Menopause has long been a taboo topic. Talking about it can help women learn more about an overlooked treatment.
Menopause, for many women, is an unknown — a confusing tunnel to pass through, with limited signage for what to expect.
But one effective treatment has been overlooked for decades, signaling that women’s suffering is widely regarded as unimportant, according to the cover story in today’s New York Times Magazine. I spoke with Susan Dominus, who wrote the article, about her reporting and the reactions it has received from women.
Lauren: I learned more from your story than I’ve ever learned about menopause. It has been so absent from public discourse.
Susan: I too knew almost nothing going into this. I told a friend I was working on a story about menopause. Her eyes went wide and she just said, “Thank you.” And I could tell that what she meant by that was: That’s good, because I know nothing.
After I got up to speed, I was constantly bringing the subject up at dinner parties, asking my friends, “Hey, how is your menopause going?” You’d think that would be really inappropriate — except that practically all of the women around my age I spoke to were bewildered, really struggling and eager to talk about it. Yet a lot of them just accepted their uncomfortable reality: years of horrible hot flashes, night sweats, sleeplessness, depression and brain fog as their bodies approached their last menstrual cycles.
But you explain that those symptoms can be managed — that there is a treatment for menopausal suffering that is often overlooked. Why do you think so many in the medical community do not readily offer it?
It’s called menopausal hormone therapy, an estrogen and progesterone prescription that comes in various formulations: pills, patches or vaginal rings. It is the single most effective treatment for hot flashes.
The therapy does carry some risk, as do many medications people take to relieve serious discomfort. But many women, if they’ve even heard of this treatment, regard it as vaguely dangerous. I know I did. We’ve made that assessment on the basis of what I would call misleading information.
In the early 2000s, researchers who studied the therapy found that it could hurt women’s heart health and increase the risk of stroke, clotting and breast cancer. They announced the risks before developing a clear sense of how it affected women of different ages. Most menopause experts now believe that for healthy women under 60 suffering from bothersome hot flashes and night sweats, the benefits of the therapy outweigh the risks.
What do you see as other factors that have contributed to our aversion to talking about menopause?
In 1966 there was this blockbuster book called “Feminine Forever,” and the author, a gynecologist named Robert Wilson, talked about menopause as a kind of castration — the start of a woman’s desexualization, decline and definitely her inevitable misery.
That shame has held. I remember being 45 and asking an older friend about menopause, and she got really uncomfortable. I was shocked because we were so close. And she just said: “I don’t want to talk about it. It feels too personal.”
Women also feel reluctant to talk about symptoms because they don’t want it held against them in the workplace. That awkwardness and aversion flows through conversations with medical practitioners as well.
Some people may say sexism is the response to the question: Why is menopause so understudied? But is the answer more complicated than that?
It’s important to note that menopause is not life threatening. It is part of life. So much energy has been put into studying pregnancy and childbirth, which can be very dangerous and even fatal.
But I do also think that there is some sexism at play. To paraphrase Rebecca Thurston, a leading figure in menopause research, we have a high tolerance for women’s suffering. She considers it one of the great blind spots of medicine.
Bewilderment is the operative word for many women, of all ages, trying to understand their bodies with limited information. We play roulette with birth control side effects and hope they will be manageable. We get blindsided by the violence of pregnancy and menopause. Do you see signs of change?
If you’re good at anything by the time you’re a 50-year-old woman, it’s coping.
But I think that, since we went through the collective trauma of Covid, many people have become more open about their health in general. And I have the feeling that talking about menopause more is likely part of that.
I’ve been moved by how many women have written to me to say they feel seen, or they feel empowered to get help, rather than just suffer. But in a way, the most powerful emails I’ve received have been from doctors expressing regret about what they did not know all these years — and saying they’re encouraging their colleagues, in various fields, to learn more about it.
Susan Dominus is a staff writer at The New York Times Magazine. Her interests are wide-ranging, but she frequently covers the intersection of science and culture.
More from the magazine
The author Robin Wall Kimmerer says you don’t have to be complicit in a culture of destruction.
Atlanta’s district attorney built a career taking down gangs. Now she may be coming for Donald Trump.
Letter of Recommendation: Hunt for sidewalk fossils.
Poetry: “Birthday,” by Ana Božičević, reminds that wonder needs no ornaments.
Read this week’s full issue.
The U.S. shot down a Chinese spy balloon over the Atlantic Ocean, ending a saga that inflamed tensions. (This video captured the moment.)
The balloon had spent five days traveling southeast from Idaho to the Carolinas.
China declared its “strong discontent and protest” at the shooting down and continued to claim the balloon was a civilian research airship blown off course.
The Northeast confronted record-setting cold yesterday. The weather system led to the death of an infant in Massachusetts.
Wildfires in Chile, which is in the middle of a scorching heat wave, have killed at least 13 people.
Other Big Stories
Pervez Musharraf, the former military ruler of Pakistan and a U.S. ally after the Sept. 11 attacks, died at 79.
Memphis’s Scorpion police unit spread fear, and records show that Black men were overwhelmingly their targets. Five Scorpion officers are charged in the death of Tyre Nichols.
The U.S. Navy wanted to retire eight flawed combat ships. Lobbying saved several of them.
A prospective aide who briefly worked in Representative George Santos’s office accused him of sexual harassment.
Democrats approved changes to their primary calendar, prioritizing racially diverse states.
Bowen Yang played the Chinese balloon wreckage on “Saturday Night Live.” Pedro Pascal hosted.
Factory farms claim to slaughter pigs humanely. Watch this video and decide for yourself, Nicholas Kristof says.
Doctors aren’t just suffering from burnout; they’re demoralized by America’s diseased health care system, Eric Reinhart argues.
Floods and fires are already producing climate refugees in the U.S., Jake Bittle writes.
Online culture encourages young people to put themselves on display even as they’re discovering who they are, Elle Mills writes.
An avian flu pandemic would be even more devastating than Covid. The world needs to act now, Zeynep Tufekci writes.
The Sunday question: Is Biden right to end the Covid public health emergency?
Covid has become endemic, and ending the emergency will help public health officials focus resources on the people who remain most vulnerable, The Washington Post’s Dr. Leana Wen argues. But it will probably also limit access to tests, vaccines and treatments, especially for uninsured Americans, The Atlantic’s Katherine Wu notes.
Work friend: Attempts to avoid a co-worker’s baby photos escalated.
The bright side: Traits that optimists share can help improve anyone’s outlook.
Rarefied clothes: See the fashion inside and outside the Paris couture shows.
Vows: They waited nearly a decade to go on a first date.
Sunday routine: A radio producer considers foraging in Brooklyn’s Prospect Park.
Advice from Wirecutter: Revive a dead car battery with a portable jump starter.
A Yale library: Leigh Bardugo transforms a temple to learning into a portal to Hell.
Chronicle of an investigation: Mark Pomerantz, a former prosecutor, likens Trump to the mob boss John Gotti in a new book.
By the Book: The journalist Alex Prud’homme has a growing colorful pile of books by his bed.
Our editors’ picks: “The World and All That It Holds,” a love story in the time of war, and eight other titles.
Times best sellers: “The Bill of Obligations,” a case for reimagining American citizenship, is a new hardcover nonfiction best seller.
The Book Review podcast: Previewing the next big books.
THE WEEK AHEAD
What to Watch For
The European Union expands its embargo of Russian energy supplies today to include diesel and gasoline.
The Grammys are tonight. Beyoncé leads with nine nominations.
NASCAR opens its season tonight with a race at the Los Angeles Memorial Coliseum.
President Biden will deliver his State of the Union address on Tuesday.
New York Fashion Week begins on Friday.
What to Cook This Week
This week’s edition of the Five Weeknight Dishes newsletter is about the joys of using a knife. Cut up shallots for creamy chickpea pasta; chop onions for a vegetarian dish with farro and lentils; or mince eight cloves of garlic for these garlic-ginger chicken breasts with cilantro and mint.
NOW TIME TO PLAY
The pangrams from yesterday’s Spelling Bee were hematic, mathematic and thematic. Here is today’s puzzle.
Here’s today’s Mini Crossword, and a clue: Martini garnish (five letters).
Take the news quiz to see how well you followed the week’s headlines.
Here’s today’s Wordle.
Thanks for spending part of your weekend with The Times.
Here’s today’s front page.
Lauren Hard, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Ashley Wu contributed to The Morning. You can reach the team at email@example.com.