When I was growing up, age 30 was the absolute end of a woman’s youth. Menopause (horror-movie music plays) meant the CHANGE (maniacal screams in the background). When women “weren’t really women” anymore. No one talked about it. Doctors didn’t learn about menopause in medical school.
Today, you’ll see women 50+ rocking bikinis, 60+ doing porn, and 70+ women hitting the gym like kids. I love it!
Everything In Its Time, Like It Or Not
Yet, as we become more age-positive and willing to redefine what “old” means today, many women still fear and dread menopause. And, for some women, the chemical shifts are terrible. They bring headaches, hot flashes, loss of libido, and worse. As the International Menopause Society states, “Menopause is not a disease, but it can bring symptoms and health risks that need personalised care.”
If you read my previous blog, The Joys of Menopause, you know fear and negativity stem from the collective cultural contempt for women who are infertile. Ironically, sex without fear of pregnancy is the number one perk that menopausal women acknowledge. Similarly, with lubrication a common issue in older women, many older women choose and are delighted by creative, non-penetrative sex.
Lived Experience Is How You Learn
What last week’s blog taught us about the 23 women is that most of them were enjoying the hell out of it! So much pain vanished for so many of them, as did some disorders related to menstruation. They hated the monthly cramps and mood swings; they hated dealing with the blood.
Knowing how women feel and experience the reality of menopause is as important as medical studies about sexual behaviors because it fills in all the traditional blanks. Such questions as “why does one person react better to this treatment than another?” or “how can we make treatment more comfortable for patients?” need to be asked.
The 21st Century Science of Menopause (So Far)
Combined anecdotal evidence AND medical studies have shown that a woman’s attitude towards sex and self-care ultimately determines the path she will take in future years. From my sexology POV, the Lancet nailed it when they published an influential 2024 series arguing for a shift away from viewing menopause as a medical condition. The authors criticized the “just replace the missing hormones” model. Instead, the Lancet writers proposed a holistic/empowerment model to treat menopausal women in their care. Patients are informed partners in their medical care, not passive recipients of prescriptions.
Another study supports both the Lancet’s research and the 23 women I interviewed! The Study of Women’s Health Across the Nation (SWAN) says so on its homepage: “The menopause transition can be a transformative phase in a woman’s life that can impact psychological well-being and health-related quality of life (QoL).” This enormous and ambitious study strongly supports self-care as a critical step in your journey.
The Medicalization of Female Reproductive Health
Medical doctors (primarily, if not exclusively, male) throughout history did not include female sexual health in their wheelhouse. They let that, along with pregnancy and delivery, be entirely in the hands of midwives. Even in the late 1800s, the emphasis of reproductive medicine was on men, with a great fascination for and industry in how to either restore penis function or how to cease the practice of male masturbation.
By the turn of the 20th century, doctors realized they could earn a fortune treating women. Doctors suddenly dismissed midwives as incompetent, even dirty, and were replaced by male doctors and trained female nurses. Frankly, the field did not greatly improve in terms of sexism and misogyny for nearly a hundred years.
Male doctors were notorious (some still are) for shrugging off women’s complaints as neuroses, withholding information from women about treatments, not asking permission to perform life-changing surgeries, and refusing to accept criticisms of their methods. It’s enabled a culture of misogyny that previous generations of doctors believed was the norm.
The days of male doctors intimidating women are slowly coming to an end. Let me re-emphasize SLOWLY. The good news, however, is that more and more women are becoming doctors and choosing reproductive medicine as their field. That has already improved the gender climate, as female health workers are banding together to help women who were previously given short shrift in the healthcare landscape.
Active Research
There are currently 2 drugs available to raise female libido. The first is Addyi, which may give a woman one additional satisfying sexual event per month. Vyleesi showed slightly better desire scores but no change in actual sexual events. You might feel a little hornier, but not enough actually to do anything about it. What?? Pharma calls it ‘modest improvement.’ I call it expensive nonsense for minimal gain. Buyer beware
Precision medicine initiatives in the United States are increasingly focusing on menopause transition, with studies and trials employing advanced technologies for personalized care. There are at least 23 active clinical trials registered on ClinicalTrials.gov exploring precision medicine using biomarkers to predict the onset of menopause, weight management strategies, and digital health apps for symptom management.
What Really Matters
Medicine has enabled misogyny. When doctors treat older women without body respect, when they make a woman feel she is somehow less important at 60 than she was at 30, it sends a clear message not only to the woman, but to her husband, her sons and daughters, rippling out to the world at large.
Fight the old wrongs by creating your new empowered reality. When your body needs care, doctors need to listen to your concerns and complaints. Sometimes it’s your job to make sure they HEAR you. A positive attitude and self-respect are better medicine for the soul than pills.
Photo credit: RF._.studio South Africa @Pexels.com
