At least 6,000 women reach menopause, or their final period, each day in the U.S., according to Let's Talk Menopause, a nonprofit dedicated to menopause advocacy. There is no uniform reality to going through the biological shift of perimenopause. And while every person with a uterus will experience it, many don't have the knowledge about menopause to talk to clinicians, let alone their loved ones or employers.
We spoke to a Houston Methodist psychologist specializing in women's health to understand how women can understand the feelings and changes they experience and feel empowered to talk with loved ones.
Why don't we talk about menopause more?
A 2023 survey published in the journal BMC Women's Health showed that most women had limited knowledge about menopause before age 40, and more than 80% of respondents said they'd received no education on menopause while at school.
While many may remember their parents sitting them down to give "the talk" regarding puberty, the conversation probably didn't include information about what occurs in the body during the phases of menstruation and what happens when menstruation eventually ends. Nor is there a similar "talk" at some later point about menopause's challenging biological shift.
"The idea of knowing what hormones do in our body, which ones there are, how they change across puberty, our menstrual cycle and perimenopause — nobody's ever said anything to them about it," says Dr. Jessica Rohr, a clinical psychologist at Houston Methodist. "I will give talks to people ages 20 to 80, and I'll put up a simple chart showing what happens across your cycle phases, and people will take pictures of it because they've never seen it before.
"There is this sense that the only reason you need to pay attention to what's happening in your body is to keep it clean, and that needs to be secretive," adds Dr. Rohr. "We call it your cycle, or 'that time of the month.' We've been socialized to hide what happens to our bodies."
Dr. Rohr emphasizes that many women may only pay attention or discuss their periods when they believe something is abnormal, or when they require something from their bodies, such as trying to become pregnant. That can have consequences down the line when facing perimenopausal symptoms.
"A lot of people don't ever actually experience their normal cycle until they're trying to become pregnant," Dr. Rohr says. "They may come off birth control for the first time in many years. Then they're starting to track ovulation, or they're having extreme symptoms around their cycles, and a doctor asks them to track it.
"So for many women, they'll come in starting perimenopause, and I ask, 'What is your normal cycle like?' And they don't know. So how can we get a sense of if it's abnormal right now?"
Plus, Dr. Rohr says there is a misconception that menopause happens to "older women" in their late 50s and 60s. However, women reach menopause at different ages, usually between ages 45 and 55.
Moreover, the symptoms people most often discuss — hot flashes, mood swings, trouble sleeping — occur during perimenopause. This phase can last anywhere from 4 to 10 years before that final period. Women can still get pregnant during perimenopause and are still very much in the prime of their lives — managing everything from careers and families to caring for aging loved ones and more.
"We're having kids later, and I have plenty of clients who will say, 'I'm not sure if I'm in perimenopause or if I'm pregnant,'" Dr. Rohr says. "These used to happen at separate timelines, and now they're starting to overlap."
Dr. Rohr says that between the misconceptions and lack of education about women's health, a vicious cycle emerges that keeps people feeling ashamed.
"At the core of it, the reason we don't know enough about menopause is we truly just don't know enough about women's health in general," Dr. Rohr says. "When we don't talk about it, we don't normalize the symptoms or the experience, and people feel ashamed and don't share. It then becomes this cycle where everybody is going through the same thing and each person feels like they're the only one going through it."
How to talk to about menopause
Take stock of your own thoughts and feelings
Dr. Rohr says that people in perimenopause may have to do some internal work before having constructive conversations about their experience. This can look like building an awareness and vocabulary for the various changes and symptoms they are dealing with, whether those are hot flashes, irritability, night sweats or brain fog.
"Trying to learn about yourself enough to be aware of changes — as well as adopting a dose of radical acceptance — is really important," Dr. Rohr says. "A big piece of being able to communicate it with anybody else is coming to terms with it yourself — and if not fully coming to terms, then at least deciding you want to."
Dr. Rohr acknowledges that this road to radical acceptance can be challenging. Many feelings come up during times of transition, like perimenopause. Someone may grieve their past self, and how their mind or body used to be.
"Radical acceptance can look like saying, 'OK, regardless of how I used to function and how easy things used to be for me, I can grieve that, I'm here now,'" Dr. Rohr says. "And I do need to change my sheets because I'm sweating through them every night. I do need to carry around a tiny cooler with ice packs so I can put it on my neck when I'm having a hot flash."
Denial about the transition can also occur. In psychology, Dr. Rohr says it is the difference between pain and suffering.
"There is the pain of the experience, and when we struggle against it, we cause unnecessary suffering because we don't want to believe that it's happening," Dr. Rohr says. "Radical acceptance takes a while. It's going to be back and forth from 'I can't believe this is happening' and 'Why do I have to deal with this?' to acceptance and back again. Those are normal responses, and struggle doesn't make the pain go away. The more we can work to remove any struggle against the natural transition, the better."
Partner with your partner to tackle perimenopause
The BMC Women's Health survey results showed that women believed that more education and open conversation around menopause and women's health could help their partners support them.
For instance, the Men's Perception and Attitudes Toward Menopause survey of male partners of postmenopausal women showed that men were aware of their partners' symptoms, but didn't consistently connect the symptoms to menopause. Just over half of men knew that treatments existed for perimenopausal symptoms, but their knowledge of the actual options was limited.
Women may need to have conversations with their partners about their symptoms before they reach radical acceptance. Remember, perimenopause lasts years — Dr. Rohr says that's an opportunity for the couple to accept that both partners are going through a transition, not just the one with symptoms. Much like with pregnancy and childbirth, one partner is having the physical experience, but both partners are equally involved and invested.
"And so, approaching it as, 'I am interested in learning about this, would you want to learn about it with me?'" Dr. Rohr says. "Treating the transition as, 'This is something we're going to do together,' not 'I'm going to suffer through this alone, and I'm just letting you know.'"
The non-perimenopausal partner taking the initiative to know the language and share in the experience, as opposed to acting like a bystander who has nothing to do with it, can be incredibly meaningful to the partner in perimenopause, says Dr. Rohr. She says this couple-centric approach will look different for each couple.
"I've been surprised by how little two people in a relationship actually talk to each other— not because they don't want to, but because people's lives are hectic, and they're just trying to get through," Dr. Rohr says.
"And so having conversation check-ins is important," Dr. Rohr adds. "Things they probably should have been doing, but better late than never — 'How are you? What do we need to be trading off on? What do I need to be taking care of? How can I make it easier? I thought of this: I can always have that cooler in my truck with ice packs. Would that be helpful? Is that a cool idea? A stupid idea?'"
For same-sex couples, both partners may experience perimenopausal symptoms at the same time. Dr. Rohr recommends communication and avoiding comparison.
"Everybody's going to experience perimenopause differently, and even if they're experiencing symptoms at the same time, they're still going to be bringing different stances around it," Dr. Rohr says. "I suggest some discussions together like, 'This is what helps me. Is that helpful for you? Can we help support each other in this way?'"
Comparisons can arise in all relationships, Dr. Rohr acknowledges. But partners can respond with more difficult feelings when both people are experiencing (theoretically) the same experience.
"It can come up, like, 'Well, mine wasn't that bad. I don't know why you're so affected by it,'" Dr. Rohr says. "I think some real empathy and compassion around the fact that everybody will respond differently is required. Getting on the same page and being aware of each other's experiences and of your own can be really helpful in joining together to move through this transition rather than doing it separately and struggling through."
How to talk about sex and libido changes with perimenopause
Sex can be a complex conversation topic for couples even in the best of times, let alone during times of transition. Perimenopausal symptoms such as painful sex and libido changes can add a new element to navigating intimacy. That, paired with the biases that exist around not discussing sex and beliefs that sex should always be easy and passionate, can make for tough conversations.
"Unfortunately, the first time perimenopause may come up in a heterosexual relationship is when sex and libido have become a concern," Dr. Rohr says. "And we see issues about sex coming up in the relationship that probably should have been raised 25 years prior: How is sex happening? How is pleasure balanced with desire? Are you enjoying it? What is sex for in your relationship? Perimenopause, much like having children, forces couples to confront things that perhaps should have been talked about before but just weren't."
Dr. Rohr says navigating these changes as a couple can come down to exploring and understanding what pleasure and desire look like for each person, and how that translates into their relationship.
"When it comes to sex drive, we all have accelerators and brakes," Dr. Rohr says. "There are things that accelerate, such as feeling good, getting things done, seeing a sexy show, wearing a sexy outfit, or the context of being on vacation or the kids are out of the house.
"And then there are brakes. Being exhausted, feeling sick, eating too much that day, whatever it may be, can pause sexual desire. And these perimenopausal changes can be understood as brakes. When we have more brakes, we need to up the accelerators in order to manage that. That's going to mean having more purposeful conversations around sex."
Dr. Rohr acknowledges that talking about sex can be uncomfortable, but if having a healthy, loving, sexual relationship with our partner is a priority, acknowledging that is a helpful first start.
"The context has changed," she says, "and so we need to change with it. 'I'm not 20 years old, and my body's not responding the same way.' But sex is still an important part of our relationship. So how can we do this?"
Should we talk about menopause at work?
Women in their 40s and 50s can be at the peak of their careers while balancing "the change of life." So it's probably no surprise that around a third of women reported moderate or severe difficulties coping at work because of menopausal symptoms, according to the 2022 Health and Employment after Fifty study.
"Even though some women are having babies later and also starting menopause earlier, many women are going through perimenopause, in their 40s, at the same time their parents are getting sick and their children are leaving and going to college," Dr. Rohr says. "This is an enormous social transition happening along with the hormonal transition. There's a lot happening there that's hard to manage."
Menopause is not considered an illness or disability as defined by the Family and Medical Leave Act. However, research from the AARP shows that 1 in 3 female workers missed work in the past 12 months due to menopause symptoms and only 22% of employers provide benefits related to menopause. Talking about perimenopause can be difficult enough with loved ones. Should we be talking about this deeply personal topic at work?
"Going back to radical acceptance and coping is this idea of 'I need to determine whether the way I've been showing up is the way I have to show up to keep my job and keep myself feeling confident,'" Dr. Rohr says. "Because for many women, it's not the way. They're doing way too much. There is a social expectation that women need to perform better than everyone else at work just to be considered mediocre. Some of this is an accurate perception. However, some of it is self-perpetuating.
"So can women allow themselves to not perform at the same level on more difficult days? A lot of what I do in my office with people is, 'How do we practice mediocrity? Can we just be mediocre for a day?' You can be excellent every other day, but maybe today just do baseline. So much of that is us confronting the realities of how we think we have to show up to be of value."
I'm having symptoms of perimenopause. Who should I talk to first?
"Keeping your primary care provider and your gynecologist in the know about what's going on is the first step," Dr. Rohr says. "They can help you find some method of tracking that you are comfortable with and get a sense of what's going on."
Your primary care provider can help connect you with menopause specialists and potentially suggest treatments that can ease symptoms.
"Your care team should be your first step to get your experiences recorded, and then you can talk to them about what other specialists might be useful to support you as you're going through this transition," Dr. Rohr says.
