A new podcast from the award-winning body hair and care brand Flamingo, hosted by author, curator, and critic Kimberly Drew. Each week on Unruly, we unpack the quiet ways women’s bodies are commodified, defined, and regulated by social media, the medical profession, the beauty industry, and more. Then we name them, out loud — because information is power, and your body is your business. New episodes drop on Wednesdays.
Episode 5 Transcript | Menopause and the Media
[MUSIC IN]
Susan Dominus: I know in my doctor's office in that moment, I had that feeling of, don't be a whiner, don't be a complainer. So many other people have it so much worse than you do. Why can't you just suck it up? One of my favorite doctors whom I interviewed is quoted in the piece, Dr. Rebecca Thurston, saying, you know, why don't we have more options to help women's suffering during the transition to menopause? And the answer, she said, is, as a culture, we have a high tolerance for women’s suffering.
Kimberly Drew: When reporter Susan Dominus wrote a cover story for the New York Times Magazine – “Women Have Been Misled About Menopause” – it quickly got people talking about a huge, overlooked issue. An issue that half the population either is dealing with, has lived through, or will face in their future. For me, it was a massive eye-opener. In it, she recounts how a landmark study looking at hormone treatment for women in menopause got cut short and then misrepresented in the media. The result? Suddenly, patients and doctors panicked. What was once a reliable answer for horrible symptoms had become hard to get. For many, ‘suffer through it’ became the answer.
I’m your host Kimberly Drew. And From Flamingo this is Unruly: Where we take the quiet ways women’s bodies are commodified, defined, regulated and we name them– out loud. We want to educate and support each other. Because your body is your business.
This is Episode 5: Menopause and the Media
Joining me is New York Times reporter Susan Dominus.
Kimberly: Welcome to Unruly. Thank you so much for being with us.
Susan: It's really my pleasure. Thank you for having me.
Kimberly: I would like to just start with the beginning of your journey. Why did you pursue this type of reporting? What was going on in your life? If you want to define menopause for yourself through your own lens and through your own words, I feel like there's so many ways in which that word means things that it doesn't actually mean. And so I want to invite that kind of introduction as well.
Susan: Basically, the way doctors talk about it is you're officially in menopause when a year has passed since your last period without your having had a period. So basically they don't sort of say that you go through menopause. They say you are “menopausal” when a year has passed. When you are in this transition from your reproductive years to the period of time in which, basically, your egg sacks are waning in number and the eggs that they're producing are declining in quality. That is called perimenopause, and that's a phase that can last many years for some women. And for many women, that's when their symptoms are most acute because your hormones are firing up and down in response to other, you know, their own fluctuations. And your body's making a huge adjustment. So much of the body runs on estrogen for women. And as estrogen declines, the body is trying to find kind of workarounds and coping mechanisms. And in some cases, women have pretty intense symptoms.
Kimberly: I have to admit to all of the people interacting with us that I thought menopause was like a day up until probably a year ago. I think we're socialized to think that it's this thing that kind of happens to our bodies. And I wonder if you could talk a bit more about some of the symptoms often ignored, often overlooked in this stage of perimenopause.
Susan: Another great question. I mean, one of the most important symptoms I think gets overlooked is joint pain. Some women have more eczema. Some women start having GERD, skin changes, hair loss, I think it is commonly known that some women do experience weight gain. There's often anxiety. The most common symptom of perimenopause and menopause are hot flashes, which often also interrupt women's sleep. But if you have a new symptom and it coincides with your being in your late forties, even mid-forties, early fifties, it's worth bringing it up with your OB-GYN, assuming your OB-GYN is well trained in menopausal care, to discuss whether that's something that could be a symptom of perimenopause or menopause.
Kimberly: I think that you hint at something that's so important in your article in the shift in ways in which folks who are approaching perimenopause and menopause are able to access medical care. I wonder if you could talk us through, kind of, some of the treatments that were made available for these symptoms. How are they effective? Let's just start there.
Susan: So there's a long and complicated history of how menopausal symptoms have been treated. But basically the most effective way to treat hot flashes, it is known, is through estrogen, by giving women estrogen. Because women who take estrogen, if they have uteruses, that can be known to increase their risk of endometrial cancer. Women who take estrogen – if they have uteruses; many women have had hysterectomies – they don’t – but if you do, then they also tend to take a progestin, which we know has a really powerful countervailing effect on that additional risk. But it was widely prescribed, both of these medications up until 2001, when the Women's Health Initiative released the findings of a study that it had done on the effect of hormones on women's heart health and breast cancer risks. And what they found was that actually being on these hormones in conjunction did elevate some women's risks and some health risks for things like breast cancer, for example. They found that after five years, they saw a 26% increased risk and likelihood of getting breast cancer for women who took both of those hormones. Now, they later found that for the women who didn't have uteruses and didn't have to take the progestin, therefore that their breast cancer rates actually declined. So there's two things basically happened, which is that the risks that women were informed of were not exactly put in context. So if you have a very, very tiny risk of breast cancer in your fifties, then adding a 26% increased risk on top of that, you still end up with a very, very small number. And the bottom line is that when the WHI results came out, people who had been hoping that actually the findings were going to reveal that estrogen and progestin were like nothing but good for women's health, were so shocked that it created a tremendous backlash and there was, I think, not enough information contextualizing the risks for women. There wasn't enough discussion about what risks might even be acceptable to certain women who are really, really suffering in terms of lifestyle, in terms of quality of life. And they just stopped. They were no longer prescribed regularly in many many circles. Information came out over time that was more reassuring. The numbers started creeping up. But, you know, if you're a woman who had the misfortune of going through a very, very difficult menopausal transition in 2002, that would have been a very hard time.
Kimberly: And for those of us who are not familiar with the WHI, could you talk a bit about the purpose of the WHI and how, how their findings then create this kind of avalanche of information or response?
Susan: Yeah, I mean, so there was an assumption in some medical circles that estrogen was, you know, ‘so good for you,’ as one doctor put it, ‘it should be in the water.’ You know, even for women who were menopausal or postmenopausal. Men have many more heart problems than women do, basically, until the minute when women hit menopause, and then they start to catch up to men. So there was the thinking that, well, okay, first women have estrogen, they're in great cardiac health. Then they lose their estrogen levels, they decline. Suddenly they have the same heart problems men do. It must be the estrogen. So there was this great hope in some communities that estrogen was going to be this miracle drug. And there were other circles of women who thought, but we don't really know because we haven't done a randomized controlled trial to actually compare women who've never been on estrogen to women who do take it and see what the discrepancies are. For all we know, women, you know, who are taking estrogen will fare worse. There was some thinking that maybe the women who took estrogen were only doing better in observational studies, which they were, because maybe taking estrogen suggested that you were someone who was very plugged into your medical community and that you had good health care in general. So there were all these confounding factors that women's health advocates really thought needed to be teased out.
Kimberly: And then there's this study that comes out in 2002 that just kind of shakes the table and has everybody kind of pens down is what it sounds like.
Susan: [Laughter]
Kimberly: They’re like, stop everything. 26% is too big of a number. We're freaking out. We're going to change the way we do everything. Is what it seems like.
Susan: Yes, there’s a huge needle scratching moment, in part because the WHI felt this news was so important that they did something quite unusual, which is hold a massive press conference. And so the media were alerted in a kind of– everything about it just felt different. And even though some of the people at that press conference from the WHI said, you know, for individual women, this risk is very small. It's more epidemiologically speaking that we would see a real difference. Which is true. Even still, there was just this shocked reaction. They also announced that they were halting the study. They had deemed that the risks were sufficiently high that the study had to be halted. And I think people conflated the idea of the ethical standards by which study would stop with the standards that a woman herself would make in order to stop taking the medication. The study wasn't intended to measure risks and benefits that included things like quality of life or relief from suffering. It was really just intended to measure actual health risks– risks of, you know, of aging or even mortality. And so that's what it was looking at. And by those measures, yes, it was time to stop the study. But for women who were trying to weigh brain fog– another common symptom– total lack of interest in sex because vaginal dryness made intercourse so painful. All of those kinds of factors might lead many women to have a different equation in the end.
Kimberly: Can you clarify why the WHI study was halted.
Susan: When the WHI set out to study the effect of menopausal hormone therapy on women's health, they had determined ahead of time that if the increased risk of breast cancer hit a certain number, that was it, they were going to halt the study. For them, I think it was if they saw an increased risk of about 25 or 26%, for example, for breast cancer, then they did not feel it was ethical to continue. You know, to have women enroll in the study without letting them know that, by the way, if you are in the non-placebo arm and we're giving you this hormone, you have this increased risk. So when they hit that number, which was about five years into the study, that was when they halted the study and that was when they held the press conference, which was this tremendous needle scratch of a moment.
Kimberly: What role did the media coverage of the WHI findings around elevated breast cancer risk play in the ways that doctors treated menopause?
Susan: When the WHI halted the study they were doing or the trial they were doing on hormonal therapy for women who had uteruses, um, they held this big press conference and there was a segment on the Today show, certainly, that a lot of women watched in which the conversation was extremely alarmist. A lot of statistics were thrown around with very little context so that women had very little opportunity to really assess what the actual risk to them was going to be. All they knew was that it was going to be higher, and it just triggered this cascade of doctors stopping prescribing menopausal hormone therapy to such an extent that medical schools really just didn't think there was that much of an option in the way of menopausal care. Doctors stopped learning about it in medical school. Even now, so many women and men and other people in the medical school talk about wanting more training, but just because of the way that medical schools are set up and because of the limited time constraints and perhaps because it hasn't been a priority, there's just very, very little education about this issue.
Kimberly: And you, in your reporting, cited this specific episode of the Today Show. Could you just talk to us a bit about that segment and its impact?
Susan: It's hard to know exactly what the impact was of that particular segment on the Today Show, but I think there was this general feeling of a bunch of numbers being thrown out like, there's this elevated risk, it's 26%, Anne Curry's freaking out, and everyone's, you know, very emotional and shocked and horrified. I can't help but think that the average listener would think like, oh, a 26% increased risk of breast cancer. Does that mean I have a 26% chance of getting breast cancer? Was my risk pretty high? And no matter what they might think, that 26% increase, that's, that's a really scary number. And I do think that certainly one OB-GYN, whom I interviewed said that that particular episode was something that so many of her patients talked about, and she said to me that she has three dates that she remembers: one is the day JFK was shot, one is 911, and one is the day that the WHI report came out because so many of her patients, and this is a story you hear many doctors tell, they were calling, they were flushing their hormones down the toilet. They were distraught, really distraught.
Kimberly: And how did this impact the ways in which doctors were providing this care?
Susan: I believe there was a significant shift that happened after the report, based on my many interviews with many OB-GYNs, went from an opt-out situation to an opt-in situation that, you know, women would come and say, ‘I'm not feeling like myself. I'm having hot flashes.’ It used to be that doctors would say, ‘Well, you might want to consider hormone therapy.’ Now, I think women really had to fight for it. I think doctors kind of shamed them for not seeming to want to put up with their symptoms, didn't know the nuances of the numbers because there was just this general sense that it was bad for you. I mean, in my article, I tell the story about how I went to my doctor and said I was having symptoms, and she said, ‘We really only prescribe this for people whose symptoms are significant.’ And we didn't really even get into what that threshold was in her mind, how bad did it have to be to justify it? But it was a feeling that one would have to really make a case before the doctor would prescribe them, that kind of thing.
Kimberly: It's just so upsetting all the time to have these conversations about the ways in which our suffering must be normalized, and how that creates such a barrier for each of us who are coming in to get what should be pretty basic care.
Susan: I agree. I mean, I know in my doctor's office in that moment, I had that feeling of like, ‘Don't be a whiner, don't be a complainer. So many other people have it so much worse than you do. Why can't you just suck it up?’ One of my favorite doctors whom I interviewed is quoted in the piece, Dr. Rebecca Thurston, saying, you know, ‘Why don't we have more options to help women's suffering during the transition to menopause?’ And the answer, she said, is, as a culture, we have a high tolerance for women suffering. I have a whole riff in the article about, you know, imagine if men went to the office and were like, tearing off their hoodies and were showing up sleepless because they had had their sleep interrupted by hot flashes the previous night. And if their actual penises were starting to change in ways that were undesirable and that sex were painful for them. Like, it is quite hard to imagine that there would not have been more care put into this phase of life if it weren't women who are going through it.
Kimberly: We're gonna hear more about the ways conversations about menopause are changing in just a moment.
Normally, this is where you’d hear an ad – and honestly, maybe you’d skip through it. But instead, we’ve got a story from a nonprofit that supports women's bodily autonomy and mental health. It’s one of the organizations that Flamingo donates to as part of its mission to “keep your body in mind.”
Kimberly: As a journalist, how did you see the media talk about or cover menopause, perimenopause and its treatment before you began your own reporting?
Susan: When I went back and researched, the New York Times did coverage this issue really thoroughly and really well. I don't know that it got the same kind of promotion or attention as the cover of a New York Times Magazine article could have. And I think that was really part of the vision of Jake Silverstein, the editor of the magazine, to decide that this needed to be a cover story. And, you know, I think there was this just sense that even if the information was out there, it was in bits and pieces, and it was hard to identify what was new and what was old and what was reliable. And I myself, you know, I remember reading a piece that Sandra Tsing Loh wrote for The Atlantic many years ago about her experience with menopause. And like, it was like a little side note in there that eventually she got an estrogen patch and started to feel better. But the tone of the article wasn't ‘why was I need to feel this way for so long when there was an estrogen patch all along that could have helped me.’ It was more of a cri de coeur about the experience itself.
Kimberly: I wonder what are some of the things that you're seeing now in relationship to these conversations around menopause. Of course, now we're, what, 21 years later. What are some of the shifts that you would say have been particularly substantial in access to care or even the language around access to this care?
Susan: Well, one thing that's happened a lot of people would argue is that the kind of Gen Z, ‘put it all out there’ sensibility, or the Millennial sensibility, has really changed the conversation. And the same people who brought you underwear to help you with your period, even if those people weren't going through menopause or some of them already are going through early menopause, their openness about all things body, I think, has affected a generation of women who themselves were going through menopause. And so they were inspired to start businesses that would make menopausal care more available to more women. I think there was a sense of shock when people of my generation hit 50 or so and we're like, wait, what's going on? Like, I can't get hormones easily? Okay, I– Alloy will start an online business that links doctors up with patients so they can more easily get care. Or, or Midi, which is a telehealth portal platform that allows people to meet with a doctor who's an OB-GYN, who is trained in menopausal care. So I think there's just been more discussion about it. Michelle Obama and Oprah have had conversations about it. And, you know, Courteney Cox has a whole TikTok about it. I just think there's a sense that we don't have to be embarrassed. Once women can start to talk about their symptoms and recognize what they are and not feel like it's a topic that is shameful, which it was for many years, then they can start to advocate for themselves.
Kimberly: You shouldn't have to be overly courageous or overly brave to get access to the care that you deserve. But when we live in a culture that shames so many of us for the natural things that are happening in our bodies, it puts us in this really terrible spot.
Susan: I agree. I think menopause itself is bound up with ideas about aging women and sex. Aging women and sex alone is a topic that makes people very uncomfortable that, I think, is rooted in misogyny and a kind of disgust for the aging female body. I think that, you know, OB-GYNs are now increasingly pressed for time, and so broaching the subject of something as sensitive as a middle-aged woman’s sex life, there is just not a lot of space for that. I think the workplace– women are really afraid of being associated with aging. We know that there's aging in the workplace and so who wants to be the first woman to advocate for workplaces that are sensitive to the symptoms that women experience during menopause? You're starting to see it more and more often. In England, there's a huge movement to make menopause a bigger part of the workplace quality of life conversation. But it's the rare woman who's eager to lead that charge.
Kimberly: One of the symptoms that you mentioned in your article is a decrease in libido. In your reporting, how did the response to this issue change? Because I feel like we often, adding too much pressure to women and female pleasure in general. And do you see this kind of shift evolving at all, especially in this cultural moment?
Susan: You know, again, when there was a resistance among even feminist groups to the advocacy of the use of menopausal hormone therapy, some of that sentiment was, ‘This is being foisted on us. You can't stand that we're aging. You want us to be forever young so that we will be readily and sexually available and desirable to men. Why can't we naturally age and be valued in our postmenopausal state without these additions of hormones?’ So there was always a tension, even in the feminist movement, about whether this was something that women had the right to advocate for so that they could be their best, most efficient, most engaged and well-rested selves in the workplace, versus people who saw it as something that was being pushed on women to keep them desirable in the eyes of men. And I feel like that conversation has kind of receded a little bit because there is just such an awareness about how difficult it can be for some women to be their best selves, either in the workplace or in their married lives or at home in the absence of some of this treatment. By the way, menopause doesn’t alway decrease libido, and we don’t know that it increases libido to give people menopausal hormone therapy. What we do know is that the absence of vaginal estrogen, sometimes women experience so much dryness that sex becomes aversive and painful. And there are other ways of approaching vaginal dryness other than estrogen, but it’s certainly a very effective way, and known to be a very low-risk way when it’s topical with a topical cream. I do want to say, many women do not have terrible menopausal symptoms. I always feel like it's really important to get that out there. You don't want the power of suggestion to put everybody in a panic. I myself have lots of friends who, you know, gave the whole thing a big shrug. But I guess I just want to say that, you know, for women who are experiencing a hard time – I think women have to fight too hard for various treatments of that kind.
Kimberly: In your research you talk about the intersection between menopause and the brain. I think that was striking because it seems like something that's been solely kind of relegated to conversations about the uterus. I wonder if you could talk about how menopausal changes aren’t just relegated to a certain part of the body.
Susan: I think the simplest way to explain that is to say that we have estrogen receptors in almost every organ of our body. And so, just as it would make sense that your skin, for some women, becomes very dry– some women literally have dry eyes when they go through menopause, it's just, everything is trying to adjust– of course, like the brain, this incredibly complex organism is extremely rich with estrogen receptors, is going to have certain effects. And, you know, some women have suffered debilitating depression when they go through menopause. For some women it is very linked to this phase of life, and it can be life saving for some women in that regard because they're so mentally not themselves, basically. So, you know, one of the doctors I interviewed said when she has a patient who comes to her with a new symptom in her late forties or early fifties, you know, she'll say, ‘Look, try hormones. If the symptom goes away, you will know it was caused by menopause. And then you can make an assessment about how much better you feel and weigh that against whatever risks, I'm here to tell you, you know, do you exist or thought to exist or could exist.”
Kimberly: You know, I'm, I guess in the next round of generation that's nearing this point in life, and it feels incredible to get more tools at this stage of my life to begin those conversations and to think about those things and not have to feel as if we're walking into this like grand expanse with no answers and no support tools.
Susan: I am very happy to hear you say that. One of the reasons I did write the article is because I went away with a bunch of my college friends. And, you know, these are very well-resourced, very capable women. And we were all sitting around asking each other questions about menopause. And not only did we not know the answers, but we couldn't fathom that none of us knew the answers. Why didn't we know the answers? I think there's been a real shift even in the past three years. I think that connotations with menopause have changed. I think that the women talking about it have changed. There's a famous episode of All in the Family in which poor Edith is going through it. And, you know, maybe that's, you know, the sort of addled house-dress wearing woman, worrying that her husband will ditch her and think she's a used up rag. It was a very famous episode and maybe that implanted itself on people's memory and to say you were menopausal was to align yourself with Edith. Now you are in the company of people like Naomi Watts, who started a skincare line. And I think that's exciting and marks a real shift in the evolution of women that feminism didn't really take into account, to be honest.
Kimberly: I think we're in a space where societally it becomes either too serious– I mean, this is women's issues in general, right?– things become too serious and it's like, rah rah, the feminists are at it again. Or it's too funny or it's so easy to poke at women, and especially women at certain stages of life, that there is kind of this, this middle ground that we have to find in the ways that we have these conversations, which is kind of largely to just normalize them.
Susan: Yes, that is definitely it. And also to talk about the range of experiences and to talk about it in various contexts. Just to take it seriously as a subject of important conversation. You know, menopause is as serious a conversation as any other health issue, even though it is, quote unquote, you know, a “normal process.” And, yeah, to cover the way it's experienced in the workplace, to cover, what is the research happening around it? What are the ways that it's affecting, you know, women's quality of life? It gets at a huge range of issues for women over 50, and that's a huge segment of the population. And the fact that this physical experience that we're having was overlooked for so long, it's almost hard to wrap your brain around it.
Kimberly: I mean, ageism and sexism doing their work.
Susan: Yeah, you put the two together and wham, you have a radio silence around something that is really affecting women's daily lives in a profoundly startling way for so many of them because there has been so little discussion about it.
Kimberly: One of the things that we talk often about on the show is how our body is our business. And I wonder if we can talk more about how women can make more informed decisions about their bodies in relationship to treatment and menopause, and also, too, if there are options that you think people might be missing out on. I wonder if you could share some of those in that rich tradition of kind of oral history and finding ways to better pool our resources together?
Susan: I guess I would start by saying that I have tremendous respect for whatever choices women make and that I have plenty of friends who have really intense symptoms and have said, for their own personal reasons, it just doesn't feel right for them to go on menopausal hormones. And for them, that's great. And I think that's a perfectly valid choice. I wouldn't want to be misconstrued as someone who is like pro menopausal hormone therapy. I'm pro the conversation. I'm pro women going to the doctors and saying, ‘What's going on with me? How do I address this?’ And the doctor saying, ‘There's a range of menopausal treatment methods, right, like, you can have a patch that has estrogen. You can have a vaginal insert that delivers both local and systemic estrogen. You can take a pill. Each of these methods has pros and cons in terms of the risks that are associated with it. One of the things people worry about with estrogen, if you take it orally, as you get older and your risk of stroke increases, then the increased risk of stroke that does come from estrogen, which is a kind of coagulant, that's something to think about.’ So what method you take, something that people need to talk about in an informed way, which can be pretty time consuming.
Kimberly: I have learned so much in this conversation. [Laughter] Thank you so much for being with us and for doing this work that should not be contextualized as brave, but nonetheless is. And I know I am not alone in just sitting in gratitude for your work. So thank you for joining me.
Susan: So kind of you. And I really enjoyed talking to you so much. So thank you.
Kimberly: Like so often on Unruly, once again, we’re reminded that talking about symptoms, feelings, and confusion around our bodies matters. It can shift the narrative from taboo, to empowering. When women talk about perimenopause and menopause – with each other, with our physicians– we know we’re not alone. And we have a greater chance of receiving the care that we both need and deserve. Or, at the very least, we have a better idea of what’s out there! Questioning the narratives that we learn from media and making informed, personal decisions – free from stigma and shame– can help us reframe what aging looks and feels like. And… it can help us be a bit more…. Unruly.
I’m Kimberly Drew. For more information about today’s guest, a transcript of the episode, and more resources, visit www.shopflamingo.com/unrulypodcast.
Unruly is a podcast created by Anna Wesche and produced by Pineapple Street Studios in collaboration with Flamingo. Our associate producer is Marialexa Kavanaugh. Our lead producer is Natalie Brennan. Our mid episode profiles are produced by Sophie Bridges. Our managing producer is Kamilah Kashanie. Our editor is Darby Maloney. Our Head of Sound & Engineering is Raj Makhija. Our Senior Audio Engineers are Pedro Alvira and Marina Paiz. This episode was Mixed by Davy Sumner. Our Assistant Audio Engineers are Jade Brooks and Sharon Bardales who also gave scoring assistance. Our Executive Producers are Je-Anne Berry and Aggi Ashagre. Our Music is from Epidemic Sounds.
