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August 08 2019

Menopause: Beyond the Stereotypes

By Lindsay Taylor, PhD

Disclaimer: I have not gone through menopause. I am, however, turning 40 this year. Statistically speaking, this is the decade in which I’m likely to enter perimenopause, so I have a vested interest in understanding what might be in store for me. 

I’m all too familiar with the stereotype of the belligerent, out-of-control menopausal lady plagued by hot flashes and mood swings, bewildering her poor, beleaguered partner. [Note that for convenience I am going to use “menopause” to include the perimenopausal period as well.] Frankly, this narrative doesn’t suit me at all. I know very well that hot flashes and mood swings can be a part of menopause, but obviously there’s a lot more to it than that. 

Of course, I want realistic view of what lies ahead so I might prepare mentally, emotionally, and physically. However, I also want the nuances. Plus, as an optimist I want to know the good, not just the bad and the ugly. To my mind, any major life transition is a chance at a reawakening of sorts, even if the road through it is rocky. My natural tendency is to find the silver lining and reframe situations as growth opportunities. 

Menopause is much more than a collection of symptoms that need to be combatted. However, much of what’s written about menopause, from the scientific literature to the blogosphere, focuses on coping with and dealing with menopause. After a while, one wonders if the scientific and medical communities aren’t overeager to problematize and medicalize menopause by putting all the focus on the symptoms and, naturally, the treatments (they can make money off of). You have to dig deeper to find discussions about the meaning of menopause through the eyes of women who are living it.

Nevertheless, plenty of women and scientists (and women who are scientists!) are exploring how menopause fits into the flow of a woman’s life. I came away from my research seeing that menopause is, in fact, not terrible for many women. There’s tremendous variation in individual women’s experiences of menopause, not only in terms of the actual symptoms but also in the way she appraises them. Menopause is far more nuanced and idiosyncratic than sitcom stereotypes or medicalized portrayals would have us believe. It can be a time of tremendous growth and transformation, and a lot of women embrace that opportunity.

Moreover, although hormone therapy is by far the most loudly promoted remedy, it’s not the only game in town by far. There are actually a wide array of options that women might use to prepare for and alleviate the troublesome aspects of menopause. (Stay tuned for a future post on this topic.)

Why We Go through Menopause: The Value of Elder Women

One of the fun facts I came across in my deep dive into menopause is that scientists have so far identified four non-humans species whose females experience menopause: orcas, narwhals, belugas, and short-finned pilot whales. All toothed whales—fascinating! Other primates probably do not, although chimps and gorillas might (this is controversial, apparently). In other words, we’re pretty special! 

While the biology of menopause—the when and what—are well understood, the why is still not totally clear. Human females might spend 40% or more of their lives in the post-menopausal phase. As the authors of this paper bluntly put it, “If the main purpose of women is to propagate the species (survival of the fittest), as postulated by Darwin for all species, then going through menopause many years before dying should be selected against unless there are distinct advantages to it.”

Ouch, but also fair. Scientists have come up with various theories about the nature of those advantages and how they came to evolve. The most compelling explanation is that our post-menopausal longevity directly contributes to the reproductive success of our offspring. Because humans mature slowly, not only do our children require a ton of resources and caretaking, but we also have additional children before our older children are anywhere near self-sufficient. 

The Intergenerational Network of Caregiving

The “grandmother hypothesis” proposes that elder women enhance the survival of their lineage by caring for their biological grandchildren, but they also pass down their considerable knowledge and wisdom in and beyond the family itself. Post-menopausal female orcas assume leadership roles in their pods. They’re instrumental in helping other whales find food. Research has shown that their ability to lead others to fruitful fishing grounds is especially important in times of food shortage. 

These older females possess skills and knowledge that enhance the survival of their offspring; and their offsprings’ mortality risk increases dramatically following their mothers’ death. The same is probably true for humans. Indeed, there is historical evidence from the 1700s and 1800s that women reproduced earlier and more often if their children’s grandmother was alive. The grandchildren’s odds of surviving to adulthood decreased if grandmothers were distant or deceased. 

Competition versus Cooperation

A related theory to the grandmother hypothesis is that intergenerational conflict drove the evolution of menopause. In both human and cetaceans, daughters reach sexual maturity while the mothers are also still capable of reproducing. However, there are only so many resources (both material and energetic) to go around. 

When female orcas continue to reproduce once their daughters have themselves started reproducing, the older females’ babies are less likely to survive than the younger females’ babies. The same might have been true for humans. According to this line of thinking, as we age, it’s better that we cease having children of our own and instead step into a supporting role for direct caretaking—and a more expansive role beyond caretaking itself. 

Personally, I like the view of our roles changing through the lifespan, providing different types of value at different times. We have different gifts to offer in our post-reproductive years. 

Different Women, Different Menopauses

In both the scientific literature and everyday conversation, people tend to talk about menopause as if it were one thing, a singular experience shared by all women. Nothing could be further from the truth. 

Although some symptoms are common enough to be considered standard—hot flushes/flashes, night sweats, vaginal dryness, and mood alterations being at the top of the list—the range of possible symptoms is considerably greater than that. Not all women will experience even the most common ones. Among women who do, the severity of those symptoms can vary tremendously. Depending on whom you ask, anywhere from 20-75% of women experience symptoms severe enough to significantly impact their quality of life.

A huge number of factors influences any individual woman’s experience. To start, the onset and severity of symptoms can differ depending on what type of menopause she experiences: if it is premature (younger than 40-years-old) or early (between 40 and 45 years), or if it’s induced by surgical removal of the ovaries versus natural changes in hormone levels. Other factors shown to affect a woman’s symptomatology include her physical and mental health before starting menopause, activity level, lifestyle factors such as smoking, socioeconomic status, and perhaps even geography. 

Mindset Matters

It’s also clear that women’s expectations about and attitudes toward menopause shape her experience. Part of the stereotype is that menopausal women complain and kvetch their way through menopause, periodically pausing to stick their heads in the freezer. (I hear this does help.) However, surveys show time and again that most women actually have neutral to somewhat positive attitudes about menopause.

Many at least hold a mix of positive and negative beliefs and expectations. Understandably, women tend to hold negative attitudes towards hot flashes, night sweats, and other unpleasant physical symptoms. On the other hand, most women are only too happy to stop having monthly periods, and many of them are ready to move past the need for contraception.  However, this can be an emotionally fraught time for women who are not ready for their reproductive years to end. 

There’s a complex interplay between physical symptoms, attitudes and beliefs about menopause, and psychological well-being. Studies show a bidirectional link between a woman’s attitudes and her subjective experiences. Women who experience disruptive symptoms such as frequent and severe hot flushes understandably have more negative attitudes. The reverse is also true. One prospective study also showed that premenopausal women who had more negative attitudes about menopause later reported experiencing more frequent and more severe symptoms. Another study found that women are less likely to be bothered by menopause if they have other more pressing issues in their lives. (“Pssht, menopause? I can’t be bothered worrying about that, I’m too busy dealing with this crisis over here.”) 

Cross-Cultural Differences

Women’s attitudes about menopause are also shaped by her cultural milieu. This could help explain why women around the world have quite disparate experiences in menopause. Not only do women in different cultures report being more or less bothered by menopause overall, the specific symptoms they describe differ as well. The reasons for this are not well understood. It’s not clear whether cross-cultural differences are due to factors like diet, climate, and number of children a woman typically bears, or whether they reflect the varied beliefs and meanings that cultures ascribe to menopause. It’s probably all of the above and more. 

Finally, women’s subjective experiences of menopause do not perfectly map onto objective markers such as hormone levels. Two women reporting the same number of hot flashes and sleep disturbances might also report very different levels of distress about those symptoms, for example. This might be due to differences in psychological and emotional well-being, as I will discuss in the next post. Women who have better coping mechanisms, more social support, or higher emotional intelligence are likely more resilient to the physical symptoms. 

This all goes to show there is so much more to the menopause story than we’re typically presented with. It’s important that healthcare providers understand this and take the time to understand their patients’ unique situations. Likewise, women should know that there’s no right or wrong way to experience menopause.

“Second Adulthood”—A Lot to Look Forward To

“Menopause starts out as a horror movie, but then transitions into a coming of age story. The time after menopause can truly become the best part of our lives as we create a vibrant second half of life. … Second adulthood is the best!” Lynette Sheppard, RN

Now for the really good news. As I said above, many women have positive attitudes toward menopause, even when they are in the thick of it. Lotte Hvas is a Danish doctor and author of the book, Menopause—Better Than Its Reputation. Her research shines light on the positive aspects of menopause. In one study, Hvas asked women to reflect in an open-ended manner on how they experienced menopause and how it affected their lives. About half of the 393 women in the study spontaneously offered positive assessments. 

Not surprisingly, many women were happy to be done with PMS and monthly periods. (This is something I saw often while reading menopause blogs—”No more cramps, and I can finally wear white pants again!” White pants are apparently a big deal for a lot of ladies.) Others described it as a “wonderful” and peaceful phase in their lives. Still others celebrated the fact that now that their children were grown, they had the time and freedom to explore new areas of interest.  Nine of Hvas’ respondents reported that menopause improved their sex lives. 

Plenty of women celebrate menopause as the beginning of a new phase of their lives. Menopause coincides with coming into their own in a new way. They talk about exploring new creative channels, experiencing greater patience, and being more selfish in a good way.

As Margaret Mead once said, “There is no greater power in the world than the zest of a post-menopausal woman.” Once women walk through menopause, whether it’s an easy stroll or a walk through fire, they emerge on the other side more confident, with a renewed vigor, and a take-no-baloney attitude. These sentiments were echoed by participants in a study in which Dr. Hvas conducted in-depth interviews with 52- and 53-year-old women. The women perceived themselves as more experienced and more competent than their younger selves, and more assertive about speaking their minds. 

As my own mother told me, “Once you get older, you stop giving a $%&! about what other people think.” This theme is echoed time and again by post-menopausal women who say they feel less constrained and more self-confident. Some researchers believe this is actually due to the hormonal changes of menopause, but there are probably psychosocial influences as well. Whatever the cause, a lot of women affirm this, and frankly it sounds pretty great. 

A Shift in Perspective

At some point in my reading I came across the term “menostart” as an alternative to “menopause.” This seems apt for the many women who experience menopause as a turning point after which their interests, priorities, and attitudes change. 

The psychological principle of socioemotional selectivity theory (SST) offers a lens through which we might understand some of these shifts. The central tenet of SST is that as we age, our future time perception changes. Whereas once we were young and time felt expansive, with aging comes a growing recognition that time is limited. This changes how we approach the world. According to the theory, when time seems expansive in our youth, we focus on future-oriented goals, seek novelty and knowledge, and invest in individual achievement. In contrast, older adults prioritize relational goals and positive emotional experiences.

Three decades of research into SST bears this out. Although SST is not a theory of menopause per se, it does postulate that older individuals facing important life transitions that signal an “ending,” such as retirement, will effortfully focus on positive aspects and downplay negative aspects. Menopause surely falls into this category as well. Older individuals also tend to be better at emotion regulation in everyday life and enjoy more stable positive emotions. 

Consistent with this, Hvas relates, “Some women describe that they have used the menopause as a trigger to changing their lifestyles. To others it has meant that they have realised that life is not eternal and that it is important to, ‘use life while you have it’. The statements indicate that the phase has resulted in personal development.” Some of the women in her other study described themselves as more tolerant. “The women also experienced that they had become better at prioritising and at ignoring trifles and instead focus on the important things in life, viz. things that were crucial to themselves.”

I’m Starting Now

No, this isn’t my public announcement that I’m starting “the change.” (Ugh to that term.) I’m laying the foundation upon which I hope a healthy, meaningful “upper middle age” will be built when my husband and I will become empty nesters, and when we fully intend to be healthy, vibrant, active, and on the move.

I’ll talk in my next post about psychological and emotional considerations as well as non-hormonal approaches to easing one’s way through menopause. Hint: I bet you’re already using a few of them to improve overall well-being. I am, and now I see them in a new light.

Because attitude is clearly important, I’m cultivating a positive mindset about menopause. It’s necessary to be intentional about this in a world that often treats menopause like it’s the worst thing ever. One strategy is to gather positive role models of women who are celebrating this period of life. I’m starting with Oprah, who says, “So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time and talent.” That sounds good to me.


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Deeks AA. Psychological aspects of menopause management. Best Pract Res Clin Endocrinol Metab. 2003;17(1):17-31.

Hawkes K, O’Connell JF, Jones NG, Alvarez H, Charnov EL. Grandmothering, menopause, and the evolution of human life histories. Proc Natl Acad Sci USA.1998;95(3):1336–1339. 

Peccei JS. Menopause: Adaptation or Epiphenomenon? Evol Anthr 2001;10:43–57.

Sievert, LL. Anthropology and the study of menopause: evolutionary, developmental, and comparative perspectives. Menopause 2014;21(10):1151–1159.

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23 thoughts on “Menopause: Beyond the Stereotypes”

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  1. A well rounded post. I am female 60 yo. I did have a positive attitude about menopause, but I also experienced some rough times. Altered sleep patterns still exist. I deal with them that is the way it is so live with it.
    I did not gain weight or have mood swings. I am reaping the benefits of 40 years of working out because I always had the attitude that I am in it for the long haul. Weights, WOD, yoga and cardio.
    That said my beautiful off spring have not reproduced yet. I was blessed to have both sets of Grandparents to be a part of raising them. Our culture today has families often isolated or blended where so many available grandma and grandpa are not in their grandchildren ‘s lives. I mean being hands on grandparents instead of distant observers. This is not a judgement call, but a suggestion that elders find ways to mentor youngers for everyone ‘s benefit. Peace from n.c. Thoughts?

    1. Yes having grandparents around to help is always great. My sister and I had children young, so my mom became a grandma at 35. She practically raised my sister’s first child and I don’t know what I would have done if she wasn’t there to watch and care for my toddler when I gave birth to my second. My younger half brother was raised most of his childhood by my paternal grandparents. Grandparents are awesome! I’m from NC also 🙂

  2. Just had to stop by for a giggle. I’m going thru perimenopuse at 56. There’s something to be said for coping, particularly with poor sleep.Any study of negative or positive attitudes should also ask – how much sleep are you getting? I bet you’d see a trendline. I recommend looking into progesterone. Overall I agree that there are plenty of positives to be had in this experience. My main negative is it is one heck of a long transition.

  3. Interesting post. I appreciate the effort to approach it from a positive perspective, and it’s nice that you have that attitude going in. Good luck with that!
    As a menopausal woman myself, I have a couple comments. First, yes, it would be lovely to see this as a time where older women are turned to for wisdom and advice, and we have something to offer, and this does indeed happen in many cultures and families, but as a whole, in our western society, older women are invisible. Women spend enormous time and money to hide any signs of aging, because it is understood that being old as a woman has no value in our society. If you choose not to conform, well, bye. It was nice knowing you.
    Second, menopause is still very “taboo” in terms of public discourse. It’s like the women’s “hysteria” of old — when someone is experiencing symptoms, particularly those involving mental health, it’s laughed off, or shrugged off, or patched with a pill. “She’s menopausal” is not said as a statement of fact, but as a slight. It would help if we could talk about it, support one another, share stories without shame. I personally didn’t have it too tough, aside from weight gain, but that has impacted my mental health more than I would like. I always identified as a lean, fit individual. Now? I have a bit of weight around my belly and thighs that seems determined to stay. I don’t feel as good in my skin. My sense of worthiness, value, whatever, has suffered. I can already almost hear the responses — You can beat this, you can lose the weight! Try harder! Diet! Exercise! But you know what? That “I don’t give a sh*t anymore” part of menopause is also real. It reminds you that you’re on the downhill side of this journey called life, and it’s a friggin shame to waste valuable time panicking about stubborn fat bits. I want to celebrate all the things I can instead – the people I love, the places that speak to me, all those things that bring me joy. WHY NOT?
    So that’s my two cents’. I’m sure you’ll get many more.

    1. Thank you for sharing, Mary! I too wish we could talk about it more without it simply being something of a joke. The public discourse that prevails right now lacks nuance, that’s for sure.

  4. Thanks for this! I have been living the Menopause adventure now for a few years and have tried from the start to see it as a healthy process, not a disorder to be treated. So far, so good! Some things are challenging, but attention to not eating my personal inflammatory foods and spending time de-stressing helps a great deal.

  5. I’m a 54 yrs old long term yogi who just didn’t believe that menopause or aging will be an issue. The only thing is that as I look slim and fit for my age, society doesn’t think treat me as such and I am fading into invisibility when younger crowd veered for teaching jobs or any jobs I hope to have. I have sleepless nights and fatigue but I soldier on, yes, I do but it’s tough. Especially when jobs are scarce and you find yourself omitted in most C list let alone A list.

  6. Menopause was complete when I was 50. What a relief not to menstruate! Life begins when the period ends. We gain miles, and life experience. Once in our 60s, we are ignored. We feel this, and it hurts.

  7. I guess I was one of the lucky ones. Menopause came and I scarcely noticed. I didn’t have any of the major symptoms many women get and only a few minor ones that were of short duration. My doctor wanted to put me on HRT, just as a matter of course. I refused. I told him, “I’m fine. I don’t need that stuff.”

    I don’t know whether it was due to attitude, heredity, a healthy diet, or that I just didn’t have time to stress out over it, but for me, thankfully, menopause was really a nonevent.

    1. I liked reading your comment. I know I might not be as lucky as you, but reading that some women get through menopause with ease helps me feel hopeful.

      I’ve never struggled with eating healthy food (it feels natural and easy other than trying to figure out who to believe when there is debate), but I could certainly work on my attitude. A good attitude seems to be easier with a sense of hope rather than dread, which your post provided.

  8. For me, pre menopause (age 46 to 50) was the WORST as my periods were long, painful and heavy. I needed to take up to 8 ibuprofen per day just to get by!!! So when my periods stopped I was so overjoyed I hardly noticed the hot flashes! It was at this point that I quit eating sugar, eventually wheat, then all grains. I also noticed that I had no “night sweats” when I didn’t drink alcohol!
    My weight stabilized and I had lots of energy.
    I am now in my mid sixties and have adopted a primal low carb high fat diet (cycling in and out of ketosis)supplementing with collagen, vitamin c and magnesium. I also eat lots of fermented foods,( making my own sauerkraut). I feel so much better than I did in my 40’s….I was even starting to feel arthritis in my joints!
    I will never go back to eating processed foods!
    I strongly believe that healing your gut by cutting out inflammatory foods like sugars and grains and limiting nightshades, as well as mindfully moving your body daily so that every muscle group is attended to.
    It is moving through life MINDFULLY, that has come to have so much importance for me! Read Dr. Dan Siegel, AWARE!
    And Katy Bowman and Esther Gohkale all have wonderful and practical tips on how to make your every day movements “exercise”…just like Mark’s recent post on micro workouts!
    Good luck and my you live life joyfully and with gratitude!

    1. Your pot gives me so much hope!! I don’t have painful periods, never have. I lost an ovary with an ectopic at 41 ( I am almost 49) and things went to crap after that.
      I was a lean healthy energetic 115 lbs…i went to a fat dumpy cellulite covered zombie within just a few years, all the while working out and eating right just as I was before. I have gained about 25 lbs now, I would be thrilled to just lose the extra inches of fat around y middle, heck with the scales! It is so hard to lose an ounce.
      It sucks.

  9. Great article! I turn 50 this month and am already postmenopausal. Other than some hot flashes earlier this year that completely disrupted my sleep, I had no other symptoms and flew through menopause entirely. I’ve never felt calmer, more centered, happier, and vibrant. I am looking forward to the second half of my life.

  10. I very much appreciate the article and applaud your preparation. I am in perimenopause right now. An older friend helped me by emphasizing that I take self-care more seriously from now on. Exercise, introspection, diet upgrades, and pampering myself become necessary, not optional.

    Another huge help I have found is practicing “mindfulness,” which I do by counting my breaths, when a hot flash or pain flash occurs. I focus intently on each breath like a lifeline, knowing each one gets me closer to the end of this particular flash. This helps distract me from the knee-jerk reaction I used to have of “oh, fudge” (only I didn’t say fudge).

  11. I’m 67. I would like to see an article written by someone who HAS already gone through menopause and can share her experience and thoughts, and not just cite papers and articles as well as rolling out the same old re-re-re-regurgitated ‘information.’

    1. I entirely agree with you in that Menopause is the story you must actually EXPERIENCE before you leap in and write about it – women who have actually passed thru it and have words of wisdom and antidotes; not a blog of redo and re-read. Menopause is something you cannot speak to until you’re in it and/or thru it. Keep passing good advice to those who qualify!

    2. I agree 100%. I had NO idea what I was in for 🙁 It sucks so bad.

      I was so hoping for an article on someone who knew what I was going through although it did help me be a bit more positive. Things can always be worse I reckon!

  12. I am a 58 year old woman who went through menopause 8 years ago. All I can say is that it was hell for me. As a senior executive in a large multinational corporation I could not tolerate the brain fog and chronic insomnia. I couldn’t care less about the hot flashes but when you cannot remember important information that you know you know, and you need to do your job…well that is unacceptable. I spent a lot of time educating myself about bioidentical hormones and went on them 8 years ago. I have not looked back and have never been happier with my choice. I agree that not having periods is a great benefit to menopause but for me at least, the number of horrible negatives meant that HRT was, and is, a godsend.

  13. I started the journey at 37, like my grandmother, and my mom began at about 38/39. I took estrogen (birth control pills) for a few years and was in menopause by 40.

    It was lovely to no longer have a monthly cycle. The hot flushes were fun, thought it was a private furnace thing until my husband, while we were in a public meeting situation, said “are you having a hot flash?” Me “yes, why?” He: “ there’s heat radiating off you” so much for private inferno….. I rather enjoyed them since I typically am freezing most of the time at below 75 degrees.

    Then there was the “A” person and the “B” person “A” person was me, the “B” was this other outspoken person who typically would keep her mouth shut, yeah, ripped a few new ones until I realized I needed to keep a lid on that.

    For the most part it was entertaining for sure.

    Oh, and, I would ask my husband a question and then for some reason not even remember the answer nor that I’d asked. Eventually I’d just ask if I’d ask’d him, if he said yes, I’d ask what he’d said….. that was pretty comical.

    The only regret is that you lose your youthful shape. I was the same size for such a long time and then my body got bigger between my hips and my arm pits. I would try to buy clothes for that new shape and not like the outcome. Eventually I started to lose the wheat, then all grains, then legumes….. my chiropractor said “ it sounds like you are paleo” add in a google search and Viola, MDA !

    Still learning to keep stress at bay, get more than 5 hours of sleep, but I’m doing well at 65 and that’s 25 years into menopause.

    What I’ve learned? Don’t sweat the small stuff, keep a lot bigger sense of humor and enjoy wearing white pants!

    1. I love everything about your comment, especially that last line, I’ve never even bothered trying to wear white pants! Thanks for the laugh and for sharing your story. 🙂

  14. I began peri-menopause at 46 and endured heavy periods that would last for months at a time, brain fog, insomnia, migraines and cluster headaches, fatigue, and a general feeling of blah-ness to my mood. I did not have mood swings or hot flashes, but my head would drip with sweat if I was doing laborious work. I went to my ob/gyn and had a biopsy done just to make sure I didn’t have cancer because of the non-stop bleeding. I chose to go the natural route and not take HRT and I’m glad I did. HRT was just too scary to me. I found the main thing that helped me was keeping my sense of humor and knowing that what I was going through was normal and that it eventually would end. Now that I have officially entered menopause (my period stopped at age 49) my sleep has gotten better as well as the headaches. I feel more comfortable in my own skin than I ever have and I believe a keto lifestyle has 80% to do with that.

  15. I’m in the middle of perio-menopause, one cycle can be 4 weeks, the next couple 10-12 weeks, etc. So far, with the use of progesterone and a couple other creams to minimize estrogen, I’m experiencing only minor brain fog, no hot flash/flush. I am very much looking forward to being done with the periods.

    I’m finding my best information coming from Christiane Northrup’s “The Widsom of Menopause.” Her most recent edition has her own experiences, on top of her research and work in her clinic. Invaluable resource.