Yahoo Lifestyle The flash and burn moment: Perimenopausal women are ‘enraged’
Samantha Bee was 47 years old when she found herself sobbing at the doctor’s office.
The comedian and former prime-time talk show host went in for her annual appointment but burst into tears after her gynecologist asked how she was doing. “I was like, ‘I never sleep. I get my period every eight days, I don’t know what is going on with my body, my job is so hard,’” Bee, now 55, recalled in a phone call.
She had been suffering for over a year, she admitted. Bee, who debuted her limited-run off-Broadway show “How to Survive Menopause” in New York City this October, said she’d been scared she “was losing [her] mind … I was like, ‘something terrible is happening to me.’”
But the doctor offered another explanation. “She was like, ‘Hold the phone!’” Bee said. “‘How old are you? Oh honey, you’re in perimenopause.’”
Perimenopause - the time leading up to menopause - has recently entered pop culture with the ferocity of a hot flash. That’s when hormone fluctuations can trigger heart palpitations and night sweats (vasomotor symptoms, in doctor speak), mood swings, memory lapses, vaginal dryness and more. Yes, women have long been told (however vaguely and inadequately) about menopause, but the turbulent trip to get there? Nobody really prepared them for that shock. And now they’re looking for answers, anywhere they can get them. Google trends data shows that searches for “perimenopause” started rising in late 2022 and jumped up again in early 2024, with no sign of slowing down.
A-listers are literally shouting about it: In May, Halle Berry spoke on Capitol Hill, the dome of the capitol building framing her from behind. “I’m in MENOPAUSE, okay?” she announced with guttural, pathbreaking pride, in support of a $275 million federal pledge for menopause research and education. “Our doctors can’t even say the word to us, let alone walk us through the journey.” Earlier in the year, Berry also talked about a herpes misdiagnosis she had received a few years ago during perimenopause, saying her doctor had no understanding of the condition.
Other celebrities preaching from the perimenopause pulpit include Drew Barrymore, 49, and Gwyneth Paltrow, 52, who has been noodling on the once-shrouded life transition with the buy-in of her well-heeled Goop-ies. Two high-profile Naomis have shared details about their symptoms: Naomi Campbell, 54, fanned herself when a hot flash hit on camera in the Apple TV docuseries “The Super Models,” while Naomi Watts, 56, has launched Stripes Beauty, a product line aimed at midlife customers.
The dawn of the perimenopausal woman has arrived, and with it, a flood of creativity. In May, Miranda July published her best-selling novel “All Fours,” in which a 45-year-old “semi-famous artist” finds herself on the edge of a hormonal cliff and jumps, leaving the comfortable shores of domestic life - the New York Times called it “the first great perimenopause novel.” “The Substance,” starring Demi Moore, turns a 50-year-old woman’s quest for eternal youth into a gruesome, phantasmagoric satire that has been interpreted as a metaphor for the “disorienting emotional carnage of menopause.” And who could forget a 2019 episode of “Fleabag,” in which Phoebe Waller-Bridge’s train-wreck, 33-year-old character encounters an older woman, played by Kristin Scott Thomas, who monologues on the pleasures and pitfalls of the path to menopause?
Bee, who will release the Audible version of her show in March, couldn’t be happier that people are finally talking about it. “It’s reverse puberty!” Bee said emphatically. “Puberty was really really hard, okay? But when we were in puberty we were younger and we didn’t have any responsibilities, we didn’t have children ourselves, we didn’t have jobs, we didn’t have mortgages to pay.”
Something clicked - personally and professionally - when she learned she was in perimenopause. “We get to this one phase that literally half the population is going to go through … and suddenly, we all feel we have to shut up and be really quiet because all the problems that we rack up feel really embarrassing.”
But it doesn’t have to be that way, Bee said. “We gotta rip the Band-Aid off … I just think we have to talk about it with humor and zest.”
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Before we go any further, let’s define our terms. “Menopause” is a catchall word but technically, it describes just one day - a year after a woman’s final period. After that, the person is considered postmenopausal. But it’s perimenopause, the stage before menopause that can last anywhere from two to eight years, when things tend to get hairy.
Perimenopause, which begins on average at age 47, is when women are “the most symptomatic,” said Mary Jane Minkin, a gynecologist who has been practicing and teaching at the Yale School of Medicine for more than four decades. “The problem is, in perimenopause, estrogen levels fluctuate all over the place,” Minkin explained. “It’s tough, it’s hard and it drives people crazy.”
Don’t be surprised if you haven’t heard all of this, even if you’re a person with ovaries. “Menopause education stopped in the United States as of July 9, 2002,” Minkin said definitively. That’s when the Women’s Health Initiative, or WHI, announced it was halting its trial of the use of hormone replacement therapy (HRT) in 16,000 healthy postmenopausal women because of an increased risk of breast cancer, heart attack and stroke. At that time, “the world stopped as far as menopause is concerned,” Minkin went on. Residency programs, already intent on cutting back hours, stopped investing time teaching menopause, she said, while practicing doctors became much more hesitant to prescribe HRT.
And women didn’t want to take it anyway. The WHI study has since been criticized by doctors and women’s health experts, but at the time the fallout was instantaneous. “Women threw their estrogen in the toilet,” Minkin recalled.
These women suffered through their perimenopausal symptoms while their daughters watched. Now, 20 years later, those daughters are fumbling toward middle age themselves - and they want answers. “I actually predicted this would happen,” Minkin said. Since 2002, she explained, the vast majority of doctors and nurses haven’t received good-quality menopause education. The difference is that now, their Gen X and millennial patients won’t stand for it:
“The women who outgrew the WHI have become enraged.”
Many women are enraged because they’re being told they have to grit their teeth and power through perimenopause, without the option to explore potentially beneficial hormone therapy. Or worse, they’re seeing doctors - the ones who didn’t get any menopause training in medical school - who downplay their symptoms and tell them it’s just the new normal. There’s a reason that articles like 2017’s “The New Midlife Crisis” in Oprah magazine and last year’s “Women Have Been Misled About Menopause” in the New York Times have gone viral: women are hungry for information and community surrounding this stage of life.
“Once you see the injustice that’s been done to women by not talking about this for all of time, you can’t unsee it,” said Heather Hirsch, an internist who headed the Menopause and Midlife Clinic at Brigham and Women’s Hospital in Boston until 2022. “I think that the rise of this as a cultural phenomenon is a little bit like a #MeToo movement. We’re not going to sit and suffer anymore.”
Just like with #MeToo, the watershed moment was situated in the strange topography of social media, according to Hirsch. “It was definitely part of the pandemic,” she remembered, “Women were starting to share their stories [on TikTok and Instagram] and be vulnerable.” The hashtag #menopause now has 2 million posts on Instagram. “And women were really galvanized and came together and were like, ‘Yeah, what the f---?’” said Hirsch, who has parlayed her own social media footprint (almost 80,000 followers on Instagram and 148,000 on TikTok) into a private, cash-pay telehealth practice. She said the refrain has been consistent across patients and women’s health influencers: “‘Why is everyone gaslighting us?’”
That’s how Aanu Benson felt when, starting in her late 40s, she experienced a rapid decline in her physical and mental health. The normally active, hardworking mother of two noticed a number of unsettling changes, all at once: new belly fat, problems concentrating, irritability, itchy skin and intense sweating, among other symptoms. Benson, who lives in Lagos, Nigeria, and is 52, sought medical help a number of times but “nobody could give [her] an answer,” she said. “That was scary, really very frightening. I thought I was going to die, really, or that I was going crazy.”
Finally, a friend who is two years older suggested it might be perimenopause. “I had a eureka moment,” recalled Benson, who works in aviation administration. “Okay, this is menopause!” Just that simple explanation made her feel better. She threw herself into research, took online courses in menopause health and made lifestyle changes (hormone therapy, she said, is not commonly prescribed in Nigeria). In 2022, she started a YouTube channel titled Sister’s Keeper, devoted to the issues women face in midlife. She started a TikTok account with the same name less than a year later. Today, she has almost 50,000 followers.
Benson, who had experience neither with acting nor social media before 2022, posts humorous, candid videos in which she reenacts her worst symptoms and offers perimenopausal viewers advice on diet, exercise and mental health. Comments on posts such as “Top 6 Perimenopause symptoms Women & Men Need To Know About” - which has more than 4 million views - are a mix of gratitude, solidarity and good-natured TMI. “People are very happy, they’re like ‘Thank you, God bless you, you saved me, I had no idea, I can’t believe this is what is happening,’” Benson said.
Benson does some one-on-one menopause coaching, but she still works a full-time job and said her biggest motivation is “creating awareness … to let women know that they are seen and they are heard and they are not alone.” She isn’t peddling any lotions or potions.
That isn’t always the case on social media.
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Even just five years ago, the idea of a menopause influencer might have sounded absurd. Now, Instagram and TikTok are rife with them. And it makes sense, if you think about it: Kids learn about puberty in school, but there’s no equivalent education for people in perimenopause.
Social media has become the middle-aged woman’s classroom.
But like everything else on the apps, you can’t always believe what you see and hear. Or, maybe you can believe it, but you also have to question the motivation of the person that’s doing the sharing. “It’s like the Wild West out there,” said Hirsch. “Billions and billions of dollars are being spent on marketing, targeting women 44 to 55 because of these symptoms.”
On offer are supplements, wearables, serums, creams and various other pricey palliatives, such as cooling pajamas intended to combat night sweats. Jen Gunter, who has been a practicing OB-GYN since 1996, said she started her first WordPress blog in the mid-to-late-2000s to challenge the medical misinformation she was seeing online. That’s since become a hallmark of her Instagram presence too, where she has 316,000 followers. “It’s amazing that people can talk about menopause,” Gunter said of the online chatter. “It’s amazing that people aren’t embarrassed to have a hot flash … [But] just with any subject on the internet, there is also misinformation and disinformation.”
Scrollers should be “very, very wary” of anyone shilling supplements, Gunter warned, which aren’t regulated by the Food and Drug Administration. When it comes to all the other products that have emerged to combat midlife changes, she said buyers should also be skeptical before whipping out their wallets: “Put menopause on it and it’s like the new pink tax,” she said.
Even social media’s recent vociferous embrace of estrogen - a complete 180-degree turn from the WHI days - should be treated with caution, Gunter said. “There’s this kind of gestalt that I’m feeling online, and I know many of my colleagues are as well, that every single thing in your life can be solved by menopause hormone therapy,” she said. “If you have a sore toe, it must be menopause. If you have frozen shoulder, it must be menopause. And we have to be really careful about what we say because we don’t know a lot of the answers to these questions.”
Samantha Dunham, co-director of NYU Langone’s Center for Midlife & Menopause, agrees.
“All of social media, everybody’s an expert. There’s a lot of mixed information out there,” said Dunham, especially when it comes to hormone therapy. “I want people to be able to seek information that’s reputable and evidence-based. And not rumor-based. So that’s a real risk.”
The good news, according to Dunham, is that with all of the cultural interest in menopause, medical studies of things like ovarian aging and women’s brain health in middle age and beyond are finally happening.
“I think the field is burgeoning,” Dunham said. “Most women spend about 40 percent of their lives in menopause … I don’t think it’s just a flash in the pan.”
And no matter the medical breakthroughs, women who have walked through the sweat-inducing fires of perimenopause say that there’s genuine relief at the end of it.
In the final pages of “All Fours,” the narrator reflects on her four-year journey through perimenopause, which she’d once worried would rob her of her essential self. “Now, I was forty-nine,” she thinks while gazing out the window of an airplane. “There had been cliffs and caves on this odyssey, a golden ring, a tower, but had there been a labyrinth and a crystal? Was I really any different?”
In the much-heralded menopause monologue from “Fleabag,” Scott Thomas’s character tells Waller-Bridge that being postmenopausal “is the most wonderful f---ing thing in the world. Yes, your entire pelvic floor crumbles and you get f---ing hot and no one cares, but then you’re free. No longer a slave, no longer a machine with parts. You’re just a person.”
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