Are you there God? It's me. I’m in menopause.

It's time for women to band together and become activists for menopause care

(I write at length about many of the ideas below in my new book, “Fired Up: How to Turn Your Spark into a Flame and Come Alive at Any Age” out in June. Pre-order now and enroll for free in Firestarter University starting in the Fall.)

In July of 1983, days after reading Judy Blume’s seminal novel about puberty and menstruation, I got my first period while on a summer trip to my grandparents’ home. I was 12. Three biological children and 37 years later, I had my last period in July of 2020. I was 49. A few months after that last period, I made an appointment with my doctor to talk about all of the new weird symptoms I was experiencing: sleeplessness, brain fog, headaches, dry skin, hot flashes, having to pee constantly, and bursts of anger so intense that I fantasized about cutting our living room couch in half with a chainsaw.

As my doctor reviewed my blood panel, she informed me that my hormones indicated I was officially in menopause. And then she asked me, “Is that ok with you?” This seemed like an odd question. Mainly because I wasn’t sure what my options were if I wasn’t “ok” with being menopausal, but also because she wasn’t offering any solutions to the symptoms I was experiencing. “What about hormone replacement therapy?” I asked. My doctor’s face contorted as though I’d asked her if I should take up smoking. “The side effects aren’t worth it unless you’re really suffering. And I wouldn’t want you to risk getting breast cancer.”

To be clear, I was suffering, but apparently not enough (I’d love to know who gets to decide how much a woman should suffer?). And I also have no familial history of breast cancer (which my doctor was aware of). But the medical system isn’t set up to alleviate women’s suffering — it was created by men for men and it’s riddled with bias, racism, and misogyny. For too long, some doctors, insurance companies, and even government entities have served as gatekeepers with the power to unlock treatments for men while holding them back from women — either because they can’t be bothered to care about women’s health or because women’s sexual health is still seen as taboo. It’s a system that deprives too many women of safe and effective treatments at a time in our lives when access to healthcare determines our lifespan.

Twenty years ago, a flawed study by the Women’s Health Initiative (WHI) misrepresented and overgeneralized the risks of HRT, creating unfounded fears for an entire generation. And even though newer studies show that hormone therapy actually prevents osteoporosis, decreases the risk of Type 2 diabetes, and treats the genitourinary syndrome of menopause, symptoms of which include painful sex, urinary urgency, and frequent recurrent urinary tract infections, ALL estrogen products — regardless of dose, application, and use — STILL have a black box warning, the highest level of warning information in labeling.

Other products, like Viagra, which have been FDA-approved for men for 26 years, are still not available for women. Even though trials show good evidence that topical sildenafil is a helpful tool to enhance sexual desire in most women with zero contraindications, it isn’t available — due to both a lack of investment by drug companies and cultural taboos about women and sex. Also, there is no FDA-approved dose of testosterone for women, despite extensive research on testosterone in men. As a result, women seeking to treat symptoms like low libido are forced to use formulations designed for men that contain much higher doses of the hormone.

The WHI study from 20 years ago that froze HRT access (afterward, the number of women on HRT dropped by about 80 percent), also had a chilling effect on women's health issues more generally, according to Jennifer Weiss-Wolf from the Brennan Center for Justice at NYU Law School: "Menopause became absolutely deprioritized. Doctors stopped learning about it. Medical schools stopped teaching about it. The government also stopped funding federal research on it. So, we found ourselves in an information vacuum that persisted all the way up until this new chapter where people have started demanding change."

But it’s not only a lack of medical research and training preventing women from accessing treatments for menopause – it’s all of the roadblocks put in place by insurance companies and the government, too: from companies that restrict or deny financial reimbursement for treatments, making them unaffordable for many, to the erroneous FDA “black box” warning labels on package inserts that imply dire illnesses as side effects that scare patients off without cause.

Just like women become advocates and demand change on a whole host of issues — from gun safety to abortion to the climate — we must also demand access to menopause care. ALL women deserve information about their options – including the risks and benefits – along with a variety of treatment options, and the autonomy to decide how they want to proceed.

After my physician refused to prescribe HRT, I read up on the subject and finally found an OB/GYN who would (I also found a new general practitioner). I read up on the subject, including the incredibly helpful book “Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives — Without Raising the Risk of Breast Cancer,” by Avrum Bluming and Carol Tavris. And then I went to menopause.org and made an appointment with a gynecologist who I knew in advance supported HRT. The combination of estrogen, progesterone and testosterone I’ve administered or taken every day since has turned me into a proselytizer about the benefits of HRT. I now sleep through the night, my brain fog has evaporated, and my mood has improved. And I just got the results of my first-ever DEXA scan back, and my bones show no signs of osteopenia.

And while HRT is not for everyone — like any medical treatment, there are downsides and even overpromises — the women it might help deserve to understand the risks and benefits and make that decision for themselves. I’m incredibly angry that for a generation, a combination of bad science, too little medical training and misogyny resulted in a dearth of information about menopause and related treatment options. And it’s a tragedy that many of our mothers were robbed of access to HRT to prevent symptomatic suffering and to provide long-term health protections.

The National Institutes of Health allocates only 10.8% of its $45-billion budget to women’s health, even though women make up more than half of the U.S. population. Of that, only a fraction goes to research on women in midlife and menopause. Last year, President Biden signed an executive order creating a national task force, the White House Women’s Health Research Initiative, with a call for a $12-billion investment in women’s midlife and menopause research. All of those dollars are likely to be scrapped from the budget, given the recent election of Donald Trump and his anti-women stances and policies.

Anthropologist Margaret Mead once said, “There is no greater power in the world than the zest of a postmenopausal woman.” In order to fix the system, we have to become advocates for ourselves and other women; we have to demand our doctors understand the science and listen to their patients when treating our perimenopausal and menopausal symptoms. One way to do that is to get educated about menopause, understand your treatment options, and advocate for yourself.

Gen X women, 40 million of whom are now well into their forties and above, hold over $15 trillion in purchasing power. We are the wealthiest, healthiest, and most active generation in history, and by 2025, it’s estimated that 1.1 billion of us will be post-menopausal. It’s time we band together to demand the care we need and deserve to live full, active, and healthy lives.

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