It's time for women to become activists for menopause care

A new book by Dr. Sharon Malone shows women how to navigate the medical system and to advocate for themselves in midlife

Did you know that back in the early 1900s, only about half of all women in America lived past the age of 50? Today, women live on average to be 81 years old — 30 additional years. If you’re lucky, it’s not out of the question that you’ll live to be 100. And yet, even in the year of our Lord Beyoncé 2024, the medical system expects women to live all of those extra decades without the protective benefits of estrogen, progesterone, and testosterone, hormones that protect our hearts, bones, brains, muscles, and organs, yet drop precipitously after menopause.

When I went through menopause four years ago, I made an appointment with my doctor to talk about my symptoms — a lack of sleep, brain fog, weight gain, and mood swings. After reviewing my blood panel, she told me what I already knew given that I hadn’t had a period in over a year — I was officially in menopause. And then she asked, “Is that ok with you?” An odd question because I wasn’t sure what the alternatives were, but also she wasn’t offering any solutions to my symptoms. And when I asked about hormone replacement therapy, her 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,” she said. “And I wouldn’t want you to risk getting breast cancer.”

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.

To be clear, I was suffering, just apparently not enough. 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.

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 learn how to advocate for yourself. I highly recommend the new book by Dr. Sharon Malone, a leading OB/GYN and expert on menopausal and post-reproductive health, called "Grown Woman Talk: Your Guide to Getting and Staying Healthy.” I spoke with Dr. Malone about her new book during an IG Live last week, and luminaries like Michelle Obama and Maria Shriver are also celebrating this guide for women — especially Black women — who have been ignored or marginalized by the system.

A new book by Dr. Sharon Malone shows women how to navigate the medical system and to advocate for themselves in midlife

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). And the combination of estrogen, progesterone and testosterone I’ve administered or taken every day since, 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.

Like any medical treatment, there are HRT downsides and even overpromises, but for millions of women in need of relief, experts like Dr. Malone believe hormones can and should be a first-line option. "Estrogen is not the only answer, but it is the most effective answer,” Dr. Malone says. “For women who are symptomatic – and by that I mean women who have hot flashes, night sweats, sleeplessness, mood swings, and the list goes on and on – nothing treats those symptoms better than estrogen therapy. And that's period, end of sentence.”

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.

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."

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. Gen X women, 40 million of whom are now well into their forties and above, hold over $15 trillion dollars 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 demand the care we need and deserve to live full, active, and healthy lives.

(PS — I’m often asked what to do if your doctor doesn’t know enough about how to treat menopause or refuses to prescribe HRT. I recommend Alloy (check out the company here), a telemedicine network of doctors who understand and treat perimenopause, menopause, and HRT. Dr. Malone is their Chief Medical Advisor).