For many women, menopause seems like a mystery. There’s a vague idea that it starts later in life and might include hot flashes, no more periods and vaginal dryness. Still, it takes so many women by surprise. To help combat this, Dr. Jen Gunter, a San Francisco-based OB/GYN, wrote "The Menopause Manifesto: Own Your Health with Facts and Feminism," available on May 25, to help women understand the transition.
“It’s crazy to me that there’s this really absolute cultural silence about menopause,” she told TODAY. “Most people have a general concept of puberty. Maybe they’re not always accurate on the information but they know it exists. They have an idea when it might be starting and what the implications are. And we just don’t have that with (menopause).”
This silence creates loads of misunderstanding and can even negatively impact women’s health. So often, women just know about menopause in the context of fertility. That means they might not be thinking about how it’s associated with an increased risk of cardiovascular disease, diabetes, osteoporosis and dementia.
“Menopause is associated with a sequence of events that increase risk of many health conditions and bothersome symptoms,” Gunter said. “When you don’t know what to expect when you’re no longer expecting a period, you don’t know what’s normal or abnormal. You may not have the right words to discuss things with your doctor.”
Often women don’t talk to their friends or their doctors about what might be worrisome symptoms. Even if they do address it with their doctor, their concerns go unheard.
“The sad thing is these conversations don’t happen often enough or you may get dismissed. I hear over and over again women saying, ‘Well I was just told that is part of being a woman.’ OK, well that’s not an acceptable answer,” Gunter said.
Menopause is inevitable and many women simply accept that it will make their lives miserable. But women can prepare for menopause and make it a better experience. In the book, Gunter even notes that women in countries that don’t use the term menopause don’t experience as much anguish.
“A healthy menopause is a healthy life,” Gunter said. “So everything that you’ve been told for good preventative health care — like exercise, don’t smoke — those are all things that will prepare you for the best for menopause. Those aren’t the sexy things that you can sell special supplements for or prescribe a pharmaceutical for, but those are the healthiest things.”
Eating a healthy diet and maintaining a lower weight can help, too. But having an open dialogue about menopause and its symptoms also makes a difference. Women know about hot flashes, painful sex or waning interest in sex, but often discuss them as a joke, not a real concern. But these symptoms can be linked to health problems and also impact women’s quality of life.
“Hot flashes are a bothersome symptom,” she explained. “Women who have more hot flashes have a higher risk of cardiovascular disease.”
Understanding this can mean that women can be more proactive about their health instead of chuckling about how hot and sweaty they feel. Hot flashes can also disrupt sleep adding to stress and worsening their experience. That’s why women should consider speaking up about their transition with others and talking to their doctors before they even think they’re in menopause.
“The menopause transition is a pretty long phase that can start even in the early 40s for some women and possibly even late 30s. So knowing in advance that this can happen is very beneficial,” she said. "(Imagine) that a girl would wake up at the age of 12 covered in blood and had no idea what was happening to her body ... menopause is like for a lot of women.”
Younger women’s health can impact their menopause and understanding this might also change their experience. Women who had anorexia, for example, are more likely to have a greater risk of osteoporosis. Women who had a hysterectomy, but still have their ovaries, are at risk of earlier menopause.
“The earlier you’re in menopause, the greater your risk of heart disease,” Gunter said. “Knowing all of this helps people make more educated decisions about their body and the more you know earlier on the more educated you can be.”
Brain fog is another concern. Women going through menopause often notice they struggle to remember things. While upsetting, the good news is that it doesn't last forever.
“It is temporary and reversible and it doesn’t affect everybody. Researchers summed it up best as sort of a temporary slowing down of taking in new information,” she said. “Interestingly, in one study … women who were in their menopause transition, they still outperform men.”
And, having brain fog “is not a sign that dementia is coming.”
“That’s a really important thing for people to know, that it’s in many ways like the baby brain a lot of people talk about when they have a newborn,” she said. “Brain fog feels alarming, but that’s not a cause for alarm.”
But, starting menopause at a younger age also puts women at more risk for dementia.
“When people ask about what’s the best way to prevent dementia, the best way is to not smoke, eat a healthy diet and exercise,” Gunter said. "Those are some of the modifiable factors."
The bottom line: More education about menopause is needed. It will help women feel empowered about their health and maybe even ease their menopause transition.
“Menopause is a vast diaspora and there are people who have really bothersome symptoms and there are people who don’t,” Gunter said. “Think of the menopause transition and the time leading up to menopause as characterized by hormonal chaos. It’s a bit like puberty. Just as you went through puberty and things were pretty rocky and they settled out, that’s the case with menopause.”