Inside The Big Business Of Menopause
IT’S 11 A.M. IN BROOKLYN, New York, on a seasonally confused late October morning. Still-summery air is humid and overripe, as if the climate itself were dysregulated, water-retentive, hormonal—peri-autumnal? I’m at 1 Hotel Brooklyn Bridge for The New Pause, a menopause symposium that’s now in its third year, hosted by The Swell—an online community for the middle-aged. I’m standing because the convention space is so packed there’s nowhere to sit. “It’s worth it!” a menopause coach from the Tri-State area says as she stands next to me. The woman tells me her name, but I can’t seem to remember it or locate the card she gave me; it’s probably perimenopause.
If menopause is the cessation of a woman’s menstrual cycle, perimenopause is the three- to sometimes 10-year hormonal circus that precedes it—a symptomatic “zone of chaos” as Texas-based celebrity ob-gyn Dr. Mary Claire Haver has called it. It can involve—among other things—heightened anxiety, irregular periods, labile moods, night sweats, sleep disruptions, brain fog and forgetfulness. I’m 48 and in the zone.
I’m here (with my $424 ticket) alongside more than 400 women d’un certain age dressed in what I can only describe as meno-core—ethically sourced cashmere, designer Caddis readers (the brand Gwyneth Paltrow sported at her viral ski trial) and a profusion of leopard print—today’s sartorial antivenom against the invisibility historically associated with female aging. (Men—I spot only one—appear to be as rare as hot-flash-trapping synthetic fabrics.)
The Rolling Stones’ Start Me Up blasts, attendees’ fists are pumping, and the event’s co-hosts—Swell’s 50-year-old founder Alisa Volkman and 56-year-old actress Naomi Watts—take to the stage to applause and a sea of hoisted iPhones. Menopause has gone Hollywood, and Watts has emerged as one of its well-hydrated faces. This January, she released her memoir, Dare I Say It, chronicling her early menopause journey, and in 2022, she founded Stripes Beauty, a “pro-aging” wellness line of “scalp to vag” beauty and skincare products. They include such punny products as Vag of Honor, a vaginal moisturizer, and a hydrating cream called Dew As I Do. At this event, discussions are fairly soaked with allusions to perspiration and exhortations to lubricate.
Watts introduces the day’s all-star lineup of speakers: a sort of women’s health League of Nations, heavy on physician influencers. They’re all founding members of the so-called “menoposse,” a group of roughly three dozen celebrity doctors who command more than 5 million Instagram followers. The redoubtable high priestess of the posse is Haver (anointed by the New York Times as The Queen of Menopause), who has parlayed her platform into a multimillion supplement business called The Pause Life. Haver was scheduled to headline today, but is a no show. Throughout the day, I hear attendees whisper speculatively about her mysterious absence. Although, at least philosophically, hushed tones are not the vibe here. Menopause has entered the chat, has grabbed the mic and is living out loud.
The Swell is part of a global shift in how menopause is discussed, understood, collectively metabolized and marketed. Long referred to as The Change, menopause is in the throes of its own full-scale transformation and PR rebrand. Canadian ob-gyn Dr. Jen Gunter, author of the Menopause Manifesto, has partly attributed menopause’s pivot to arithmetic: She told Wired magazine that 471 million women worldwide were in menopause in 1990, but by this year, that number is projected to be more than 1 billion. “This is not a niche [medical] event,” she says. “This is a main event for half the population.”
The population inflation dovetails with our increasing lifespan, the pandemic-enabled algorithmic rise of the Instagram celebrity doctor and a cross-generational, morally directed rejection of the mute button. “There’s a cohort effect: Prior generations were silent about menopause, but Gen X, who tend to reject things, are like, ‘We’re not doing this anymore!’” says Dr. Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause and treats menopausal women in her practice. Millennials, who are more open and active online, are even less willing to put up with the silence and shame around it, she adds.
A-listers have taken up the gauntlet, too, turning menopause into a cause célèbre. Halle Berry, in a cri de coeur, shouted, “I’m in menopause!” on Capitol Hill last May, helping to pass legislation to fund research and education. Michelle Obama spoke candidly about a hot flash she had on Marine One on her podcast, describing it “like somebody put a furnace in my core and turned it on high.” And last September on The Today Show, Alanis Morissette summed up her current mood as “this beautiful perimenopausal unravelling.”
All of this has delivered me to this overcrowded room in Brooklyn’s Dumbo neighbourhood, where, over the next seven hours, we will be educated on the havoc menopause will wreak on our bodies, bones, skin, hair and brains. And we will be exhorted by panelists to, in no particular order: reclaim our power, let go of lies, take up jumping (box jumping, squat jumping or even jumping jacks will do), lift heavy weights, see aging as a privilege, stop mourning the passage of time, eat more protein, advocate for ourselves, grant ourselves permission, take what we need (but with discernment), and feel the “earth energy” and “freedom in our pelvis.” I’ll admit that I had expected something more cortisol-soothing and Goop-ian—more flower walls and green juices. Yes, the energy is friendly and confiding, but it’s also rousing, evangelical, thrumming with outrage, equal parts conference and crusade, rally and rave. Except instead of, say, glow sticks or protest placards, guests are aggressively waving fans in time to a Gen X-friendly playlist (OMD, Madonna, George Michael).
At some point in the early afternoon, as my energy declines and my attention sags (much like my estrogen levels and my jowls), I take a break. I wander through the Middle Aged Marketplace. There’s a library of menopause literature, featuring the guest speakers’ books (including OB Dr. Sharon Malone’s Grown Woman Talk, Italian neuroscientist Dr. Lisa Mosconi’s The Menopause Brain and Dr. Vonda Wright’s Guide to Thrive) because menopause is now a genre.
It’s also a movement and a marketing ploy, fecund with financial opportunity. Next to the bookstand and across from Nutrafol, a line of hair-growth supplements (because hair thinning and loss is another potential menopausal symptom), a woman with her eyes closed sits and vibrates on an electromagnetic-powered chair called the Emsella, designed to incite quick muscle contractions for better-than-kegel pelvic-floor strengthening. Other women mill around dipping their fingers in pots of Jones Road jojoba seed-oil-packed “Miracle Balm,” moisturizing cream blush designed for dry, mature skin. “What brings you here?” one woman asks her new friend, who gloomily replies, “I make toys, but it’s terrible.” I don’t know if the woman is referring to making sex toys or cat toys, but I don’t ask. I stay unfashionably silent. The toy-maker continues brightly, popping a calcium chew being sampled at the Seen Nutrition stall: “I’m thinking of getting into the menopause field!” Given the turnout here, it’s a solid plan.
***
MENOPAUSE HAS HISTORICALLY BEEN framed around a narrative of loss, tied to the full stop not just of a woman’s ovarian function and reproductive life, but of youth, beauty, sexuality, relevance and worth. The message: Yes, it’s a natural and inevitable life transition, but it’s also a fate—if not worse than death, then at least death-adjacent.
I first heard the word menopause from The Golden Girls, the OG menoposse. In a 1986 episode, titled “The End of the Curse,” Blanche—presumably in her early 50s—thinks she’s pregnant (her period is nine days late). She visits her doctor for confirmation and returns disconsolate. Rose and Dorothy deduce from the grimness of Blanche’s mood that she must be terminally ill. “I’m not dying, Rose, but I might as well be. It’s menopause,” Blanche announces to a swelling and vaguely tragic soundtrack. “I wish I could die, because as far as I’m concerned, it’s the end of my life!” Her career as a seductress—her life as herself—is over. Blanche slams the door on her friends and retreats to her bedroom to suffer in silence.
“There are so many things that women are supposed to keep quiet about and just endure. Menopause is part of that continuum,” Thurston tells me, “but it is imbued with an extra layer of shame and silence because it’s gynecologic, it’s associated with aging, it’s not particularly sexy.”
The silence around menopause is both internally and economically motivated, perversely endorsed by the Canadian and American medical systems. Women are not encouraged to talk to their doctors because doctors themselves receive little to no education in menopause care. (In fact, a U.S. survey conducted by the Menopause Society found that just one-fifth of OB/GYN residency directors reported that menopause education was part of their training.) “Why aren’t we training the providers? Because menopause is seen as a financial loss leader,” explains Thurston. In all Canadian provinces except for Manitoba, and in the U.S., family doctors can’t bill appropriately for menopause care and therefore aren’t motivated to educate themselves or properly treat their patients; the financial model is set up to put both patient and physician on mute.
The system is built around menopausal women quite literally not getting the time of day. “There’s no comprehensive fee code for primary care for menopause,” Toronto-based Dr. Woganee Filate explains. In other words, if you go to your doctor and say, ‘I want to talk about menopause,’ your doctor can only get paid for a 10-minute increment.” This blind spot in women’s health care has been called the biggest medical ball drop of the last 100 years. The menopause movement, dubbed the MeToo of women’s healthcare, represents a sort of reckoning.
The Menopause Clinic and Premature Ovarian Failure Clinic at Toronto’s Mount Sinai Hospital, helmed by Dr. Wendy Wolfman, is attempting to help fill this gap. The clinic has fundraised $31 million in the past two years and will have a new space with more staff in 2027. In the meantime, Wolfman tells me, the clinic currently has a waitlist of 2,500 people. When I ask her how long it might take to see a doctor at the clinic, she looks into the distance, considering the incalculable. “A long time,” she ventures.
What may be an epic ball drop and financial loss for the medical system is a windfall for the menopause market. The new Meno Inc., estimated at US$16.9 billion globally, bleeds into the beauty and wellness industries, ever-fired by our collective obsession with self-improvement and optimization. Today’s menopause economy is flooded with femtech start-ups, entrepreneurs, menopause coaches, books, naturopaths, supplement companies, conventions, doulas, snacks, influencers, trainers, podcasters, digital health platforms and even menopause entertainment (there’s the PBS documentary The M Factor, comedian Samantha Bee’s off-broadway show How To Survive Menopause, and a new CBC menopause comedy in production called Small Achievable Goals from Baroness Von Sketch alumni Meredith MacNeill and Jennifer Whalen).
What has long been a black box to most practitioners now also serves as a kind of welcome mat for new private healthcare clinics. In December 2024, Filate co-founded Lume Health + Wellness in downtown Toronto. The new clinic “connotes illumination” and that “women have been in the dark,” she says. “Especially after we’ve had our babies, we’re forgotten by society and by the medical community. We wanted to [turn] the light back on.”
Lume offers programs in pelvic health, sexual wellness and peri/menopausal care and support (a three-month package that will run you $895). The latter provides individualized care and guidance around MHT (menopause hormone replacement therapy). The care is individualized because menopause affects women in wildly different ways. For Black and Hispanic women, menopause symptoms, like hot flashes and night sweats, are more severe and can last longer, while Asian women, for example, have fewer hot flashes but suffer more from musculoskeletal pain. “Menopause care shouldn’t be tacked on as a 10-minute conversation after a blood pressure or UTI appointment,” says Filate. “We want to give doctors and patients the time.”
In the new menopause economy, MHT—which typically consists of a combination of estrogen and synthetic progesterone—is enjoying a dramatic pendulum swing. Once among the most prescribed treatments in North America and widely viewed as a miracle potion, its use sharply dropped after a 2002 study conducted by the Women’s Health Initiative determined that MHT increased the risk of breast cancer. Researchers have since established that the study, which caused widespread fear and panic, was extravagantly misleading and, summarily, wrong.
Today, MHT, which can treat hot flashes and bone loss during the menopause transition, is back in vogue, but it remains a highly fraught, inflammatory subject. “There is so much emotion around hormone therapy. But it is a drug like any other drug: there are risks, there are benefits,” says Thurston. “We keep layering onto it this expectation that it’s going to do all the things: it’s going to prevent brain aging, it’s going to make your skin look great, it’s going to improve your libido. It defies logic.”
Thurston believes we need to get away from thinking about MHT as a panacea—or a poison: “We vacillate between these two poles.” In the New Menopause era, there seems to be a New Shame in not taking it, as if failing to immediately demand a prescription from your physician is also a failure in proactivity and self-advocacy, an anti-feminist sign of self-abandonment. Shame, alas, is still trending.
But not everyone even knows to ask for MHT, and visiting your doctor about peri/menopausal symptoms can inspire a sort of head-patting dismissal—the suffering not considered significant or life-compromising enough to warrant the RX pad. The healthcare system, with its educational deficits and history of medical gaslighting, has often left women siloed and suffering. It’s also escorted them directly to their naturopaths, to “natural remedies,” to the supplement aisles of Whole Foods, and even—most problematically—to certain medspas where doctors can administer Botox with a side of bio-identical hormones.
This new surfeit of information and choice feels less empowering to me than overwhelming. I wonder whether or not I should go on MHT, or whether I need to start drinking the “Hot Girl Menopause Smoothie” (your basic status-smoothie confection of maca, blueberries, coconut water and vegan protein) that The M Factor producer Tamsen Fadal sips cheerfully on her Instagram page. Maybe that will give me the energy to start a strength training regimen before my bones snap like twigs. Perhaps I should order a weighted vest and some dumbbells, except that my house is too small for a home gym, so obviously we’ll need to move. I suggest this to my husband, but then we have an argument, so perhaps I need a new husband. Or maybe I just need to attend a menopause retreat? (There’s one I can’t afford—it’s $8,600—in the Maldives called the Pause Retreat.)
When I meet Toronto-based virtual personal trainer and menopause coach Samantha Montpetit-Huynh, she tells me that she is also hosting a retreat, called Flip Flops and Hot Flashes, in Costa Rica this spring (starting at $1,800 a person, not including airfare). These tropical hormone holidays invite peri/menopausal travellers to spend a slow, restorative week partaking in gentle yoga, sacral dance, strength training, cold plunging and journalling. “So many women think that this time of our lives means everything is over. No more fun,” says Montpetit-Huynh, “I say fuck that! This is our time!”.
Montpetit-Huynh recounts her own experience with menopause and the healthcare system. “I had zero support from my MD,” she says. “When I would bring up menopause, she would be like, ‘Well, I don’t know if it’s menopause.’ Umm, ma’am! ‘Of course you don’t know because nobody taught you.’ My naturopath, a hormone specialist, was a life saver!”
Montpetit-Huynh educated herself, completed menopause courses with a gynecologist, fitness coach and personal trainer, and started coaching women over Zoom. A menopause coach might offer fitness, nutritional and emotional counsel; Montpetit provides all three. I take the opportunity to ask for her expert advice: how does a regular person navigate this new world? “It is highly recommended to get a menopause coach!” Montpetit-Huynh says plainly, with a caveat: “There are now a ton of coaches. A ton. It’s very predatory. Everybody is slapping menopause on their brand, on every product.” (There is no standard certificate to become a menopause coach, which further fogs the landscape.)
“As a scientist, steeped in this literature, it’s hard for me to navigate my way through this, to sort fact from fiction. There’s no hope for the average individual,” Thurston says. “It’s a buyer beware situation.” At the very least, it’s wise to avoid magic-bullet products that overpromise with such cha-ching (and nonsense) catch-phrases as “balances hormones,” “dissolves belly fat” and “speeds up metabolism.”
This all reminds me of flailing my way through the wilds of early motherhood. I recall that, wrapped in a fuzzy postpartum hyper-fatigue that left me at once numb and over-sensitive, I somehow needed to summon a militant philosophical position on nearly everything (sleep training, breastfeeding, swaddling, slings, coffee). At the same time, I felt a peculiar rising pressure to hire staff (lactation consultants and sleep doulas) to instruct, cheerlead and shame me at every turn. Motherhood, like menopause, leaves you disoriented, ill-armed, in extremis: the ideal consumer.
“Every time a woman is in a vulnerable state, there is something to sell her,” muses functional medicine practitioner Dr. Shalini Bhat, who helms Toronto’s the Movement Boutique and designs customized protocols to treat everything from a patient’s mindset to their microbiome. “There’s business in vulnerability.” This strikes me as correct and deeply depressing. Instead of flying to a Costa Rican beach or hiring a personal hormone concierge, I long to take to my bed like Blanche.
This is not to say that I’m recommending a return to suffering in silence or to viewing MHT, for example, as poisonous, or all supplements as snake oil and money-wasting exercises in self-delusion. I’m a fan of knowledge, information and personal choice, and I subscribe (and find hope and comfort) in one of Haver’s taglines: “Menopause is inevitable. Suffering through it is not.”
I thought of this recently while chatting with a friend at her house when her doorbell rang and she beamed with excitement. Was it a food delivery? A lover? “My hormones are here!” she said, gleefully, as she unparcelled her estrogen gel and her progesterone pills. My friend had gone through menopause in her mid-40s, and when she was ignored by her family doctor, she found a naturopath who listened, prescribed MHT and changed her life. “Some people have great success with MHT and others don’t,” says Bhat. “People want answers and the quick fix: What’s the supplement? What’s the medication? But it’s about individualized medicine and finding [a trusted healthcare provider] who works in nuance.”
In hopes of finding more clarity, I attend Toronto’s inaugural Menopause Show, hosted by television personality and host of the podcast Aging Powerfully Melissa Grelo. More than 3,000 people attend the day-long event, which features fitness trainers and authors and virtual health-platform reps, as well as matcha companies (“matcha for menopause!”) and so-called hormone-balancing snacks with names like Lady Bits and Bites. I stop at a Jamieson drugs stall that features a “Dear Menopausal Me” wall that’s covered with pinned, hand-written confessions and imperatives such as “Men are stupid. We aren’t crazy,” and “Don’t worry what others think. Do what is best for you, always. And get the divorce!”
Aeryon Ashlie, Vancouver-based founder of five-year-old supplement company Aeryon Wellness, shares her own advice with the motivational let’s-do-this energy of a locker-room coach: “My big message to women in their 40s and 50s is: Have a menopausal plan! Go have a conversation with your doctor! If your doctor gaslights you, go find someone else. This is game time!” That checkbox plan, while hardly revolutionary, can include ways to : exercise, sleep well, manage stress and eat more protein and fibre. “You can’t out-supplement, out-MHT a crappy lifestyle,” Ashlie says.
She—like many of her customers—believes natural health products provide, as their name suggests, supplementation. While all Canadian supplements are third-party tested by Health Canada, their purported benefits are often not scientifically proven. Aeryon Wellness products, available in more than 600 stores across Canada and the U.S., include a perimenopause supplement called “Reclaim.” One satisfied customer states her mother-in-law’s menopause symptoms disappeared completely after one week on Reclaim.
Ashlie—the sort of CEO who walks on her treadmill on an incline while sending emails—has a muscular conversational style, each sentence lunging after the next; it leaves me feeling like I’m constantly running breathlessly behind. Ashlie, 50, tells me that she can leg press 390 pounds, takes micronized creatine every day to boost muscle strength (and so should I), and maintains a strict squat, lunge jumping and skater practice to improve bone density and agility. She concludes: “I’m training to age powerfully.”
***
ONE OF THE UPSIDES to aging, as I have sometimes liked to think, is that it might be freeing in some ways. “It’s called the Fuck You Fifties,” Jane Fonda has said, reframing midlife as a time when women can finally become not only who they want to be but who they are. A monologue from British comedy drama Fleabag flashes to mind. Belinda tells the younger Fleabag that with menopause comes liberation: “You’re free. No longer a slave, no longer a machine with parts. You’re just a person in business.” Bewildered, Fleabag responds, “I was told [menopause] was horrendous.” Belinda takes a celebratory sip of her martini and says dryly: “It is. But then it’s magnificent.”
The problem, it seems to me, with the commercialization of menopause is that it feels freshly confining—it’s a new prescription. Today, you’re not just a person in business, you’re a business opportunity, a consumer category, someone being aggressively sold a million different products. We’re now being instructed—again—how to eat, how to exercise, how to moisturize, how to optimize our suboptimal bodies, how to remain attractive and relevant, how to go for walks and how to age. I think about the title of Tamsen Fadal’s new book, out this March: How to Menopause. Menopause is now a verb. It’s something else we have to perform, master, do.
At the end of The Pause in Brooklyn, neuroscientist Dr. Wendy Suzuki, known for her work on the brain-changing effects of exercise, takes to the stage and urges us to chant and punch the air in unison: “I. Am. On. Fire. Now. I. Am. Wonder. Woman. Strong.” Suzuki asks us to turn to the stranger next to us and say: “You have a beautiful brain!” As I leave the room, my brain feels unfresh, weary, foggy. I feel another personal affirmation coming on: “I. Am. Exhausted.”
Maybe it’s because my brain, according to Dr. Lisa Mosconi, is not in decline but in the midst of a full system update. In her 2024 book, Mosconi argues that the female brain undergoes three major neurological remodels: during puberty, pregnancy and perimenopause. “While the general mindset in the Western world is that menopause takes things away from us,” she writes, “the untold story is that it’s also busy endowing us with new gifts.” After menopause, Mosconi says, women are capable of greater empathy, emotional mastery, general life satisfaction and what she dubs “self-transcendence.” I want to believe in all of this, in this freeing, empathetic, transcendent magnificence ahead. But I’m not buying it yet.