At age 44, Marni Penning felt extremely off. Some days, she felt as if a weight was sitting on her chest. Other days, she had an urge to just openly weep. Then there were the days she wrestled with intense anger and rage. She was so concerned about these rapidly changing mood swings that she sought out a neurologist. Penning thought she might be on the brink of dementia. It wasn’t until she went to her OBGYN’s office in tears that she found an answer. The mood swings weren’t a symptom of cognitive decline, but instead the beginning of perimenopause, which is the period before menopause.
“My doctor said, I think that you are in the first stages of perimenopause,” Penning told Salon. “And she's like, 'Here's what's going to happen: periods are going to get closer and closer together, and then they're going to start skipping.”
Penning said nobody had ever told her this before in her life. She thought her menstrual cycle would just stop. Plus at 44, she didn’t give much thought to perimenopause. She had her son when she was 41 and nursed him until he was three. Nearly a decade later, Penning said it’s become her mission to shout it from rooftops that the “menopause talk” should be as normalized as the “period talk,” in terms of what to expect.
Indeed, Penning said she and many of her Gen X peers have felt “left in the dark” in terms of what to expect around menopause. Women know they will have their periods when they’re young. There is more discussion about what happens if a woman gets pregnant and how the body changes in the postpartum period — but what about the transition to the end of the female menstrual cycle? “I wasn't told anything,” Penning said.
Most OBGYN residency programs in the United States “lack the curriculum necessary to effectively prepare residents to manage menopausal women.”
Penning’s story mirrors a growing chorus of Gen X women experiencing menopause who are speaking out about the lack of public discourse, knowledge and research around the experience. Earlier this month, actress Halle Berry lobbied for a bipartisan legislation aimed at increasing clinical research into, and de-stigmatizing, menopause. “Our doctors can't even say the word to us, let alone walk us through the journey of what our menopausal years look like," Berry said.
Why? A lack of resources and conversations from doctors is, in part, driven by a lack of required training on managing menopause symptoms and true level of standardized care in obstetrics. According to a survey published in 2023 in the journal Menopause, only an estimated 31.3 percent of the obstetrics and gynecology residency program directors reported having any type of menopause curriculum as part of their training. The Menopause Society said that the results show that most OBGYN residency programs in the United States “lack the curriculum necessary to effectively prepare residents to manage menopausal women.”
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“It's such a tragedy in healthcare that patients are feeling really unseen and unheard at a very vital time in their life,” Dr. Catherine Hansen, head of menopause at Pandia Health, told Salon. “Women in midlife are at their most productive peak, and yet when they're finding that their body and their physiology is somewhat holding them back — they reach out for help, but a lot of health care providers don't necessarily have the knowledge.”
The lack of research at a “bare minimum” results in “a lot of suffering.”
Hansen is a Menopause Society Certified Practitioner, which is a certification that specializes in providing resources in menopause. There are 1,000 practitioners across the country. But Hansen said that’s not a lot to cover the 6,000 patients per day who are entering menopause.
Dr. Sharon Malone, chief medical adviser at Alloy Women's Health, told Salon a lack of public discourse around what to expect also results in women feeling caught off guard.
“It’s sort of a combination of not enough information and guidance from your doctor, and not enough intergenerational conversation about what to expect,” Malone said. “We don't talk enough amongst ourselves as peers.”
Malone added that the state of research of “deplorable.” The biggest study that was done on postmenopausal women and menopausal hormone therapy concluded in 2002.
“It’s been piecemeal since then,” Malone said. “And there still is not a real serious research effort for women in perimenopause, because that's really the time to start to intervene when we've already done it, and through menopause.”
Anne L. Peterson, a 55-year-old in Texas who runs a group called Goddess Living, said menopause is a frequent topic of discussion in her women’s group. For her, perimenopause started at 42 when she had a partial hysterectomy — but at the time, nobody was calling it perimenopause. She was having very painful menstrual cycles. She went through with the partial hysterectomy, but kept her ovaries. After her procedure, she still had horrible pains that left her gasping for air once a month. When she asked her doctor, the only recommendation was to complete the hysterectomy. Throughout perimenopause, she said she found more answers from her friends.
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“All of my advances have been from my own research or talking to my girlfriends,” Peterson said. “Regularly, the conversation comes up ‘How are you guys doing? I'm getting night sweats. What do you do for night sweats?’ It's not like we treat each other, but I get more information from my women's circle.”
The lack of research, Malone said, at a “bare minimum” results in “a lot of suffering.”
“There are women that are going through hot flashes, mood swings and brain fog — all of the 34 symptoms that we associate with menopause, and they are not accessing care,” Malone said. “Not only because they don't recognize what's going on, they're aware of the fact that they're suffering they just don't know where to go, and because doctors don't know and don't really put it all together under one rubric and say, ‘This is perimenopause.’”
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