17 Oct 2023

We still need to talk about menopause

9:01 pm on 17 October 2023
Doctor (gynecologist or psychiatrist) consulting and examining woman patient's health in medical clinic or hospital health service center

We need to keep talking about menopause, says journalist Niki Bezzant. Photo: 123RF

By Niki Bezzant*

Nearly two years ago I wrote a book about menopause called This Changes Everything. I expected it would be reasonably well-received, and I hoped it might help some people, which both happened. I didn't really anticipate how it would change things for me, too.

I've spent a lot of time since then talking to people about menopause, and sharing what I know with women (and people of all genders) in workplaces up and down the country and overseas. When I started my book research, menopause was hardly talked about. Now, I don't think we can say that at all. Some would say we're talking about it far too much, in fact. To which I say: we've got hundreds of years of silence to make up for, so I don't see us shutting up any time soon.

Author Niki Bezzant's new book about menopause is called This Changes Everything.

Niki Bezzant Photo: Reuben Looi

It's interesting to reflect, this World Menopause Day, on the fast pace of change in the menopause landscape over the past couple of years. Here are some things I've been reflecting on, noticing, and seeing in the research.

We're getting more knowledgeable

Among the half of all people who will experience perimenopause and menopause, knowledge is growing. The women I talk to now know more about menopause - what to expect; what their treatment options are - than women I met two years ago. We can see that, possibly, in the swift increase in demand for hormone therapy (HRT or MHT) that's caused supply issues on and off for several years (somehow our drug funding agencies and the drug companies themselves did not see this coming).

However, the same basic questions come up often from women, showing we've got a lot of education yet to do. A constant theme is that women don't always recognise the symptoms they're experiencing - especially mental health struggles like anxiety, depression, panic and low mood - as being potentially hormone-related. There's definitely a need for us to understand more about this life stage before we get there. I'd love the millennials - who are starting to hit perimenopause right about now, believe it or not - to be way better prepared for it than the average GenX-er is.

Doctors are upskilling

Perhaps in response to more demand from half their patients, health practitioners and GPs in particular are getting more up-to-date knowledge about the menopause transition (perimenopause and menopause) and becoming more confident prescribing MHT and other therapies. Which is great. But - and not to bag GPs, who have a seriously tough job - there's still a way to go. The NZIER/Global Women report The Silent Transition, released today, found GPs are still often missing the memo when it comes to perimenopause.

The report includes this sad statement: "Women are… as likely to be offered sleeping pills, antidepressants, pain medication or other medicines as they are to be offered hormone replacement therapy (HRT)."

The report also found GPs more likely to offer advice on diet, exercise or other 'lifestyle adjustments' than they were to offer hormone therapy. I'm the first to agree those things are important - but they're just one piece of the treatment puzzle. If a woman has got as far as the doctor's office seeking help, there's a pretty good chance she's already tried lots of the lifestyle stuff, and a whole lot of other things besides. She should be able to expect to be assessed for hormone therapy; a highly effective and safe treatment which can be, in the words of more than one woman I've met, life-changing.

Older woman working out on gym equipment

Diet and exercise are important, but they are only one piece of the treatment puzzle, Niki Bezzant says. Photo: Centre for Ageing Better / Unsplash

We're talking more about menopause at work

I've been invited to talk about menopause at 30 organisations this year. Workplaces are responding to demand from their people for education and support around the menopause transition. They're understanding it's important for the good of the women who work for them, and also for the bottom line. Retaining senior talent and attracting the best people means showing you're committed to looking after them.

Still, there's a disconnect. The NZIER report found 42 percent of women who were experiencing menopause symptoms took one or more actions that resulted in a loss of economic productivity, with costs to employers and society, and, of course, costs to the women themselves in the form of lost income. The report found that women still feel reluctant to talk about menopause with their managers, despite most employers saying they were open to the conversation and wanted to offer support. And despite employers showing a fairly low level of knowledge (half were not aware, for example, that many women struggling with menopause consider reducing their hours or quitting their jobs), less than 40 percent felt they needed to learn more about menopause.

Marketers have sensed a new feeding ground

As someone who worked in the nutrition space for a long time, I've seen this before. Where there are vulnerable people with a problem, there are marketers ready to step in with a 'solution'. Hang out on menopause Instagram, as I do, and before long you'll be targeted with ads for everything from tests to tell if you're in perimenopause (not recommended by any expert, FYI) to supplements to ease menopause symptoms 'the natural way'; to diet and exercise programmes promising to melt away your 'meno-belly' and turn you into a sculpted goddess. Not to mention the constant assault by beauty and wellness companies with products to stave off the ravages of time. These companies have all identified the serious purchasing power held by midlife women. They haven't quite grasped that gendered ageism might just be a turnoff for a lot of that cohort.

We're not always accentuating the positive

I'm constantly saying this: menopause stuff is not all doom and gloom. I think that's a really important message, especially in the face of media stories that can miss a bit of the nuance around it and go for the 'crisis' angle.

Yes, there are really rough times during menopause for some women - and I've heard truly tragic stories recently of women misdiagnosed and poorly treated with devastating consequences - it's so important to think about what this transition offers us, too. I believe it's an opportunity to look up from our busy lives; to reassess where we are and where we want to go, to reconnect with ourselves and think about how we want the next 40, 50 or more years to be.

If we're lucky, we're going to live longer in a post-menopausal state than in any other during our lifetime. Now's the time to think about what we want that to be like, and take steps to make that happen. It's also the time to embrace the wisdom, experience, authority and mana we gain by moving through this stage and into the next.

*Niki Bezzant is a writer, speaker, journalist and author focusing on health, wellbeing and science.