October is Menopause Awareness Month.
When I was in my late 40s, my gynecologist told me almost casually that I was going through menopause. I was shocked. I didn’t think I would have to worry about menopause for years. At first I was told it could be early menopause, but I later learned that it was technically in the “normal” range, just a little earlier. Still, it felt way too soon for me. I wasn’t ready and didn’t know anyone who was going through it. There was no clear cause, no dramatic symptoms that brought me here – just routine tests and changing hormone levels.
To understand what this means, it’s helpful to know the medical differences. “Premature menopause is menopause before age 40,” explained Alyssa Dweck, MS, MD, FACOG, MSCP, chief medical officer of Bonafide Health and board-certified physician with the Menopause Society. “Early menopause is menopause before the age of 45 and occurs in approximately 8 to 10% of women. Most enter menopause between the ages of 45 and 55, but some do not experience menopause until they are 60.”
I wasn’t expecting a strong emotional reaction and wasn’t prepared for how it would affect me. As an adoptee, I never made having biological children a priority. And I have spent most of my adult life pursuing a creative career full of travel and projects that I loved. Still, the diagnosis stuck with me like a bad cold that wouldn’t go away. When I left the office I felt ashamed and broken, as if I had been quietly pushed into a new phase of my life before I was ready.
The emotional weight of an unexpected diagnosis
I consider myself a feminist, someone who has pushed past outdated ideas about what makes a woman valuable. So I didn’t think that menopause would shock me. And yet it happened. I wondered if I had done something wrong by launching this so early. I took good care of myself, exercised, ate well, and followed checkups, but I felt marked like my body had betrayed me.
After my adoption, I never had a clear idea of what to expect from my body. When menopause came, it felt like a loss, not just of fertility, but of continuity. Another reminder that I had no roots or biological lineage to compare myself to.
“A woman’s mother’s menopause experience is a good predictor of her own,” said Lauren Tetenbaum, LCSW, JD, PMH-C, psychotherapist and author of Millennial Menopause: Preparing for Perimenopause, Menopause, and Life’s Next Period. “Not having access to a biological family for information about genetics can feel like a loss or a missed opportunity.”
Even among women without the added mystery of adoption, Tetenbaum sees a lot of overwhelm, confusion and loneliness. “Women are often under-informed about menopause. If it occurs earlier than expected, they may not know where to turn or talk to.”
Why I kept my menopause a secret
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Part of me was proud of looking younger than I was. I didn’t want to be considered “old” and was ashamed of what this diagnosis meant. When I went through menopause, I didn’t tell anyone, not even friends or family. I didn’t have the classic hot flashes or weight gain, so I just stayed calm. At doctor’s appointments, I would write “N/A” for my last period and move on.
“Our culture values youth as a sign of a woman’s worth,” Tetenbaum summed it up. “Women experiencing the menopausal transition often experience loss of identity and fear of growing older, and these feelings are heightened when menopause occurs earlier than expected.”
The price of silence
By keeping my menopausal transition a secret, I thought I was protecting myself from being seen in ways that made me uncomfortable. But this secrecy prevented me from seeking treatment. I didn’t ask any more questions for months. I don’t have any tests scheduled. I pretended it didn’t happen. However, menopause affects many systems such as the heart, bones and brain – not just reproduction. And that meant that even without symptoms like hot flashes, I was still at risk for conditions like bone loss, osteoporosis, heart disease, metabolic syndrome, mood disorders, and possibly dementia.
The costs of stigma extend beyond my personal situation. In the USA this is deeply rooted culturally. Tetenbaum noted, “Because of stigma, women don’t get the information they need, we don’t fund enough research, and we feel isolated instead of supported.”
But we’re seeing a cultural shift lately as more and more prominent women are speaking openly about menopause. As conversations about menopause become less taboo, women are starting to talk more openly about this normal period of life. And access to health care is improving thanks to these increased conversations and relatively new telehealth options.
Take steps towards health
I began to notice systemic changes in my body. I wanted to feel more in control of my health and not let the fear of the unknown paralyze me. I also wanted to feel better emotionally, so I finally started taking baby steps. I scheduled a DEXA scan to measure my bone density and had my cholesterol checked, which normalized both values. Despite this certainty, I decided to make preventative changes and focus on improving my diet.
I also took a closer look at a symptom I had suppressed for years: increased anxiety and irritability. I had blamed it on stress, but now I wondered if it was hormonal. Over time, I realized that it was true. These changes were part of the hormonal changes during menopause. Acknowledging this has helped me develop routines to deal with it. I stuck to my exercise routine and added more structure to my days, which made me feel more grounded.
“So many women don’t feel like themselves during perimenopause,” Tetenbaum said. “If we can identify what is going on with us (e.g. hormonal fluctuations), we can better receive the treatment and support we deserve.”
Given my symptoms, my doctor suggested that hormone therapy (HT) might make the transition easier.
“Hormone therapy in the right person, at the right time, and in the right dose and formulation can relieve symptoms and reduce the risk of cardiovascular disease, bone loss and cognition,” Dweck said.
Despite a flawed 2002 study by the Women’s Health Initiative that incorrectly linked HT to an increased risk of breast cancer, the latest guidelines show that HT is safe for most women, especially if started early enough. So I agreed to bring hormones into the mix. I started to feel less anger and less anger. I was no longer on an emotional roller coaster and my life no longer felt like it was spinning out of control. I felt like myself again.
Break the silence
It took some time, but for me menopause is no longer a failure or something to hide, but a new chapter. I started opening up to friends. And when I did, I discovered that some of them went through menopause just as quietly. Opening the conversation normalized my experience and helped me feel more comfortable with my new status as a postmenopausal woman.
“We should change the way we talk about menopause in schools, with our children, in medical training programs, in politics and in the media so that it becomes normal,” Tetenbaum said. “When we talk about this completely normal phase of health and development, we all benefit from it.”
There is no single right way to experience the menopause transition. But silence is not the answer. When we share something, we realize that we are never alone.
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