Why don’t we treat menopause the way we treat birth?

I have spent most of my career working with birthing people. I will declare at the outset that I am interested in a critical, holistic, lifespan approach to reproductive and sexual health, rather than a biologically deterministic view. Just as the transition into birthing can be fraught, biologically and socially (when the birth plan gets thrown out), so can the transition out of being a birthing person. There is a difference though. The former is largely accompanied by rituals, celebration, and joy. The latter not so much, maybe because birth is a future-focused event, while menopause is a slower less predictable process (or an event if surgically induced) that is overlayed with ageism and sexism or as Leah Lakshmi Piepzna-Samarasinha says in What Fresh Hell Is This?: Perimenopause, Menopause, Other Indignities, and You “menopause is kind of a collision course with parts of the patriarchy and sexism and oppression”. In many cultures, it marks a transition to valued roles but in the dominant white culture where I’ve spent most of my life, cultural messages suggest that the menopausal person no longer has any social value, their value is in the past and not the future. No longer beautiful or desirable, no longer useful or productive (Atkinson et al., 2021), instead a transition marked by degeneration, deficit, atrophy, and entropy. There’s no party, no gifts, no cards, and no supply of casseroles to mark the liberation from periods, or societal strictures. The silence extends beyond the social to the informational. There are few apps and a million fewer self-help books. 

The solution to managing both birth and menopause in neoliberal white settler colonial societies like Australia and New Zealand, is individualized rather than structural. Healthist and responsibilization discourses circulate and permeate the performance of intensive motherhood in the perinatal period and or being an “agile worker” during both, where bodily functions and evidence thereof are supposed to remain hidden (Atkinson et al., 2021). If one simply obeys the health advice to  “take care of oneself” that is drink less alcohol, eat carefully, exercise regularly, etc, then you’ll reduce the risk of X and feel better. Never mind whether you are in precarious work, or housing, are poor, a carer, Indigenous, or a person of color. The representations of menopause are typically “pale and professional” and assume that everyone has the same unbridled access to resources.

The theme for March has been aging and menopause. First, I was on a panel on menopause with Dr Sonia Davison, Endocrinologist at the Jean Hailes Medical Centre and past President of the Australasian Menopause Society; Grace Molloy, co-founder and CEO of Menopause Friendly Australia and Genevieve Morris, comedian, actor and improvisor. It was organised by the City of Melbourne and MCed by the brilliant Nelly Thomas.

I also hosted a webinar for Women’s Health Victoria about codesign with marginalised groups and digital health resources. Their codesigned digital health promotion resource In My Prime, brings together accessible and evidence-based health and wellbeing information on topics relevant to women over 50, from menopause to financial security. The site also features an online exhibition of photographs of nude trans and cis inclusive women taken by photographer Ponch Hawkes. The stellar panel included: Michelle McNamara, Treasurer, Transgender Victoria & In My Prime advisory group member, Vicki Kearney, Women with Disabilities Victoria and Victoria’s Experts by Experience Research Project participant, Catalina Labra-Odde, Research, Advocacy and Policy Officer at, Multicultural Centre for Women’s Health and Associate Professor of Public Health Jacqueline Boyle Director of Health Systems & Equity at Eastern Health Clinical School, Monash University.

I am so glad that the conversations about aging and menopause are taking place. It’s really heartening to know that organisations like the Australasian Menopause Society Limited (AMS) made up of healthcare professionals with a special interest in women’s health in midlife and menopause have accurate, evidence-based information for healthcare workers and the wider community, including helping you find a doctor near you who understands menopause. Jean Hailes has fabulous accessible information on menopause and Health Talk have comprehensive resources on early menopause. Women’s Health Victoria have partnered with Professor Martha Hickey from The University of Melbourne, and people with lived experience to co-design In My Prime, a health and wellbeing resource for women over 50 (with medical information reviewed by clinical experts) which includes comprehensive resources on menopause, cardiac health, brain health and much more. It also articulates a clear aim, which is to address gendered ageism in healthcare. You can find fact sheets on menopause and women’s health translated into several community languages and videos explaining menopause, subtitled in Vietnamese, Cantonese, and Mandarin on the International Menopause Society website. It is also pleasing to see research including other populations, for example Vietnamese women in Melbourne.

I am nervous about assuming that because there is more talk, more information about menopause or destigmatization of it, we might assume that  “everyone” with ovaries is being included in the conversation. There’s a valid critique that representations of menopause typically center the “pale and professional” leaving out queer, trans, intersex, non-binary, poor, First Nations, and People of Colour, all of whom might have different experiences of menopause (Jermyn, 2023, and Riach, 2022). Equally these groups may experience multiple layers of inequality well before before they even try to get their needs met in the health system. They might experience racism, ableism, classism, and cisgenderism, in the world which might impact their trust in health services to help with perimenopausal symptoms. Organizations like Menopause Friendly Australia are trying to introduce “menopause-friendly” accreditation standards, but workplace environments, policies, and procedures tend to be skewed towards white, middle-class professional women, hence the need for an intersectional lens (see the wonderful work that Multicultural Centre for Women’s Health does in this space). The longitudinal Study of Women’s Health Across the Nation (SWAN), which began in 1994 has followed 3,000 women in perimenopause and menopause and found that Black and Hispanic women reach menopause earlier than white, Chinese and Japanese women. Black and Hispanic women experience certain menopausal symptoms for almost twice as long as do white, Chinese and Japanese women. There is also increasing evidence of health disparities in midlife between Black and White women largely due to structural racism.

The lack of culturally safe or  “affirming healthcare encounters” (Riach, 2022) contributes to the so called menopause ethnicity gap. Barriers to accessing menopause advice or taking up Menopause hormone therapy (MHT) also known as hormone replacement therapy (HRT), leading to under-diagnosis, misdiagnosis, or delayed diagnosis. In Australia, A report from the 2023 National Women’s Health Survey, titled The impact of symptoms attributed to menopause by Australian women by Susan Davis, Vicki Doherty, Karen Magraith and Sarah L. White recommendations include: “Greater action is urgently needed to work with priority populations, particularly diverse Aboriginal and Torres Strait Islander communities, to understand their knowledge and information needs and co-design culturally intelligent health promotion approaches to better manage menopause symptoms and seek care when required.”

In research about migrants, difficulty navigating the health system and adhering to healthist discourses and health promotion edicts, often struggling to access services or find health professionals that they trust. Different communities and families will also have different views about menopause, ranging from menopause just being part of living and requiring no special preparation or support, while in others, patriarchy and a lack of access to information may make menopause stigmatized. When people from migrant backgrounds eventually access their General Practitioner they might not find someone experienced in menopause care, or who is culturally competent or safe. Unmanaged menopause symptoms like vasomotor symptoms (flushes and sweats) being associated with an increased risk of coronary heart disease, and impact a person’s mental health and quality of life. Other barriers identified in the Multicultural Centre for Women’s Health excellent first issue of the WRAP (Migrant and Refugee Women’s Research, Advocacy and Policy for 2024 include the exclusion from Medicare of those on a temporary visa, which means that temporary migrants are not eligible to receive subsidized medications and treatment. People on limited incomes might also find the cost of these treatments out of reach even though they are available on the Pharmaceutical Benefits Scheme (PBS) preventing some migrant women from achieving optimal menopausal health.

I am not altogether convinced that health literacy and better health information are remedies in and of themselves. As Nelly our comedian MC quipped “Just because I can understand my body better, does not mean that I can control it”. I think instead the answer might be community. A community of health professionals who can work holistically around a person and escape the machine view of the body, and medical siloes. A community of peers, or inter-generational chosen family who might have time for slow, deep, and long conversations that could nourish and inform. I’m a bit biased since I am now a podcaster, but I’m pleased at the proliferation of alternative voices like Menopause Whilst Black hosted by Karen Arthur, Omisade Burney-Scott’s Black Girl’s Guide to Surviving Menopause” podcast, Dr Nighat Arif a GP in the UK, The My Bloody Hell podcast Episode 9:How Race, Ethnicity & Culture Impact Menopause and Why it Matters. There are also bigger conversations happening including the Senate Inquiry into the physical, mental, economic, and financial impacts of menopause and perimenopause. I also recommend What Fresh Hell Is This?: Perimenopause, Menopause, Other Indignities, and You by Heather Corinna which broadens the menopause lens to include people with disabilities; queer, transgender, nonbinary, and other gender-diverse people; BIPOC; working class and other folks. Jen Gunter in a similarly inclusive publication calls menopause, a time of reproductive reckoning that requires not buying into the patriarchal gaslighting that sees older people with ovaries as having diminished value. Not entropy and atrophy (see Juicy Crones by Jay Courtney), but value. Valuing the age and knowledge that older women have and finding ways to be informed about this transition and making structural change. It will take all of us to do this, just as birthing does.

Useful references
Atkinson, C., Carmichael, F., & Duberley, J. (2021). The Menopause Taboo at Work: Examining Women’s Embodied Experiences of Menopause in the UK Police Service. Work Employment And Society, 35(4), 657–676. https://doi.org/10.1177/0950017020971573
Downham Moore, A. M. (2022). The French Invention of Menopause and the Medicalisation of Women’s Ageing: A History. Oxford University Press. https://doi.org/10.1093/oso/9780192842916.001.0001
Ilankoon, I. M. P. S., Samarasinghe, K., & Elgán, C. (2021). Menopause is a natural stage of aging: a qualitative study. BMC Women’s Health, 21(1), 47. https://doi.org/10.1186/s12905-020-01164-6
Jermyn, D. (2023). “Everything you need to embrace the change”: The “menopausal turn” in contemporary UK culture. Journal of Aging Studies, 64, 101114. https://doi.org/10.1016/j.jaging.2023.101114
Li, Q., Gu, J., Huang, J., Zhao, P., & Luo, C. (2023). “They see me as mentally ill”: the stigmatization experiences of Chinese menopausal women in the family. BMC Women’s Health, 23(1), 185. https://doi.org/10.1186/s12905-023-02350-y
Mattern, S. (2019). Part III. Culture. In The Slow Moon Climbs (pp. 255–366). Princeton University Press. https://www.degruyter.com/document/doi/10.1515/9780691185644-005/html
Riach, K. (2022, October 18). Menopause can affect every workplace – here’s how to start supporting every worker experiencing it. The Conversation. http://theconversation.com/menopause-can-affect-every-workplace-heres-how-to-start-supporting-every-worker-experiencing-it-192711
Riach, K., & Jack, G. (2021). Women’s Health in/and Work: Menopause as an Intersectional Experience. International Journal of Environmental Research and Public Health, 18(20). https://doi.org/10.3390/ijerph182010793
Stanzel, K. A., Hammarberg, K., Nguyen, T., & Fisher, J. (2022). “They should come forward with the information”: menopause-related health literacy and health care experiences among Vietnamese-born women in Melbourne, Australia. Ethnicity & Health, 27(3), 601–616. https://doi.org/10.1080/13557858.2020.1740176