Menopause Is Having a Moment

Few celebrities have lived so much of their lives in the public eye as Drew Barrymore has. She appeared in commercials as an infant, achieved global fame after starring in Steven Spielberg’s “E.T.” at the age of seven, and became notorious for her battles with drugs and alcohol before she even hit her teens. A few years ago, the actress launched “The Drew Barrymore Show,” and it was on an episode of that program that she underwent a usually private transition in the glare of public scrutiny. During an interview with Jennifer Aniston and Adam Sandler, Barrymore suddenly peeled off a pin-striped suit jacket as she exhaled and fanned herself, announcing, “I think I’m having my first hot flash!” Aniston gamely ad-libbed, exclaiming, “I’m so honored!,” and laying the back of her hand on Barrymore’s exposed sternum like a mother assessing the temperature of a feverish child, while Sandler looked on in perplexed sympathy. The clip went viral.

Barrymore, who turned fifty this year, is not alone among high-profile women in speaking frankly and openly about the trials of perimenopause, which is now the preferred term for the extended period, lasting as much as a decade, when the reproductive hormones estrogen and progesterone are in flux, but during which a woman is still getting her period, even if sometimes erratically. The phase that encompasses the full transition from perimenopause to postmenopause is referred to clinically as “climacteric” and is colloquially just called “menopause,” although, strictly speaking, menopause designates the single day on which a woman has gone three hundred and sixty-five days without menstruating—a milestone that is easy to miss, at least for the generations who came of middle age before the advent of period-tracking apps. Michelle Obama once described on her podcast her experience of hot flashes: “It was like someone put a furnace in my core and turned it on high.” On Instagram, Courteney Cox satirized a mid-eighties feminine-hygiene advertisement in which she, then an unknown actress, had appeared. (Dressed for an aerobics workout, she confides, “Tampax can change the way you feel about your period.”) Contemporary Cox, clad in an eighties-style leotard and tights, announced, with wide eyes and a rictus grin, “Menopause will eat you alive! It’s horrible.”

Now we’ve got a triad of books about menopause, each written by a woman who has enjoyed a professional life that has depended on visibility—and, to varying degrees, has demanded of her the maintenance of an appearance of youthful femininity. Naomi Watts, the actor, has written “Dare I Say It: Everything I Wish I’d Known About Menopause” (Crown), and Tamsen Fadal, a former TV news anchor in New York City, has produced “How to Menopause: Take Charge of Your Health, Reclaim Your Life, and Feel Even Better Than Before” (Balance). From across the Atlantic comes Mariella Frostrup, well known in Britain as a broadcaster, with “Menopause Is Hot: Everything You Need to Know to Thrive” (Scribner), an American edition of a volume co-authored with Alice Smellie, a health journalist, that was published in the U.K. four years ago. The books present themselves as guides for those entering and enduring years of disorienting symptoms, which include hot flashes, night sweats, brain fog, vaginal dryness, heavy periods, weight gain, hair loss, insomnia, anxiety, and depression—a panoply of woes that often coincide inconveniently and confusingly with demanding life changes, ranging from the midlife acceleration of a high-pressure career to raising adolescent children or the emptying of the familial nest. Each of the three volumes vies to be the must-have companion for women of a certain age, a thumbed copy on the nightstand of a sweat-drenched bed—a kind of “What to Expect When You’re Exploding.”

These books join an expanding shelf of menopause-related publications, among them a pair of best-sellers—“The New Menopause,” by Mary Claire Haver, an ob-gyn who provides the foreword to Watts’s book, and “The Menopause Brain,” by Lisa Mosconi, a professor of neuroscience at Weill Cornell Medical College, who wrote the foreword for Fadal’s. (In a neat circularity, the foreword to Frostrup’s book is by Watts.) In the introduction to “Dare I Say It,” Haver notes the growing ranks of physicians who are studying and treating menopause, known, among themselves at least, as the “menoposse.” Watts, Fadal, and Frostrup are lay members, each having become in her own way an advocate for menopausal awareness. Fadal and Frostrup have applied their skills as journalists by making personally inflected documentaries on the subject, and Watts has gone the Goop route, founding Stripes, a line of wellness products aimed at the perimenopausal market.

At the heart of each book is a similar story: that of an apparently savvy, professionally successful, abundantly resourced woman blindsided by the onset of an inevitable hormonal change. Frostrup offers, “Until my late forties I’d believed myself to be a reasonably well-informed woman of the world. . . . Then wham! My ignorance about menopause knocked any such certainties firmly aside. I felt as though I was being sucked into a black hole, with no bearings and no ideas of how to change course.” Watts gives a similar account: “Why had I, a relatively worldly person who’d been going to my annual exams and hanging out with the most wonderfully open and fiercely intelligent women my whole life, never once heard, ‘Heads up, here are the details about this thing that is going to happen to you in the coming years and what it might be like’?” Fadal, who says that she spent her career as a reporter “chasing stories and hurricanes from the mountains of Afghanistan to the coast of Florida,” strikes an Everywoman note: “Being an 80s girl, I’m an expert on every diet under the sun. But I didn’t know a damn thing about menopause. If I thought about it at all, I believed it was something that happened just before you die, and hoped I wouldn’t be around for it.” How can it be that such a conspiracy of silence surrounds a process that affects every human being who has ever had ovaries for long enough?

The story of menopause dates back as far as history itself; Sarah’s laugh in the Book of Genesis, upon learning that she is to bear a child at an unusually advanced age, may be the earliest recorded instance of the habitual descent into weary irony which is among the symptoms of menopause, albeit not one on any medical checklist. But the science of menopause is considerably more recent, dating to the late nineteenth and early twentieth centuries, when physicians in Europe began to research the effects of chemicals secreted by the body which control reproduction. The hormone estrogen, levels of which surge at puberty and decline in perimenopause, was first identified, in guinea pigs, in 1917; its crystalline form was isolated in 1929, by Edward A. Doisy, the chair of the Department of Biochemistry at St. Louis University’s School of Medicine. In an autobiographical essay written after he retired, Doisy, who in the forties won a Nobel Prize for his work on Vitamin K, an essential element in blood clotting, colorfully recounted his earlier scientific endeavor. The process of isolating estrogen required obtaining a supply of it in its unpurified state, which could be found in urine excreted by pregnant women. When supplies from Doisy’s family and friends proved insufficient (in his essay, he pays special tribute to the contributions of a niece), he enlisted the help of a local obstetrics department. On one occasion, a driver ferrying the precious amber liquid was almost arrested for bootlegging—this was at the height of Prohibition—and was saved only after he invited the officer to take a whiff from the suspicious vessels.

When it was discovered that estrogen could be supplied not just by expectant women but by expectant horses, commercial production of the hormone took off. Premarin, approved by the F.D.A. in 1942 to treat menopausal symptoms, soon dominated the market, its innocuous-seeming name barely disguising its primary ingredient, pregnant mares’ urine. By the end of the twentieth century, Premarin was consistently the first or second most prescribed drug in the United States, beating out medications for common ailments like high blood pressure and diabetes, with an estimated forty per cent of women of postmenopausal age taking it or an alternative estrogen formulation. Were these women—a quarter century or so older than Watts, Fadal, and Frostrup—engaged in a conspiracy of silence about this perilous life transition while simultaneously popping pills to cope with it?

They were not. As has been demonstrated by scholars of culture and medicine, notably Elizabeth Siegel Watkins, the author of “The Estrogen Elixir: A History of Hormone Replacement Therapy in America” (2007), and Judith A. Houck, the author of “Hot and Bothered: Women, Medicine, and Menopause in Modern America” (2006), menopause was regularly discussed, in the media and beyond, during the nineties. The U.S. Senate’s Subcommittee on Aging, part of the Committee of Labor and Human Resources, held a one-day hearing on the topic, in April, 1991, during which the director of the National Institutes of Health, Bernadine Healy, announced the launch of a years-long study of morbidity and mortality in women that became known as the Women’s Health Initiative, or W.H.I. Menopause was on the front page of the Times and on the cover of Newsweek. By Watkins’s count, more than a hundred books dedicated to the subject were published in the first half of the decade. Among them was Germaine Greer’s “The Change,” which presented menopause as an opportunity for dawning clarity—“Many women only realise during the climacteric how little of what has happened to them in their lives has actually been in their interest,” Greer wrote, acidly—and argued for the liberation of becoming a crone. In 1992, the journalist and author Gail Sheehy published “The Silent Passage,” a best-seller in which she gave her own account of being blindsided. “Shame, fear, misinformation—and, most of all, the stigma of aging in a youth-obsessed society—are the vague demons that have kept us silent about a passage that could not be more universal among females,” she wrote.

In Sheehy’s telling, the era immediately preceding her own had been the one in which menopause was the life stage that dare not speak its name. As Barbara Ehrenreich noted in her review in the Times, though, there already existed “a vigorous body of work” on the matter, including by the Boston Women’s Health Book Collective, which had published the groundbreaking guide “Our Bodies, Ourselves,” in 1970. In the 1984 book “Women Coming of Age,” Jane Fonda explored menopause, and almost two decades before that a book titled “Feminine Forever,” by the gynecologist Robert A. Wilson, had become a best-seller by arguing that symptoms might be mitigated by estrogen. Watts and Frostrup both treat Wilson with disdain for his paternalistic and sexist perspective, and he certainly is very concerned with how a woman’s change of life can undermine a man’s conjugal satisfaction. (It was also revealed some years after publication that Wilson’s work was underwritten by a pharmaceutical company.) But Wilson’s diagnosis of menopausal misery is not so different from their own: “This is a condition intolerable to modern women. Such a waste of human life and happiness cannot be justified either medically or philosophically.”

If Watts, Fadal, and Frostrup share a sense that they arrived at menopause without having been warned, they attribute that deficit to a single event: the sudden, much publicized cessation, in July, 2002, of a medical trial being conducted within the Women’s Health Initiative that sought to determine whether estrogen could reduce the risks of chronic conditions afflicting postmenopausal women. Contrary to expectations, preliminary data indicated that subjects receiving a combined estrogen-progestin medication were at an increased risk of heart attacks, blood clots, and strokes. (Progestin is the synthetic form of progesterone.) Most alarmingly, women who had taken hormones for an average of 5.6 years were at a twenty-six per cent higher risk of developing breast cancer than those in the placebo group.

The findings made global headlines, and millions of women who had been prescribed estrogen-based drugs quit them on the spot. (Another consequence was that tens of thousands of factory-farmed horses were no longer needed for their urine; many were sent to slaughter.) Hormone-therapy research went into a tailspin, although, even at the time, a more thorough reading of the numbers revealed a far less scary picture. The increased breast-cancer risk was, indeed, twenty-six per cent, but in absolute terms the results showed that a total of thirty-eight women for every ten thousand taking a combined estrogen-progestin pill might be expected to develop the disease, eight more than in the control group.

Watts, Fadal, and Frostrup all cite the ways in which the results from that fateful study have since been reëxamined and found to be misleading: its subjects, with an average age of sixty-three, were older than the typical users of hormone therapy, who start on medication while in perimenopause or shortly after the onset of menopause. In 2024, a twenty-year follow-up study of the W.H.I. participants showed that mortality rates among trial subjects who had received estrogen and those who had been in the placebo group were statistically insignificant, and it concluded that hormone use was supported for women under the age of sixty with “bothersome menopausal symptoms.” Many women over sixty may consider the benefits of hormone therapy worth the associated risks; JoAnn Manson, the principal author of the W.H.I. follow-up and the chief of the preventive-medicine division at Brigham and Women’s Hospital, told the Washington Post that the increased risk of breast cancer from the long-term use of combined estrogen-progestin drugs was the equivalent of drinking one or two alcoholic beverages a day. “The absolute risk is low, and all choices involve trade-offs,” she said. Advances in hormone therapy include the delivery of estrogen through a transdermal patch or gel, which appears to impart a lower risk of developing blood clots than oral delivery does. Research suggests, too, that hormone therapy reduces susceptibility to osteoporosis, another calamitous disease of aging for women.

In Watts’s, Fadal’s, and Frostrup’s books, you’ll find personal testimonies of the transformative power of hormone therapy along with due deference to those for whom that option is unavailable. “Going on hormone therapy wasn’t a silver bullet for every last issue I had, but it did provide instant, massive relief,” Watts writes. “I no longer woke up sweating in the middle of the night, convinced my blankets were trying to kill me.” After dealing with hot flashes, brain fog, and loss of libido, Fadal is finally told by a sympathetic clinician, “You can keep struggling but I am not sure why you are doing this to yourself.” A year later, on hormone therapy, she reports, “I was alive again.” Frostrup writes that between the ages of forty-nine and fifty-one she “barely slept, raged at my husband and kids, and was swamped by levels of anxiety that were as debilitating as they were irrational.” Going on hormone therapy restored her well-being, she says, and “contributed to maintaining my state of health, hope, and (mostly) happiness ever since.” Frostrup avows that she will take hormones for the rest of her life. “My estrogen gel will have to be prised from my cold dead hands,” she writes.

Of the three, Watts’s book is the most winningly memoiristic, though a reader might wish for slightly fewer references to her own line of products. (One chapter is titled “Vag of Honor,” which is also the name of a hydrating gel available to order online.) Watts, who went into early perimenopause in her mid-thirties, gives a painful account of her struggle, eventually successful, to get pregnant with her then partner, Liev Schreiber. She also gives an account of the first night she spent with Billy Crudup, now her husband, which could be lifted straight from the screenplay of a meno-positive rom-com: after laboring in the bathroom to remove a firmly attached hormone-delivery patch, Watts emerges with raw skin and confesses, “I’m in early menopause, which means I am old.” Crudup points out that they are the same age. “Hey, if it makes you feel better: I’ve got gray hairs on my balls,” he tells her. Watts writes, “Those to date remain the most romantic words I’ve ever heard, onscreen or off.”

Watts’s profession may make the prospect of aging, or admitting to it, particularly terrifying. “I was told I would never work again if I admitted to being menopausal, or even perimenopausal. Hollywood’s lovely term for such women was ‘unfuckable,’ ” she writes. But one need not be a movie star to recognize the ways in which the onset of menopause can feel like the beginning of a cultural diminishment, not only in the eyes of others but also, alarmingly, in one’s own. None of these books exactly celebrate the status of the crone; all offer midlife beauty-maintenance tips. (Using an eyelash curler is highly recommended.) “Even when I was forty, if you asked me to give you one word to describe midlife, I would have said ‘irrelevant,’ because that is what the culture has taught us,” Fadal writes in “How to Menopause.”

Fadal offers her personal story, too: perimenopause struck while she was in the midst of a difficult divorce from a man with whom she had co-branded herself as a love consultant, together publishing advice books and appearing on a Lifetime reality show called “Matched in Manhattan.” That unfortunate knock to Fadal’s credibility as an expert aside, her book is informative, filled with useful checklists and bullet-pointed tips, including questions to pose to one’s health-care provider: “What do you recommend for treating my symptoms? Are these treatments F.D.A. approved? What are their benefits? What are their risks according to research?” She even provides a draft of a letter one might write to a partner to explain why, with the onset of night sweats and bloating, intimate relations might be less appealing than they once were. (Fadal recounts how, as a surprise for her boyfriend one Christmas, she answered the door wearing nothing but a big red bow; when he requested the same gift the following year, she told him that he had lost his mind.) Frostrup’s book also combines anecdotal revelation with research-based advice, although an American readership unaware of her fame at home—she is well known enough for the Daily Mail to publish photos of her, at fifty-five, in a bikini—may be disconcerted by her assumptions of familiarity. To begin a section about menopause and alcohol, she writes, “Speaking as someone who once spent four days holed up at the Hotel du Cap during the Cannes Film Festival with a selection of debauched movie moguls and George Clooney . . .”

Frostrup says little about the differences between Britain and the U.S. in policy, medical treatment, and public attitudes. In the U.K., Parliament has recently held hearings on menopause and the workplace, and last year the Labour Party pledged in its preëlection manifesto to strengthen protections against menopause discrimination. She doesn’t inquire into why hormone therapy is far more commonly prescribed in England—around fifteen per cent of women aged forty-five to sixty-four received it in 2023, compared with less than four per cent of American women in their fifties, according to a Menopause Society report. Nor does she mention that, unlike in the U.S., hormone therapy in Britain is available through the National Health Service at little or no cost; at most, it’s about twenty-five dollars a year.

In the U.S., entrepreneurs have stepped into what is estimated to be a seventeen-billion-dollar global market. One such effort, the telehealth startup Evernow, offers online consultations and prescriptions; it counts Drew Barrymore among its angel investors. If menopause awareness seems to be “having a moment,” as Lisa Mosconi writes in her introduction to Fadal’s book, it is in part because of the considerable purchasing power of the generation of women currently going through it. But menopause has had many moments before, precipitated sometimes by a widely publicized medical breakthrough or scare and sometimes by a public figure making it her cause. Popular discussion has flared and receded during the past sixty-odd years like a series of cultural hot flashes, each time presented as if nobody had talked about menopause before. And perhaps that’s no wonder. As with the thrilling adolescent discovery of sex or the earth-shattering destabilization of childbirth, the experience of undergoing menopause can be so disorienting that it’s impossible to conceive of its creeping but relentless onslaught until it’s your own body that’s combusting and your own psyche that’s been scrambled. It’s not that there’s a conspiracy of silence around menopause; rather, it’s that, like death, menopause is a thing that happens to other people, until it happens to you. ♦