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Menopause has a second

Nobody tells you about menopause.

Sure, you hear about hot flashes from time to time, maybe from a relative or in a joke on a TV show. But in the gender-specific courses that teach tweens and teens about their period, there is rarely any mention of the day that period ends. Even doctors rarely bring menopause up to their patients and all too often suppress symptoms when they occur.

"We hear the puberty talk, but we don't get the menopause talk," Pauline Maki, professor of psychiatry, psychology, and obstetrics and gynecology at the University of Illinois at Chicago, told Vox.

But now the American population is getting older: by 2030, the median age in America will rise to 40, from 37 today. And millennials, a generation loved by marketers, have begun their 40s, a decade in which the Menopause symptoms can begin.

That means menopause becomes a money-making opportunity as companies begin to offer everything from telemedicine advice to nutritional supplements to a specialty ultrasound machine to treat vaginal dryness (the latter is still in testing).

But what people going through menopause don't necessarily need is more ads on their social media feeds. Instead, experts say, they need an end to the stigma of this normal phase of life and the kind of real talk they didn't get when they were young.

Menopause “doesn't have to be a shame,” Jen Gunter, a gynecologist and author of the recent book The Menopause Manifesto: Own Your Health with Facts and Feminism, told Vox. "We just have to figure out how to change the conversation."

Doctors today are not trained to treat menopause

Menopause is technically defined as the end of menstruation and is officially diagnosed when someone has gone 12 months without a period. That happens at an average age of 51 years. However, symptoms can start long before that, in your 40s or even earlier (this symptomatic period is known as perimenopause). Most common, and perhaps best known, are hot flashes, in which the upper body suddenly becomes warm and sometimes turns red.

But there are many other possible symptoms – 34 in some ways – and some can have serious consequences for people's health and wellbeing. For example, the hormonal changes during menopause can lead to changes in the vagina, including dryness and loss of elasticity, which can lead to painful sex or urinary tract infections. Some people experience brain fog or memory problems. And the transition into menopause can also trigger depression and anxiety: Of those previously diagnosed with depression, more than half will experience an episode during the transition into menopause, Maki said.

But often, doctors don't really talk to patients about it. In a recent survey, only 7 percent of doctors felt ready to manage menopausal symptoms in patients.

Part of the reason has to do with history of menopausal treatment. From the 1940s onwards, doctors began prescribing estrogens to counteract the symptoms of menopause. The treatment became particularly popular in the 1980s and 1990s, but in 2002 a large, high-profile study reported that estrogen therapy increased patients' risk of breast cancer, heart attacks, and blood clots.

As a result, doctors generally stopped prescribing estrogen – but didn't replace it with anything else. "The training in menopausal medicine essentially went away," Maki said. "We lost a few generations of providers."

Experts now say that estrogen therapy is often safe as long as it is used by patients under the age of 60 and for a limited period of time. For these patients, "the benefits usually outweigh the risks of hormone therapy," Stephanie Faubion, director of the Center for Women’s Health at Mayo Clinic and medical director of the North American Menopause Society, told Vox. These benefits include a 90 to 95 percent reduction in hot flashes and night sweats, and a reduction in bone loss and cardiovascular risk while patients are on the medication.

In addition, for people whose main symptoms are vaginal, more localized forms of the hormone, such as vaginal rings, are now available and may not carry the same risks as oral medications.

Still, many doctors don't give their patients the latest information – or not much information at all. "I hear so many stories from women who have been discharged by doctors," said Gunter.

The result is that menopausal people often suffer in silence – and the stigma can affect every aspect of their lives. "One hears from women that they will leave their professional life because they cannot deal with their menopausal symptoms," said Gunter. In fact, in a 2013 UK survey, nearly 40 percent of women said that menopausal symptoms had adversely affected their work, but a majority had never discussed the symptoms with their manager, often because they were embarrassed or because of her Superior was a man.

“You are that person who has been incredibly productive and has contributed to it all your life. And now, "said Gunter," you are sidelined because of it. "

Now startups are trying to fill the void

Even when medical care may be lagging behind, brands are starting to benefit from menopause. This is a natural result of the way women's health has established itself as a business opportunity in recent years, with companies like Maven Clinic and Nurx entering the market to provide services like telemedicine maternity care and online prescribing, respectively Offer birth control. These companies wanted to fill a void left by a medical establishment that too often denies women's concerns and makes reproductive and sexual health care uncomfortable, embarrassing, or even dehumanizing.

And now startups and venture capitalists are turning their attention beyond childbearing years to the growing women's market in the 1940s and 50s. After all, by 2030 there will be more women between the ages of 40 and 64 in the US than girls under 18, according to a report from the Female Founders Fund last October, a venture firm that finances businesses founded by women. Selling to menopausal people could be a $ 600 billion or more business opportunity.

"This has been ignored in a number of ways, especially when it comes to medical research and solutions," Adrianna Samaniego, an investor in the Female Founders Fund, told Vox. "But it's a huge industry."

Recent additions to the field include Kindra, a startup selling estrogen-free supplements used to treat vaginal dryness, hot flashes, and sleep problems. There are also several companies that offer telemedicine appointments with doctors trained in menopause management, such as Gennev, who offers both gynecology appointments and life coaching to deal with body image, anxiety, and other issues. And other companies are expanding into the menopause space, with Roman, a startup first attracted by offering online prescriptions for erectile dysfunction medications, now offering telemedicine visits for menopausal symptoms, Fast Company said.

Companies respond to a real need from people who are not being served by their doctors – or from a culture that often pretends that women over 40 just don't exist. In addition to providing symptom relief, many people are looking for a community of people to share their experiences with, Samaniego said – a feature some of the startups in the field have.

However, some of the products marketed to menopausal people may not really help them. For example, a number of companies are now selling tests to tell people if they are going through menopause, Gunter wrote in a recent New York Times commentary. But these tests are actually of no medical use as they do nothing to predict whether someone will actually experience symptoms. You also can't tell exactly how close someone is to their last period – and because hormones fluctuate so much during this time, a person could have a menopausal test one month and a normal test the next month. "There's no guideline that recommends testing hormones to see where you are going through menopause," Gunter told Vox.

Diet supplements can also be problematic. Some companies are simply taking basic, widely used compounds and marketing them as menopause remedies, Samaniego said. "There are a lot of people who just repackage the same ingredients."

And despite the wide variety of diet supplements on the market, many have little research to back them up. For example, no non-hormonal dietary supplement has been proven to reduce hot flashes, Faubion said. And because supplements are not rigorously tested for safety, they can contain harmful ingredients.

Non-hormonal treatments can be marketed as better because they are “natural” – but, said Gunter, “natural has nothing to do with safe”.

It's time to end the shame of menopause

What people during menopause really need, many say, is to remove stigma at this stage of life so that symptoms can be openly discussed and taken seriously.

Take vaginal dryness, for example. There's not much talk about it – in part because the whole idea of ​​older women having sex is considered taboo, Maki says. But treatment is critical to helping patients lead healthy, pain-free lives, including sex, regardless of their age. "I see this as a woman's right," said Maki.

Hot flashes, on the other hand, are often treated as a nuisance. However, new research shows that they disrupt people's sleep, which can increase the risk of cognitive impairment and even Alzheimer's disease, Maki said. "We need to educate women adequately about the safe treatment options they have."

Fortunately, part of this education is already taking place – often driven by menopausal people themselves. Gunter decided to write her book after hearing questions about menopause and is open about her own experiences. She got hot flashes in the operating room while wearing lead protection and “when I take off my clothes, I'm literally drenched in sweat from neck to knees. And I'm embarrassed, ”she said to Vox. But: "Why should I be embarrassed?"

Meanwhile, health educators and advocates are increasingly voicing what happens to people's bodies during their reproductive lives. Omisade Burney-Scott, for example, launched the Black Girl’s Guide to Surviving Menopause podcast in 2019 out of a desire to “talk to other black women older to navigate life and this stage of life,” she told Vox. "What do you learn? What does love look like? What does anger look like?"

Today she also hosts storytelling events, shedding light on the stories of black women, femmes, and non-binary and trans people, including those going through menopause in their 30s or younger due to illness or testosterone use. "People who are going through menopause, regardless of age, identity or status in this community or society – they need to be heard," she said.

And they speak out more and more. "Women drive the conversation" around menopause, calling for treatment options and refusing to be defined by the status of their reproductive organs, Faubion said. "Women are not ready to go through their mothers' menopause."

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