Menopause Doesn't Look How You Think It Looks

On screen and in the media, menopause has a “look.” It’s the fifty-year-old woman fanning herself because of hot flashes. It’s the fifty-year-old woman uncomfortable and suffering from night sweats. (Think Kim Cattrall as Samantha in the second Sex and The City movie.) Most of us have become attached to this narrative. We recognize it.

But the prevailing narrative isn’t the truth about menopause. A study of over 40,000 women revealed that many women experience menopausal symptoms much earlier than 50 and those symptoms aren’t always just hot flashes and night sweats.

Scary Mommy spoke with Dr. Alicia Jackson, PhD and CEO of Evernow, to break down the narrative and understand the truth about menopause.

“Menopause is a critical inflection point around women’s lives,” says Dr. Jackson. “It’s one of the largest misunderstood areas of women’s health despite it being one of the most critical areas of women’s health.” Menopause can impact how we age, our health past menopause, and what diseases we’re vulnerable to as we age.

Menopause Is Not Just Hot Flashes

According to the study from Evernow, hot flashes are not the most disruptive or severe symptom women are experiencing–despite the narrative we’re consistently presented with. Nearly 80% of respondents reported brain fog, weight changes, sleep disruption, and fatigue. Over 60% reported joint or muscular pain, night sweats, and hot flashes. Over 50% reported skin and hair changes, vaginal dryness, and mood swings.

Dr. Jackson confirmed this finding. She noted that women reported that the more disruptive symptoms include: waking up in the middle of the night, difficulty falling asleep, and weight changes (despite no other lifestyle changes). In perimenopause, women reported brain fog as the most disruptive symptom.

Symptoms Change Over Time

In a press release, Dr. Jackson highlighted that “[w]e now know that the symptoms of menopause can last a decade-plus.” These symptoms also evolve over time and that evolution is critical to our understanding and treatment of menopause. Early symptoms may be subtle and misattributed. For that reason, they are frequently overlooked or dismissed, and care is delayed.

For example, a woman in perimenopause is more likely to experience mood swings, anxiety and depression, skin and hair changes, while a woman in late menopause is more likely to experience vaginal dryness, urinary issues, and painful sex. Likewise, 80% of respondents reported brain fog. However, brain fog was more severe in perimenopause.

In perimenopause, “symptoms will look different than menopause and still should be treated if women want to treat them,” notes Dr. Jackson.

The Symptoms Aren’t Merely Bothersome

The study found that menopause symptoms aren’t simply bothersome or uncomfortable. They are disruptive and impact daily life and health. The average symptom was rated 3.27 on a scale of 0-4. More than 95% of respondents rated at least three symptoms as “severe” or “very severe.”

The study also found that hysterectomies, smoking, and a higher BMI can cause women to experience more severe symptoms. When it comes to hysterectomies, women often aren’t even informed of the fact that they will likely experience strong menopause symptoms after surgery. Dr. Jackson highlights how shocking it is that a woman might undergo a major surgery without being prepared for all of the effects afterward.

The Narrative Needs To Change

The problem with the narrative that menopause is simply a woman in her fifties experiencing hot flashes and night sweats is that when women come in with any of these other symptoms, they aren’t given the solutions they need. Dr. Jackson notes that, particularly in perimenopause, when a woman complains about symptoms like brain fog or weight gain, she’s being told to eat better or sleep more, rather than being educated on perimenopause and potential treatments available.

As of now, unless a woman is experiencing hot flashes or night sweats, doctors won’t prescribe anything. But the data is showing that’s wrong. According to Dr. Jackson, treatment, even low doses of hormonal therapy, can help decrease symptoms, including anxiety, brain fog, and sleep disturbances. “Timing matters,” says Dr. Jackson. A growing body of evidence shows that treatments can have more of an impact when started earlier.

Dr. Jackson urges women to find a great medical provider who is knowledgeable and educated about perimenopause and the treatments available. If that person can’t be found, she urges women to educate and advocate for themselves. “You want to hire the person who is going to help you solve [the issue you are struggling with] in a safe and effective way that feels like a partnership.”

Menopause has been largely understudied and misunderstood. For so long the “default human for medical studies,” according to Dr. Jackson, has been male. “We have to build the science for women.” This study is a step in that direction, a step in the direction of shattering a narrative that for too long has kept women from getting the treatment and support they need to live their best lives through menopause and beyond.