Menopause Relief Is Finally Here—But Not For Everyone

There was a particular hell in going through menopause during a global pandemic. Where did my body’s troubles end and the world’s begin? Sure, I wasn’t sleeping and my brain was as soft as a mound of mashed potatoes, but wasn’t that true for everyone? If I was sweating, was it a hot flash or just panic about ending up dying alone in a hospital, saying goodbye to my family on an iPad? I was living with my family in Berlin at the onset of the pandemic, which coincided, delightfully, with the worst of my symptoms. In March 2020 Berlin began to shut down, along with the rest of the world. I would go to the Spätkauf, forget what I was supposed to buy, and come home with the same things I always bought: a bottle of Campari, chocolate bars and my allotted two rolls of toilet paper.

I barely knew which way was up, let alone why my skin was suddenly so itchy. “Is itchiness a sign of menopause,” I googled with my terribly itchy fingers. (It was.) My period, which had disappeared for months, would come gushing back, staggeringly heavy. “It looks like the conveyor belt at the slaughterhouse,” I emailed one friend. “It looks like Quentin Tarantino shot a movie in my pants.”

Stuck in a foreign city with no doctor, I became friends with Dr. Google. I looked up my symptoms. I forgot what I’d looked up. Had I always been this forgetful? I couldn’t remember. Menopause was a vast hole in my knowledge. I thought I talked about everything with my friends, but I guess we didn’t. Sex, drugs, sadness, children, disappointments, successes, travel, facials, books—but very rarely menopause. Maybe it was like mentioning Voldemort’s name: you summoned the darkness by acknowledging it.

Dr. Jen Gunter, the author and ob-gyn, likens the menopause stigma to a really bad canoe trip, where there’s no guide and no one bothers to tell you where you might end up. “The culture of menopause in our patriarchal society is something to behold. Menopause doesn’t even rate the shame that society gives to the vulva and the vagina,” she writes in her book The Menopause Manifesto. “Apparently there is nothing of lower value than an aging woman’s body, and many in our society treat menopause not as a phase of life, but rather a phase of death.”

Silence and shame are the traditional companions of the menopause transition, she writes, along with myth and misinfomation. For example, many women (and their doctors) still have outmoded ideas about menopausal hormone therapy (MHT), which is now understood to be helpful for ameliorating some women’s symptoms. “It feels as if we overemphasize risks related to MHT, and to me it even seems to go beyond the concept of infantilizing women and their decision-making skills. Medications for erectile dysfunction cause blindness for three out of every 100,000 men who take them, and yet society trusts men to decide if those risks are worth it.”

The dangers of hormone replacement, the shock of the hot flash, the pain of a dry vagina—menopause, when it was whispered about at all, was a cavalcade of doom, the dreary end of a party. In the past couple of years, however, the conversation has increased in volume, and cheeriness. Now the topic is no longer verboten, and articles and podcasts and books like Dr. Gunter’s have begun to proliferate. As a giddy CBC reporter said in a 2023 report, “Menopause: It’s hot, it’s flashy, and it’s definitely having a moment.”

Menopause has slowly emerged from the shadows of stupid jokes about moustaches and temper tantrums to assume a different cultural form. “The fucking menopause comes, and it is the most wonderful fucking thing in the world,” says Kristin Scott Thomas’s gorgeous, martini-swilling businesswoman in the British series Fleabag. “Yes, your entire pelvic floor crumbles, and you get fucking hot and no one cares. But then you’re free. No longer a slave, no longer a machine with parts.”

You might be free, if you could only afford the price. As the menopause conversations increased, I began to see the same schisms I‘ve explored elsewhere in my book. For individuals with social and monetary capital, the transition can be eased with potions and therapy and, yes, more beauty products. But for those who are already struggling, there is little help. Individual empowerment has not manifested as institutional change. In the workplace, as Jenny Godley said, it’s still every woman for herself. Out of curiosity, I began to look at some of the products and services on offer for perimenopausal and menopausal women. You could buy neck fans and hair masks, probiotics and hemp patches, fenugreek-seed libido boosters and an alarming product called “panty spray.” You could go on a Menoheaven retreat with other women Marie Kondo’ing their eggs. (Thank you for your service. Goodbye!)

“We’re in the middle of a menopause gold rush,” the New York Times noted in 2022. “The market is flooding with high-profile, well-funded menopause-related beauty products and telemedicine start-ups, as well as a growing roster of celebrities willing to admit it’s happening to them. There’s the potential not only for a big cultural shift to happen, but for some number of people to profit off it.”

And also for some people to be left behind. In the U.K., for example, one study out of the University of Warwick shows that poor women have less access to hormone replacement therapy than women with economic means. The researchers couldn’t determine why; they plan to explore the underlying causes in further studies.

Racialized women experience inequities when confronting the menopause transition, too. Black and Hispanic women, for example, experience the onset of menopause earlier and therefore endure symptoms for longer than white women. And because of disparity in the provision of medical treatment, they may find their symptoms ignored or mistreated.

“Here I am, sharing the messy, embarrassing, uncomfortable truth about being a woman over 50, at the height of my career, and challenged to keep up because of my biology,” Pamela Hutchinson, the global head of diversity and inclusion at Bloomberg, wrote in a much-shared LinkedIn post in 2021. “I used to be able to present without a script, ad lib, pivot to speak at a moment’s notice. Nowadays the severity of my symptoms on any given day can determine whether I am able to do that or not.” Hutchinson added that her menopause transition must be understood through an intersectional lens. “If we’re only tackling my gender, we’re not accounting for my experience as a Black woman. Consider this for a minute: research indicates that Black women may have longer transitions and worse menopause symptoms than White women—and we’re less likely to be offered effective therapies and receive good quality of care.”

A diversity issue. A workplace equity issue. These are crucial elements we’re missing when we reduce menopause to an increase in the variety of vaginal lubricants available (although that’s also a good thing!). 

Hutchinson is from the United Kingdom, which is one of the few countries that has tried to grapple with menopause as a workplace issue, and as a matter of equity for all people who go through the transition. So let’s look for a moment at what has happened there.

In 2021, the Labour MP Carolyn Harris sponsored the Menopause (Support and Services) Bill, a private members’ bill in Parliament. She recognized that the transition was not borne equally by all. “There’s a hell of a lot of women my age, working in supermarkets, in shops, and they are exhausted,” she told the Guardian newspaper. “A lot of those women are going through the menopause but they are not being treated, because in 2021 there is still not enough understanding about a condition that affects 51 percent of the population.”

There was ample research to support this, included in the Menopause in the Workplace report from the Women and Equalities Committee, of which Harris is a member. One study estimated that 14 million work days per year were lost due to workers trying to deal with crushing symptoms. Women felt unsupported, discriminated against, or forced to leave work.

The government responded to Harris’s bill by agreeing to subsidize the cost for hormone replacement therapy for women living in England (the cost is already covered in the other three nations of the U.K.). It also announced the creation of an all-party Menopause Taskforce. But it denied one of the main requests of the committee: to make menopause a “protected characteristic,” so that menopausal workers wouldn’t face retribution for, say, needing time off. The Conservative government rejected this proposal, claiming it might lead to discrimination against men with long-term medical conditions. The government also nixed a proposal to launch a pilot project on menopause leave. Harris and her fellow campaigners were disappointed at the government’s lack of action, but from this side of the pond I was amazed at what they had accomplished. I was stunned that there was any government action at all on menopause. An all-party committee, imagine that!

It’s not that we don’t have the same problems as women in Britain and around the world. The Menopause Foundation of Canada’s 2022 report The Silence and the Stigma revealed that three-quarters of the women surveyed felt unsupported at work when it came to the transition. We have the same challenges here—it’s just that we’re so far behind in acknowledging or improving them.

But there is action, and I take hope from that. The U.K. has just launched the world’s first menopause education program, which will be shared with individuals and employers (learning about menopause is already part of the British secondary school curriculum). Some companies have put policies in place for workers who are going through the transition, and others have appointed “menopause ambassadors.” I hope this will become common practice—not just because it’s well meaning, but because it makes economic sense. You want to keep half your employees happy in the prime of their lives.

The prime of our lives—do we believe that? Will our spirits break free of the expectations that have kept us earthbound for so long? Do we truly have no fucks left to give?

Excerpted from What She Said by Elizabeth Renzetti. Copyright © 2024 Elizabeth Renzetti. Published by McClelland & Stewart, a division of Penguin Random House Canada Limited. Reproduced by arrangement with the Publisher. All rights reserved.