The “Change of Life” Takes Center Stage

You may not be aware, but menopause is a really big deal now.

While for women of a certain age, it’s always been a big deal, in recent years, it’s become something of a cause. A couple of weeks ago, it was even the subject of congressional hearings, when Senators Kirsten Gillibrand and Rick Scott made a bipartisan request for a review of how the federal government funds and coordinates menopause research and care. Those hearings, the first ever on the topic, are prime evidence of how impactful medical influencers and celebrities (Oprah! Halle Berry!) have been in raising awareness about the effects menopause can have on women’s health and well-being.

This new openness about the physical reality of the “change of life” has been refreshing and informative for those of us who grew up in the bad old days not so long ago when “menopause” (like “menstruation”) was a dirty word, a deep, dark secret discussed only by women and only in private. I remember the sense of personal failure expressed by my mother’s generation when, despite a lifetime of dieting to maintain their slender waists, poochy menopause bellies emerged in their 50s and never went away, no matter how much they exercised or how little they ate. There were whispers about the poor ladies who’d started losing their hair and shared tips on how to mask sweaty hot flashes that struck without warning. And the most dreaded phrase of all: “vaginal atrophy.” Would men ever allow the word “atrophy” to be applied to their private parts? As an official medical diagnosis? One of the first beneficial results of the recent menopause awareness movement was the introduction of a different term for that physical symptom—the genitourinary syndrome of menopause or “GSM”—although I can’t help but think the branding still needs some work.

There’s no question an improved understanding of the aging process can be both comforting and empowering. In a world in which 80% of OB/GYN residents say they’re unprepared to talk about menopause, the new focus on better training, studies, and treatment has been an important development in women’s health. But with all the consciousness raising of what Oprah called “The Menopause Revolution” has come the inevitable commercialization, and menopause is now big business. There are menopause influencers and menopause doctors (some of whom participate in a group they’ve given the unfortunate label “menoposse”) and tons of menopause books and products. The topic has become firmly established in the “wellness” sphere, an ill-defined, unregulated industry that’s always struck me as a mix of the helpful, the aspirational, and the downright dangerous, with very little guidance for the consumer to distinguish the quacks from the legitimate service providers.

I first became aware of one of the most vocal menopause influencers, Dr. Mary Claire Haver, years ago. In a quest to find yet another diet to start the new year, I discovered her then-small online weight loss program for midlife women, which eventually became The Galveston Diet (Haver being based in Galveston). Ultimately, the diet evolved into a multimillion-dollar wellness business, The 'Pause Life, through which Haver sells a wide range of supplements and diet plans.

The commercialization of menopause presents different risks than the world of silence that preceded it but still raises serious concerns. As Dr. Jen Gunter, another well-known menopause specialist has pointed out, medical advice from providers selling their own products (e.g., vitamin supplements) is potentially biased. In addition, as noted in a 2024 profile in The New York Times, Dr. Haver’s more aggressive approach to hormone treatment has been criticized by other experts as unsupported by existing scientific studies.

I also worry the subliminal message of all these influencers—that with the proper “treatment,” the impacts of menopause can be entirely mitigated—once again puts women on a collision course with their bodies. For decades women have been pushed into buying products that are hazardous (Lysol as a douche/contraceptive) or, at minimum, unnecessary (“intimate care lines” like Vagisil’s OMV! products targeting teen girls). Now the message seems to be that an unmanaged menopause is also problematic, suggesting that if you end up with a problem like dementia, it might be because you didn’t insist on hormone treatments, not because of bad luck or unfortunate genes. Pete Hegseth’s not the only one pushing testosterone as a magical cure, and while we automatically doubt the validity of his claims, we seem to accept the word of the experts on Oprah Daily without question.

The problem for the average perimenopausal or menopausal woman is that the experts disagree on testosterone and a variety of other topics. I certainly don’t have the answers, and Dr. Haver and many of the menopause influencers seem well intentioned. At the same time, when other female doctors, also experts dedicated to high-level menopause care and also strong proponents of women’s health, question many of their claims, you can’t help but wonder if all the attention and profits are undermining the influencers’ ability to assess the medical evidence as neutral scientists. The telehealth service Midi sounds like a god send to an underserved population like menopausal women until you discover it’s been financed by a group of venture capital firms and other investors looking for a good rate of return on their money. That’s never mentioned in their oh-so-entertaining ads.

The bottom line is that on the important topic of menopause, one of the core rules of capitalism applies:

Buyer Beware.

Do your own research, investigate competing views, and follow the money. At least know where the money comes from and where it’s going. You may still decide to drink a cup of collagen while hiking in a weighted vest after taking your daily dose of hormones and Vitamin D. But at least you’ll have a better understanding of what, if anything, those things can actually do for your health.