Kathryn Clancy wrote an entire book about menstrual cycles. But even she was surprised by some of the pre-menopausal symptoms she recently began to experience at age 44.
“A lot of things that have to do with my uterus, ovaries, and breasts, I have been massively underprepared for as a Ph.D.-level expert in this field,” says Clancy, a professor at the University of Illinois Urbana-Champaign. “That should tell you how even more underprepared most people are.”
Most people who menstruate will experience symptoms including hot flashes, brain fog, and changes to mood, sleep, and sexual function as they approach menopause, defined as the point in time a year after their last period. But that transition, which typically begins between the ages of 45 and 55, is so rarely discussed in society—and at the doctor’s office—that people often know nearly nothing about it in advance. One 2023 study of post-menopausal women found that almost none of them had learned about menopause in school, and about half of them “did not feel informed at all” about the life stage.
But there are signs that menopause is finally going mainstream, as both the medical and business worlds get serious about the needs of the million-plus people in the U.S. who reach menopause every year. The U.S. Food and Drug Administration (FDA) in 2023 approved Astellas Pharma’s drug to treat menopausal hot flashes, and pharmaceutical giant Bayer is currently developing a similar medication. Some companies are beginning to offer menopause benefits to their employees. Lawmakers have pushed for more research on menopause. And a flurry of menopause-focused startups have launched in recent years to supplement traditional care, since studies suggest a significant portion of people going through menopause are not treated. The company Alloy, for example, connects patients to menopause specialists via telehealth and sells wellness products targeted toward those going through the transition.
“I have really noticed, thankfully, a new attention and interest in taking care of people during this transition,” says Dr. Ghazaleh Moayedi, a Texas-based ob-gyn who provides menopause care. She attributes that shift to growing numbers of women holding positions of power in business, tech, and medicine, and to social media’s ability to spread information among patients.
But fixing the problem will take more than well-branded startups, or even new FDA-approved therapies, which not all patients are able to get. Experts believe a meaningful shift will only take place once the core issues change: how research is conducted and disseminated, how doctors are trained, and how seriously practitioners take women’s pain.
For Dr. Sharon Malone, chief medical advisor to Alloy, the medical system’s problems with menopause go back to 2002. That’s when a major study was published, linking hormone therapy —which can ease menopause symptoms by boosting levels of hormones that have dropped off—to increased risks of breast cancer and other serious conditions. After that, hormone therapy use plummeted in the U.S.
But, Malone says, there’s a crucial caveat to the data: the study participants’ average age was 63, older than that of a typical patient receiving hormone therapy for menopause. Later analyses, and statements from researchers involved in the study, clarified that the risk of breast cancer may have been overstated, particularly for younger people.
In a 2022 position statement, the North American Menopause Society said hormone therapy has more benefits than risks for women younger than 60 and within 10 years of menopause, unless they have specific complicating health factors. But many doctors and health groups remain wary. The U.S. Centers for Disease Control and Prevention, for example, still cautions that hormone therapy may be associated with higher risks of breast cancer when taken for at least five years.
There has also been debate about whether hormone therapy is linked to a heightened risk of dementia—a risk that Dr. Kejal Kantarci, a professor of radiology at the Mayo Clinic, says her research has not borne out, at least among younger people. In a 2018 study, Kantarci and her colleagues compared a small group of women who used menopausal hormone therapy in their 40s and 50s with those who took a placebo. Three years later, they found no significant differences in cognitive function between the two groups. Other studies, however, have reached different conclusions.
The result of all this back-and-forth, Malone says, is that “we are now looking at a generation of doctors that really have not had formal or informal training in how to treat menopause. Women don’t know what to expect, and doctors don’t really know what to do.”
Moayedi says the problems in physician training go deeper than hormone therapy. “I don’t remember a single lecture from medical school about menopause,” she says. And after graduation, she, like many of her colleagues, worked in a clinic staffed by doctors finishing their medical training, which mostly served people who were uninsured or underinsured. Most of the patients Moayedi saw were lower-income pregnant people who qualified for Medicaid or older people on Medicare—which meant she hardly ever saw people who were going through menopause, despite training to become an ob-gyn.
Physicians who don’t specialize in obstetrics and gynecology likely know even less, she says, because women’s health is often (wrongly) considered “separate from the rest of medicine.” Moayedi says she often sees patients who have been misdiagnosed with other conditions, including ADHD, because their primary care doctor didn’t realize that symptoms like brain fog can be linked to menopause.
Another reason doctors are under-informed, Clancy says, is that most reproductive-science research looks at people at the peak of their childbearing years, which typically excludes adolescents and adults entering menopause. She says there’s a clear need for more studies—and more funding for studies—on people who fall outside those main reproductive years. A bill introduced in 2022 called for $100 million for menopause research in 2023 and 2024, but it hasn’t moved forward.
Even so, Malone says she’s encouraged by the fact that menopause is receiving renewed attention—and that people are noticing the need for that course correction at all.
“Women of a certain generation just assumed that suffering was just part of being a woman, our unfortunate lot in life,” she says. Now, she says, patients “are saying, ‘This is nonsense. You’re going to have to do better by us.’”