It’s Up To Us To End The Silence Around Menopause

“I was angry the entire time I was writing this book,” Jancee Dunn tells me over the phone a couple of weeks ago. I’d just finished reading Hot and Bothered: What No One Tells You About Menopause and How To Feel Like Yourself Again, and I understood completely. It’s enraging — to realize how much we — and our medical professionals — can do to alleviate the symptoms and sheer anxiety around menopause, something that happens to a full half of the human population, and how little the average person (me!) knows about it or even is willing to talk about it (also me, but I’m working on it).

My copy of Dunn’s informative, astute book is filled with underlines, stars, and not a few WTF!!!s scribbled in the margins. It’s an enraging thing to realize how needlessly people have been suffering for hundreds of years in shame and silence because this natural — and inevitable — process is so incredibly, deeply stigmatized. We talk to our kids about puberty, about sex, about all of the completely normal changes their bodies will go through. We equip them as best we can; we press our dog-eared copies of Judy Blume into their little hands. But when it comes to the phase of life that comes after puberty, after our years of trying to (or trying not to) get pregnant, suddenly there’s a total dearth of information. There’s silence and implied shame — often even from our own mothers.

Nothing is off limits, yet this was.

The very opposite should be true — we should all be talking about it. And not just moms like me who are facing down menopause ourselves and need to be prepared and informed (this is an issue where knowing your family history, if possible, is crucial), but anyone raising a human being, because that human being is either going to go through it themself or will love someone who does.

Dunn’s new book covers every aspect of peri- and menopause, from how sex can change to how to talk to your partner about what you’re going through and how to find doctors who can actually help you. She is charmingly forthright, her wry humor and well-researched advice the perfect antidote to some of the more alarming material (wait, dry what?). The bestselling author of How Not To Hate Your Husband and other books, and a longtime health reporter for the New York Times, Dunn is unafraid to share her own experiences, embarrassments, and a few hilarious horror stories (one involving a surprise period on a boat with a bunch of strangers and one involving pee on a front porch) with a generosity that is immensely reassuring.

Here, we chat about all the good news Dunn uncovered writing this book, what we want to change for our kids, and, yes, just how mad we (still) are.

April Daniels Hussar: I loved your book so much. I found it very reassuring — I want you to know that. But my primary emotion reading it was just anger. I feel so angry!

Jancee Dunn: Yes.

For all eternity we’ve just… women have just been suffering. And that’s only just maybe like 25 seconds ago starting to change.

Doesn’t that make you sad?

It’s so sad, and it makes me so mad. And think of our moms and our grandmas… it’s outrageous.

Everybody not speaking about it to anyone and not even to their friends, to no one. My mother said she didn’t talk about it with a single person, that it was just sort of understood that you didn’t talk about it. That there was so much shame and stigma around it, around this natural process. I really am on a mission to get everyone to normalize this, and not just women, people of all genders. Everybody, kids. Because what the hell is so shameful about it? I’d like to know. It’s just ageism, sexism.

Medicine seems to fall off a cliff after a woman’s done reproducing. That’s really depressing.

Because talking about it is so helpful, isn’t it? Talking about the symptoms, so that you know what’s coming, so it’s not some surprise and some shock and like, “Wait, I’m in my 40s. What?” And then just getting support from other people. Even as I was researching this and writing it, I realized, OK, half my friends and I haven’t talked about this. And we talk about the most granular sex details and death of parents — nothing is off-limits, yet this was.

What do medical professionals learn in school about menopause?

Most of them get an hour of training, if that, and that to me was not surprising. That’s why I always say that you should get a menopause specialist if you can. It’s not easy and sometimes you have to pay out of pocket, but at least everything’s concentrated in one space; the person is highly trained. But yes, medicine seems to fall off a cliff after a woman’s done reproducing. That’s really depressing.

At this stage where we are now, the onus is, as usual, on the woman to seek treatment and to find what she needs.

Right. I’m in my mid-40s and none of my regular doctors — not even my gynecologist — have mentioned menopause to me ever. Or perimenopause.

Most people can’t even identify what perimenopause is! But yeah, that’s the thing — and I’m not knocking OB-GYNs. They were so helpful to me in this book. But imagine if your OB-GYN or your primary care physician just said, “OK, you’re in your 30s. Here’s what’s coming; here’s what you need to know. Here’s what symptoms to look out for, so you can identify patterns.”

Otherwise, you’re like, “Oh, my heart’s racing. Here comes a heart attack!” or “Oh, Lord, my period’s erratic.” I thought I was pregnant because I didn’t have my period for three months. Over and over again what I hear from people is: “This is a shock. I didn’t know this was going to happen in my 40s. I didn’t connect the dots with these symptoms and it would’ve saved a lot of time and mental anguish.”

Was there anything that you learned through the research and writing process that makes you feel hopeful about the future for people who will go through menopause?

I am very careful when I talk about menopause, because I see how everyone focuses on the horrible symptoms. No. 1, there are so many treatments out there for symptoms, and it’s not always medication. There’s research that shows you can breathe through hot flashes and they’ll go more quickly. Just knowing what’s going to happen to you takes away the shock. So I see that the awareness is growing, which is really important — that people are talking about it more.

I have mixed feelings about celebrities, but thank God they’re being so forthcoming. It really does move the needle. They’re like, “Yep, here’s what’s going on.” Some of them are pushing products, but who cares? They’re still talking about it. And it does open up the dialogue.

I’m specifically glad people are talking about brain fog. I had brain fog so badly that I couldn’t figure out the word for a butter knife, and I would get enraged like a toddler telling my husband, “Just hand me the shiny thing!”

And I thought, “Oh, boy, Alzheimer’s. It’s coming for me.” The brain fog, in my case, was severe. In many cases, it is severe. I interviewed several specialists, neuroscientists, about it, especially Pauline Maki at the University of Chicago, who studies cognition and menopause. And she said, “In an overwhelming number of cases, your brain becomes sharp again.” How often does that happen, when something leaves your body that it actually comes back? And so it did for me. As I was writing this book I thought, “Oh, Lord, how am I going to even talk about it when I can’t think of the word knife?” But in fact, my marbles rolled back into my head after I lost them.

That makes me feel so much better.

You could cry with relief. And that is proven by research — it’s not just some anecdotal thing. When you get through the symptoms, most of them really do disappear for good. Not vaginal dryness sometimes if you have it, and you do have to get it treated. I did topical vaginal estrogen — life changing. Putting something on you that makes you stop peeing and makes sex stop hurting? It’s a miracle!

Learning about topical vaginal estrogen was one of the most astonishing things. I’m also outraged that I’ve never heard of that. I’ve been working in the women’s health and parenting and pregnancy space for years now. And I’ve done a lot of research; a lot of reading and writing about pelvic floor health and how women just accept that we pee ourselves after giving birth. And it gets worse as you age, et cetera. And I’ve never heard of this treatment, ever!

Oh, me neither. Same as you, I write about women’s health, and I thought, “Why did I not know this?” And I didn’t realize how safe it is and how effective it is. It takes about three months to work, but lo and behold, I stopped peeing myself. Like, talk about a quality of life issue — peeing yourself and sex hurting and impacting your relationship and how you feel about sex. Something that you have a right to experience, pleasure. And it really did help.

As I was reading the book, I found many striking parallels to the process of becoming a mother and that whole thing that you go through of planning, trying to conceive, being pregnant, giving birth, being postpartum. We have so much information now — we’re told to be our own advocates and to make birth plans, to make informed decisions about our own pregnancy process. But then there’s such a dearth of information and advice for how to do that as we approach menopause.

There are absolute parallels, not only the hormonal surges and being constantly aware of the processes in your body, but also the stigma around experiencing the stuff at work. I’m glad that there’s been strides about lactation policies at work and things like that, but there certainly isn’t with menopause. I really do think that the more we talk about it, at the grassroots level, that’s the way to eventually get some policies going up the chain. And it was hard for me at first. It was hard for me in meetings to just sort of say, “Oh yeah, oh, hang on, I’m having a flash.” Because I see how people react in their 20s, right? They’re like, “What is that?” Puzzlement, weirded out! I have a 13-year-old, she’s so sick of hearing about it. I talk about it with my nephews who are 17 and 20. I’m saying it to everybody. I talk about it at the dinner table with my extended family.

I did an experiment where I went to my local library, which is well-funded and a nice library. And I thought, “I wonder how many menopause books there are.” There was shelf after shelf of pregnancy books. So many. But there was one menopause book, and it was from 1992, and it was as dusty and dry as parts of my body. It was so pathetic.

If the motivation is to be a good parent by modeling this stuff, and that gets you over the stigma, then great.

There are baby showers, pregnancy showers, wedding showers, there are bar mitzvahs. But there’s no menopause shower; there’s nothing. There are no cultural markers at all.

That’s something that struck me as something that we as mothers of daughters can do — talk about it openly with them. And mothers of sons should be talking about it also, just in a normalizing way. But I was thinking about how I want to make sure that I share what I’m going through with my daughter.

Yes. With dates and when it all started and symptoms, just again, so that she doesn’t go through what you went through with the puzzlement and maybe the fear.

How do you feel our culture has progressed — or is progressing — since we were young women compared to now when our daughters are coming of age?

Well, I think I really do have high hopes for all of our daughters now, and anyone who’s younger in Generation Z. I can’t believe I said Generation Z, but I think that’s the way you can categorize it. I see all the movements that they have started from acne positivity, body positivity — they’re very up-front. They’re just ripping away the stigma. And I really feel confident that they’re going to tear all this stuff down, especially if we can give them as much openness as possible. We can aid in that by modeling behavior of not being ashamed or secretive about it. To keep hammering home that it’s not a disease; it’s a natural life process.

If the motivation is to be a good parent by modeling this stuff, and that gets you over the stigma, then great. If you have to shift that mindset and be like, “I don’t necessarily want to talk about my hot flashes or my vaginal dryness, but my child needs to see me accepting it as a normal transition.” If that’s your motivation, great. It’s often mine. I can confront people about stuff that I couldn’t if it’s on my child’s behalf. It’s kind of amazing.

I’ve been carrying around my copy of Hot and Bothered everywhere. On the train. I took it to jury duty.

No. Oh, my God, I’m going to cry. Oh, that’s great.

Is there one thing that you would like to say, or one piece of advice that you want to give to our readers, many of whom are moms a little younger than you and me?

Just be aware of the symptoms of perimenopause and that it happens most often in your 40s. And menopause can take a long time. It’s not like you’re going to wake up one day and your ovaries are going to fall out. It can be four to eight years, so it is gradual, gradual, gradual, but knowing that it’s coming will help. It’s just another life stage. What’s scary is the not knowing or the misinformation. It’s just another hormonal transition, like the ones you’ve already been through.

This interview has been lightly edited and condensed for clarity.

Hot and Bothered: What No One Tells You About Menopause and How To Feel Like Yourself Again is available May 2 everywhere you buy books and HOPEFULLY YOUR LOCAL LIBRARY.