Menopause Matters

Throughout history, individuals experiencing menstruation have faced the daunting task of navigating the complex, stigmatized landscape of menopausal symptoms without support. There’s a presumption that all individuals undergoing menopause will exclusively identify as women, be white and heterosexual, desire or have the ability to bear children, already have children, or be in their 40s or 50s.

The abundance of conflicting information surrounding menopause has made it challenging to comprehend its essence—its defining features, unique attributes, expected timing—and receive strategies to navigate this phase. And yet, it is crucial for anyone with a uterus and ovaries to have access to a clear and concise guide to help them navigate this inevitable and transformative journey.

Menopause takes place when a person has a continuous year without any menstrual cycle, including no instances of spotting or breakthrough bleeding. During menopause, the ovaries stop making estrogen and progesterone hormones and no longer release eggs. Before that happens, there is a perimenopausal period—“peri” meaning “pre”—that can last up to 10 years before an individual’s menstrual cycle ceases altogether. Menopause typically occurs during a person’s 40s or 50s, with the average age being 51 in the United States. The most common physical symptoms of menopause are hot flashes, night sweats, brain fog, vaginal dryness, weight gain, and dry skin. There are also lesser known physical manifestations such as migraines, dizziness, depression, burning mouth, and fatigue. 

Unfortunately, the menopausal experience isn’t often depicted or celebrated as a positive life transition with various stages and expressions; instead, it’s frequently portrayed as a fearful conclusion of menstruation. In mainstream culture, especially in media, people going through menopause are often white, cisgender, heterosexual, middle-aged, and middle-class individuals depicted as hot, sweaty, confused, and angry. Consequently, the expanding landscape of support, services, education, and advocacy lacks intentional representation of the unique menopausal experiences, needs, and struggles faced by those marginalized along lines of race, ethnicity, gender identity, sexuality, and socioeconomic status.

Much of the stigma surrounding menopause is rooted in negative societal attitudes toward people who identify as women or who have been assigned female at birth. This objectification is amplified for older individuals no longer considered fertile, perpetuating the harmful notion that they are less valuable or “washed up.” It’s important to emphasize that menopause shouldn’t be seen as the end for anyone, including gender-expansive and racially diverse individuals. All individuals, regardless of gender identity, race, or age, should be equally respected and valued throughout their life stages.

Menopause as a physical, cultural, and political experience is often overlooked in discussions related to health outcomes and systemic oppression. But, like most public health experiences, it is affected by a range of factors, including poor access to health care, toxic work environments, unsafe neighborhoods, and socioeconomic hardships. These stressors place considerable strain on the body, disrupting hormonal and biological processes and contributing to chronic inflammation. As a result, menopausal experiences can become more challenging and occur earlier for individuals exposed to these systemic injustices.

I’d like to offer an intervention: I see the Earth’s evolution, at the remarkable age of 4.5 billion years, as parallel to the life of individuals experiencing menopause. As our planet warms through human intervention, we see species dying off. What if human beings are being offered the wisdom, medicine, and warnings of an Earth entering its cosmic menopausal phase? If so, are we listening?

By 2025, there will be more than 1 billion people experiencing menopause worldwide, which will represent 12% of the global population. Now, as individuals take charge of their bodies, a contemporary revolution is taking shape, one that’s dismantling age-old stereotypes and misinformation about this pivotal phase.

Menopause’s Origin Story

Across generations, Black, Indigenous, and women of color, as well as those who identify as transgender or have expansive gender identities, have grappled with the profound challenge of asserting agency over their own bodies. Historical injustices, such as the displacement and genocide of Indigenous peoples and the enslavement and racial violence endured by individuals of African descent, have hindered bodily autonomy. These obstacles find their origins in the socially constructed concept of race, where whiteness has been artificially elevated as the societal standard. Consequently, experiences outside of this norm consistently face othering, marginalization, and dehumanization. 

In 1821, the French physician Charles-Pierre-Louis de Gardanne coined the term “menopause” by drawing upon the Greek language, where “men” denotes “month” and “pausis” signifies “cessation.” The Greeks can also be credited for coining the term “hysterikos” (a word that shares the same root as “hysterical”), which translates to “suffering in the womb.” In ancient Greek belief, women displaying “irrational” behavior were thought to be influenced by their uteri moving around within their bodies, causing disruption. 

Throughout the 19th century, the naming and defining of menopause became another means of reinforcing the perceived frailty of the female body. In the U.S., women faced a heightened vulnerability to receiving insufficient diagnoses and treatments. Prevailing beliefs of the time often attributed most of women’s physical ailments to their sexual organs or mental health issues, leading to distressing and occasionally fatal treatments. Such stereotypes became yet another vehicle to subjugate women and individuals assigned female at birth within the emerging field of gynecology. 

J. Marion Sims, the so-called father of gynecology, also influenced traditional thinking about menopause. As historian Deirdre Cooper Owens documents in her 2017 book, Medical Bondage: Race, Gender, and the Origins of American Gynecology, Sims honed his newly developing gynecological techniques in the 19th century by practicing on enslaved Black women—including Anarcha, Betsey, Lucy, and others named in the book—without anesthesia. Over the course of four years, Anarcha endured a total of 30 experimental surgeries, while all the women faced the pathologization of their gender and race, reflecting the historical trend of stigmatizing and medicalizing women’s health. 

The persistent impact of structural racism, which involves unequal access to resources, services, and opportunities based on race, significantly contributes to the health disparities observed between Black and white women during midlife. Black women often experience systemic barriers to accessing quality health care, educational opportunities, economic stability, and suitable housing. These disparities can lead to higher levels of stress, limited health care choices, and reduced preventive care. Chronic stress and limited access to adequate health care can exacerbate health conditions and contribute to a range of issues during midlife, such as cardiovascular diseases, diabetes, mental health challenges, and other chronic conditions.

Additionally, the impact of structural racism extends to health care practices, where biases and stereotypes held by health care professionals can affect the quality of care provided to Black women. A 2023 survey from The Menopause Society found that “only 31.3% of responding obstetrics and gynecology program directors reported menopause education was included in their residents’ training,” while a 2019 study published in Mayo Clinic Proceedings found that less than 10% of OB-GYNs felt adequately trained to support menopausal people in their practices. In 2021, Dr. Cindy Duke, a reproductive endocrinologist, virologist, and fertility specialist, told me, “Menopause, in general, isn’t taught a lot, not even in our training programs, unless you’re fortunate enough to be in a program where there is someone who’s decided, ‘This is my life’s work, this is my life’s mission: to learn about menopause and teach the next generation of women’s health specialists about menopause.’” 

A 2019 study published in Mayo Clinic Proceedings found that less than 10% of OB-GYNs felt adequately trained to support menopausal people in their practices.”

Addressing health disparities necessitates a comprehensive approach that acknowledges and actively works to dismantle structural racism, promoting equitable access to health care, education, employment, and other opportunities. Efforts should focus on transforming oppressive policies, fostering inclusive health care systems, enhancing cultural competence among health care providers, and advocating for social and economic reforms that empower marginalized communities. By confronting and dismantling systemic racism, we can strive toward a society where health outcomes are more equitable and just for all, regardless of race or ethnicity.

“Modernity’s menopause is an anthropocentric end-of-life event that heavily depends on aging and reproduction as productivity measures,” Austen Smith, owner of Our Lunar Intelligence, which describes itself as an Afrocentric consultancy, told me in 2022. “It claims to serve women but strangely positions patriarchy as the life-giving force by gendering menopause as feminine and conditioning society to view it as a harbinger of death.” Smith’s analysis frames changing views on menopause and invokes the question: What if we need to shift the narrative in the menopause story?

I have worked as a social justice and reproductive justice advocate for more than 25 years, so I understand the need for a cultural shift in how we think about and treat menopause as a pathway to sustainable change. Examining the past and present experiences of Black, Indigenous, and women of color, as well as genderqueer and transgender individuals in the U.S., is essential to understanding why many older family members didn’t discuss topics like menstrual cycles, sex, pleasure, pregnancy, or menopause with the younger generations. Perhaps their stories were muted by cultural or generational norms, or generational trauma of racial and sexual violence that often silences voices and stories at the margins. 

Menopause, being linked to the reproductive experiences of menstruating people, is often tied to notions of aging, infertility, and childbearing. As a result, it’s essential to foster a cultural shift that appreciates and respects aging as a natural and diverse part of life.

Unfortunately, this collective oversight within the medical industry dismisses a physiological reality affecting nearly half of the world’s population. It hampers the development of effective health care strategies, research, and accessible support systems for menopausal individuals. Addressing this oversight and promoting open discussions about menopause are essential steps toward ensuring that health care systems adequately support and cater to the diverse needs of individuals experiencing this significant life stage.

According to the Study of Women’s Health Across the Nation, Black, Latinx, and other non-Black women undergo menopause earlier on average and may grapple with more protracted and intensified symptoms than their white counterparts. (The study did not specify whether its survey of “women” included gender-expansive individuals, trans or nonbinary people, or simply any people of color with a uterus and ovaries.) This early onset has far-reaching implications for these communities, as it means they have a more extended duration of living with menopausal symptoms and their associated challenges. The heightened intensity and duration can significantly impact their quality of life, overall well-being, and ability to engage fully in daily activities.

The implications are profound, particularly for marginalized individuals navigating the intersection of race, gender identity, and menopause. Accessing appropriate health care, timely diagnoses, and effective symptom management become more challenging due to discrimination and biases, amplifying health disparities.

Addressing these disparities requires a multifaceted approach. It involves promoting inclusivity in research, health care policies, and education. Health care providers need to be culturally sensitive, acknowledging the unique experiences and challenges that marginalized individuals face during menopause. By addressing these disparities and providing equitable health care access, we can work toward a more just and supportive menopausal experience for all.

Instead of being embraced as a potentially transformative journey encompassing diverse stages and expressions, menopause often becomes shrouded in fear and solitude. 

“When considering the reproductive life course of humans, menopause affords the perfect opportunity to reflect on the unique contributions of sentient beings outside of the capacity to propagate our species,” says Monica McLemore, a professor in the School of Nursing at the University of Washington. “Negative health care related disparities—which are simply differences among and between populations—in my view are exacerbated by the imprecise dissection of humans into body parts and disease states. In other words, without focusing on a whole human being, we miss opportunities to understand assets and resilience, which should be the foundation to promote optimal health throughout a lifetime.”

When individuals move in the world with identities that exist outside of the frame put forth by white supremacy and patriarchy, they are marginalized, and their experiences and needs are invisibilized. This invisibilization is dehumanizing, violent, and typically reinforced by state-sanctioned policies. We need first-person stories that can lead to more intersectional research, advocacy, and policy change in order to shift the cultural understanding of menopause and aging.

Expanding the Dialogue on Menopause

It’s natural to seek comfort and trust in those who share similar backgrounds and qualities. However, societal structures that marginalize us can cause us to feel embarrassed about aspects of our identity, appearance, and experiences as women or people assigned female at birth. Unfortunately, societal norms can create a stigma around discussing menopause, which can make it feel like a shameful secret and leave us feeling isolated during this important phase. This is particularly true for marginalized people who may face additional societal taboos around the topic of menopause.

I created the Black Girl’s Guide to Surviving Menopause (BGG2SM) in 2019 as a counterbalance to prevalent harmful narratives and a lack of resources. BGG2SM is a multidisciplinary initiative focused on cultural organizing, narrative-shift work, and advocacy. Understanding the historical and contemporary experiences of Black women—intergenerationally, across class, and through a gender and racial equity lens—is critical for body sovereignty.

I believe that Black people are the experts of our own bodies. Owning our stories is vital to having agency over our experiences, relationships, and liberation. By integrating reproductive justice, radical Black feminism, and gender liberation, BGG2SM normalizes menopause by centering first-person narratives of those who exist at the margins of the growing menopause landscape. We nurture a community that includes all voices and lived experiences: cis, trans, intersex, queer, straight, affluent, low-wealth, activists, and creatives.

We are committed to a time-bending, expansive, culturally, politically, and spiritually grounded space for all stories and truths to be shared, accessed, and elevated. These principles require us to identify the pathways to new ways of thinking and talking about menopause, grounded in the historical, cultural, and political understanding of the lived experiences, truths, and realities of Black women and people who have a uterus and ovaries. In that sense, we have become cartographers of what I call the “Menopausal Multiverse,” and we are consistently alchemizing what we learn about the “who” inside the menopause and aging landscape. 

The Menopausal Multiverse comprises the wide array of marginalized menopausal experiences. It encompasses the diversity of menopausal individuals, both historically and in modern times, along with ancestral technologies, systems of care, and potential futures emancipated from systemic oppression. Additionally, the Menopausal Multiverse embraces cultural wisdom and the concept of generational healing that invites people to embrace their menopause experience as a journey with connective tissue to their identities, relationships, and roles.

Any journey, long or short, is made easier with a good map, provisions appropriate for the trip, and travel companions. The menopause journey is no different, and menopausal people are invited to be our own cartographers. Some of those cartographers include podcaster and Black women’s health advocate Karen Arthur of Menopause Whilst Black; researcher and advocate Tania Glyde of the Queer Menopause project; Heather Corinna, queer feminist activist, educator, and the author of What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities, and You; and journalist, feminist, and activist Mona Eltahawy. 

Gaining a profound understanding, building trust with, and effectively navigating your unique trajectory through the various phases of menstruation, from menarche to menopause, can be significantly enhanced by crafting a tangible record of your personal journey. This record empowers individuals to interpret their body’s narrative and the monthly messages received throughout decades. It promotes bodily autonomy, sovereignty over one’s body, and the agency to advocate for personal needs before, during, and after the menopausal transition. This process activates both the science and art of mapmaking.

An additional, more potent way to frame the menopausal experience is to see it as another rite of passage—a through line from menarche to menopause. In anthropology, “liminality” is defined as “the quality of ambiguity or disorientation that occurs in the middle stage of rituals when participants no longer hold their pre-ritual status but have not yet begun the transition to the status they will hold when the ritual is complete.” It is believed that social hierarchies may be reversed or even temporarily dissolved during these liminal periods of transformation. Thus, menopause should be treated as a transformation to a new iteration of yourself.

In an interview on the BGG2SM podcast, Syd Yang, ordained Buddhist minister, movement chaplain, and founder of Blue Jaguar Healing Arts, summarizes this: “As challenging, frustrating, and confounding as perimenopause and menopause may feel—what if this is your body and your sacred center saying ‘I love you, let’s get to know each other better?’”

When I launched BGG2SM, I interviewed my dear friend and mentor, Jaki Shelton Green, the first Black woman to serve as North Carolina’s poet laureate. After reminding me that “womb spaces are wet, warm, and protective,” Green pondered if aging and menopause can help heal generational wounds, especially if we ask ourselves: “What are the wombs I’ve built around me? When have I allowed myself to crawl into them?”

Achieving wellness, healing, and embodiment within a transforming body is a continuous process that involves putting knowledge into practice as a lifelong commitment. I have concluded that it is not a one-time event or a mere collection of information. Menopause is a journey involving deepening and reimagining rather than graduating. One may encounter new things to learn and experiences that could require deeper introspection and unlearning of what we thought we knew. Realizing that we possess the power to illuminate our own path through menopause can bring a sense of liberation. Fortunately, we are not alone in this journey. Many others are navigating this liminal expansiveness alongside us.