We all do it: confidently say things we’ve heard over and over because they make sense and we assume them to be true. (Heck, I’m almost 53 and I just went swimming after eating the other day; nothing happened other than I lowered a possible blood sugar spike and got one step closer to reversing insulin resistance).
Menopause is no different. You’d think people in charge of disseminating information would be a little more careful, but take it from a recovering journalist: They really aren’t. And isn’t now the time when we should be questioning everything we thought we knew? I know, it’s a lot on top of the other stuff. But it’s worth it. For clarity. Truth. Our worth. And so we aren’t manipulated by narratives designed to keep us in FUD (fear, uncertainty and doubt).
The more you know. Knowledge is power. You get it.
Here goes:
We just started going through menopause
“Menopause only started happening 100 years ago”. Before that, we all died at 50, right? No. That’s a nice story, fitting for the “it shouldn’t be happening and we’ve got to stop it” narrative and one I’ve heard everyone from a Telegraph columnist in the UK to multiple Doctor Menopause Gurus in the US – who should all know better or at least Google – repeat. There is a difference between life expectancy and life span. Yes, people used to die tragically and younger. But if they did make it past an early demise, they could – and did – go on to older and old age. If menopause only started 100 years ago, then why the references to it in the Bible, in the Quran, and from Aristotle, for starters? Why was the name menopause first coined 200 years ago? Why did historian Susan Mattern need almost 500 pages for her 2019 book The Slow Moon Climbs: The Science, History and Meaning of Menopause, and why there have been grandmothers and wise old women since womanhood began? Oh, and why do those amazing old cemeteries in the UK and Europe have so many old women etched onto the tombstones?
Only humans and whales get menopause
This is another convenient narrative, and it’s repeated almost as often as “menopause is only 100 years old”. But the truth is, when you scratch the surface, it seems many creatures go through menopause, or something like it. We know from studies that several varieties of whales, giraffes and also elephants go through this, even if the researchers themselves and the journalist writing about that last one couldn’t quite seem to believe it. We know there’s at least one veterinarian in the world who swears dogs go through it, people who wonder about their iguanas, mostly because of the osteoporosis, and that when I did some googling on camels, found a study that just casually dropped this line: “More than half of respondents reported that duration of sexual activity before menopause was about 20 years”. (Still looking into that one) I’m starting to believe that not only some creatures but maybe many go through this transition too, to some extent. The Grandmother Hypothesis may be just that, but it’s really not a stretch to extrapolate that the value humans bring to their extended families once their own child-rearing is out of the way extends to at least some creatures in the animal kingdom, too.
Menopause is a female hormone deficiency
How can nature’s planned end of reproduction be a deficiency state? “Estrogen deficiency” and anything like it is a marketing term for hormone therapy, as is brilliantly laid out here by endocrinologist Jerilynn Prior, and an insulting one at that. The term first appeared in the 1930s, around the same time as menopause hormone therapy. Inneresting. (Also, you don’t need to lie; we’ll take it if we need it, k?) I’ll leave it to Susan Mattern and The Slow Moon Climbs, to explain further: “To speak of estrogen deficiency is to say that women past menopause to not have as much estrogen as they ideally should; in this view women of reproductive age set the standard for the ‘right’ amount of estrogen. If we assumed that women past menopause had the right amount of estrogen for post-reproductive life, we would not say that they had an estrogen deficiency – just as we do not say that an eight-year-old girl is deficient in estrogen. The language of estrogen deficiency also carries the corollary that women past menopause have outlived their main reproductive function and that their lives have been prolonged past what they are naturally adapted to…”
Millions of women are leaving the workforce
The narrative strikes again! I literally just saw this again today, twice. No one is saying that “menopause quitting” isn’t a thing, or that this is easy to navigate at work, particularly if you work with the public, stand all day, or sit near an a**hole. I’ll turn this over the Magnificent Midlife’s Rachel Lankester to explain the shocking breadth of erroneous repetition: “So where does this figure come from? I see it in a UK parliament inquiry, in a UK government press release about the Civil Service signing the Menopause Workplace Pledge, in The Guardian and The Times, on Sky News and on HR websites. Recently Cherry Ainsworth, Global Head of Talent Acquisition at the Financial Times quoted it when talking on LinkedIn about the FT being a proud signatory of the “Menopause Workplace Pledge”. Please read her post about it, but basically the truth is that the number is much less sensational (by at least two-thirds if not more), based on an irresponsible extrapolation of a very small 2019 survey that was not just about menopause.
The compounding industry is a scary scam
One thing you might think if you believe everything you read (and hear) is that compounding pharmacies are unregulated, Breaking Bad-style danger factories. The truth is, compounding pharmacies are regulated and overseen by the relevant body (the FDA in the US and the General Pharmaceutical Council in the UK, for example); it’s just that by their very nature what they produce and package can’t be. They are individual preparations. Compounded menopause hormone therapy is a real and helpful option for those people who don’t, for some reason, do well with the pharmaceutical industry’s mass-produced version – and others who just don’t want to take them. No amount of ‘bioidentical is a scam’ or ‘bioidentical isn’t a medical term’ social posts by Doctor Menopause Gurus looking authoritative in scrubs can make this untrue. You can hear Scott Brunner, CEO of the Alliance for Pharmacy Compounding, and Jennifer Burch, a North Carolina-based compounding pharmacist, talk all about it in one of the most popular episodes of the Hotflash inc podcast, Compounding pharmacies are not meth labs.
Perimenopause is a mystery
This one is starting to bother me, because over and over I see people talking about “the stages of menopause” – pre (duh), peri (WTF) and post (double-duh) and they always gloss over the most massively confounding bit for us living it. It seems like a mystery but it’s really not, as Canadian naturopathic doctor Lara Briden, author of hormone repair manual, lays out clearly. (It can last longer than the above diagram, but let’s not obsess) What does seem pretty clear is that there are actually four stages to perimenopause, and once I saw this, it was clear to me that I was in the third part and had definitely moved through the first two in my own way. (I’d debate that the period can still be regular, but change, a sign that is easy to overlook) That was about two years ago, and the chart still tracks for late perimenopause – for me. Everyone is different, but some sort of reference is nice and this is a good one that needs more attention. I’m going to be giving it that, and plan to have Lara back on the podcast to talk about it further.
Menopause is direct line to disease
Perimenopause is a time of tremendous physical and emotional imbalance, and all sorts of health problems can crop up. British endocrinologist Dr Annice Mukherjee speaks eloquently about this, including on the podcast, social media and in her book The Complete Guide to the Menopause. But as Kathryn Lindley, an American MD and clinical investigator in the Division of Cardiovascular Medicine at Vanderbilt University Medical Center, told me recently, you can actually flip the script to see it as an opportunity (if not an annoying one - see: insulin resistance, above): “We really want to be proactive, particularly around that time of life when we see a lot of changes in that metabolic risk.” This is the time to get your physical, emotional and spiritual health in good order to move on to the rest of your life, because whatever you’ve done up to now, innocently or otherwise, will come home to roost. Ignore this at your peril. But anyone who draws a straight line from menopause to disease is perpetuating another overly simplistic, fear-based marketing tactic. Menopause was meant to happen, full stop, and it provides a good opportunity for a reset (that may or may not include hormone therapy) before moving forward.
There is no male menopause
One thing you hear over and over from all kinds of women is “if men went through this, it wouldn’t be happening”. Meaning that because men hold all the power and they got Viagra, if there were a male menopause then they would have sorted it the second it seemed like a problem. Yet in the almost three years since I officially launched Hotflash inc (I was lurking for two years before that) I’ve seen the headlines on go from the “Is male menopause a thing?” to this, two weeks ago in the Daily Mail: Male menopause is treated like a joke. Here’s why it’s not funny. “Low T” is a common term, and while people still ask me what andropause means, word is getting out that men in their 40s are not okay either. (This is something I witnessed personally after dating several of them in recent years). I have interviewed UK GP Dr Quentin Oury on this subject for an upcoming episode of the podcast, and he describes a parade of men experiencing trouble sleeping, unexplained weight gain, low libido, mood problems, brain fog and more – even hot flashes. Men are less likely to seek help – shame and stigma reign here – and most physicians don’t know much about the problem. Lifestyle is a huge factor. Testosterone can definitely help. Sound familiar? Most women are understanding, many report seeing this in their husbands and wanting to know more, but there are those who get grumpy when the subject is raised in a sort of “I thought it was easier for you and harder for me” way. I don’t think it takes anything away from what we are going through to acknowledge that men suffer too, and I’m going to be writing about this because another thing that’s similar is there is a real lack of unbiased information.
Editor’s note
There are a lot of new Hotflash inc Substackers - welcome!
That Progesterone-tin-togen post from the weekend really touched a nerve; and it’s just the start of my obsession with the subject. The fact that so many people responded (and subscribed) leads me to believe that there are a lot of you out there as frustrated as I am with the lack of nuance in a lot of this conversation.
On that note, and to celebrate, I made this special Substack issue free to welcome new subscribers. I’m so glad you are here. Don’t forget to join the comment section – it’s getting interesting over there!
PS 1: I purposely didn’t read fellow Tania Elfersy’s recent piece on The Wiser Woman, 10 popular myths about perimenopause and menopause that we need to release to heal before I wrote this because I had been planning a list of my own; I just left it sitting in my inbox and just read it now. I think you will find they complement each other nicely. Also, Tania is coming up on the podcast! Killer lineup; subscribe to Hotflash inc anywhere you get podcasts and don’t miss an episode.
PS I stayed so long in the coffee shop writing this that one of the baristas said “Bye Ann!” when he left, like he was going to be seeing me tomorrow.
AMx
You made it to the end, you superhero.
So, I love this. The one thing I *do* see women struggling with is ageism and certain symptoms hampering their confidence professionally. There's nothing more distracting than a torrential hot flash right in the middle your board presentation and your boss leaning forward, cringing, and handing you a tissue. There's so much we can do. It's really a matter of communicating and sharing more of what works--not from a place of fear, but from a place of practical problem solving. We try to do that w/ The Empress, but it's so individualized--having women's feedback has been everything.
Don’t agree with all of this (and that’s fine) but totally loved the part on compounding pharmacies. If you listen to one very well known axe-grinding MD on social, you’d think you’re doing the equivalent of stepping into a 4 lane highway to cross it if you were to take compounded hormones.