.
Minkin said that the study also impacted how doctors were trained. Without hormones, the go-to treatment for menopause symptoms, doctors had few options to offer women experiencing symptoms.
“Most programs, training residents and OB-GYN and some other specialties, basically stopped teaching how to manage menopause,” Minkin said. “It was just like, well, we’ll let them sweat for a while, they’ll be fine, because nobody was going to use estrogen because they were too concerned about getting breast cancer.”
The trend persists to this day: a study released in 2023 found that 68% of OB-GYN residents do not learn how to manage menopause.
Hormones safe for women under 60
In the years since the WHI, scientists and physicians have raised questions about whether the study’s data was correctly interpreted.
“The actual increased numbers of breast cancer was only eight women out of every 10,000 women,” Eger said. “So from a clinical standpoint, it was questionable whether that was actually significant, but from a statistical standpoint, the study was so large … they had to conclude that there was statistical significance.”
Additionally, Minkin said the study enrolled women who were older than menopause age, which would skew findings. Women generally go through menopause when they turn 51, whereas the average age in the Women’s Health Initiative study was 63.
In May 2024, a study published in the Journal of the American Medical Association reanalyzed data from the WHI study and other studies and found that hormones were safe for many women under the age of 60 to take.
“We no longer tell women that they absolutely are or are not candidates for hormone therapy, but rather have individualized discussions with patients,” Eger said. “For women who are at low risk and appropriate candidates for hormone therapy, hormone therapy is very safe when you look at the risks versus the potential benefits.”
Minkin has spent decades calling for better menopause care. But recently, she has seen signs that things are changing.
In February 2023, The New York Times Sunday Magazine published the story, “Women Have Been Misled About Menopause.”
On social media, influencers share their menopause experiences.
In March 2024, President Joe Biden requested $12 billion for women’s health research —noting menopause as a particular area of interest.
A new non-hormonal drug — Vezoah — recently hit the market and was advertised during Super Bowl LVIII.
“Women are finally standing up for themselves and saying, ‘I’m really suffering and I really need somebody to listen to me, to pay attention to these symptoms that I’m having, and to have a one-on-one individualized conversation about what my treatment options are,’” Eger said.
