Over the years, many of us women have heard or used lots of euphemisms to describe menstruation:
The Crimson Tide. (Yeah, sorry, Alabama, but that preceded you.)
But code words for menopause? Not so much. Menopause was a process that was shrouded in mystery, myth and misinformation. Somehow, the reversal of menstruation, tied as it was to women's aging, was viewed as just shameful. Icky.
Which is strange, considering that women make up 51 percent of the earth's population. And that barring something extraordinary, they will all go through menopause.
Despite that — crickets.
There have been a few notable exceptions. Menopause showed up on hit sitcoms All in the Family and The Cosby Show. There was a cheeky off-Broadway production, Menopause — the Musical!
In general, they did a better job of lampooning the process than their male peers. Maybe because they knew what they were talking about. (Or maybe women are just funnier?)
But it took a World War II hero who just happened to be the former majority leader of the United States Senate to move the meno-conversation further along.
"You know, it's a little embarrassing to talk about ED," Bob Dole confessed to TV viewers way back in 1988. "But it's so important to men and their partners that I decided to talk about it publicly."
That ad for Viagra, often referred to as the Little Blue Pill, helped to remove the stigma from erectile dysfunction and cracked the door open for more people to have honest conversations about how their aging bodies worked. It did wonders for men with ED. It's taking a lot longer for a public conversation about menopause.
For one thing, we're still learning about it. When Dr. Wulf Utian, a founder of the North American Menopause Society, started to research menopause back in 1967 at the University of South Africa, he said there was one line about menopause in his medical textbooks. One.
"It said, 'Menopause is physiological amenorrhea' — which means it's the normal loss of periods and there's nothing else to say about it," Utian remembers.
But menopause is more than the just reverse of menstruation. It's actually a systemic change to the body: In addition to those infamous hot flashes, many women experience what they describe as "brain fog" — forgetfulness or disorientation. Most find they're gaining weight, especially around the middle. There may be mood swings. Libido can plunge, and even when it doesn't, vaginal dryness can make it painful.
But a lot of women now experiencing menopause are part of the second-wave feminists who helped launch the sexual revolution. Their bible was Our Bodies, Ourselves, the groundbreaking handbook by the Boston Women's Health Collective that urged women to research, question and press for answers: "if this doesn't work, what about that? What are the side effects?"
And they want some of this stuff fixed. Which is why you're starting to see more ads for menopause-related products, many of them for conditions you didn't know had names. That drop of urine that escapes many women during a laugh or sneeze is now being labeled LBL — Light Bladder Leakage. And yep, there are multiple products sold for that, including pads, a tamponlike product called Poise Impressa and prescription medications.
Dr. Hilda Hutcherson remembers her mother and friends whispering among themselves about their menopause symptoms at girls-only gatherings. But those were private conversations with good friends.
Fast-forward to now: Hutcherson, an OB/GYN who teaches at Columbia University's College of Medicine in New York, and her girlfriends don't relegate The Talk to a closed-door room. "My girlfriends and I talk about it all the time," Hutcherson says. "We compare notes: How are you dealing with your hot flashes, and how are you dealing with your desire? It's so much easier to talk about all of those things now."
Partly because Dole's Viagra confessional broke the ice. And partly because, Hutcherson says, women of her generation assume they can — and should — be partners with their doctors in their health care. They did it with birth control. And now they want to do it with menopause. So they're researching, comparing notes and pressing their doctors about how to deal with some of the more uncomfortable aspects of menopause.
"Women are saying, 'I don't have to live with it. I see the commercials on TV, I'm reading about it in the magazines and online, and I know that I don't have to accept this, that there are things that can make my sex life, and my life in general, better,' " Hutcherson says.
Those commercials can be a two-edged sword, though.
Dr. Janet Pregler, director of the Iris Cantor UCLA Women's Health Center, thinks that a more open attitude about menopause is a great thing, but menopause marketing can be complicated. On one hand, if it raises awareness and gets women who think they have a problem to go in to be checked out, that's good. Especially if there is something that can mitigate their discomfort.
"Many of these things [being advertised] are important, and do give relief to a small number of women," Pregler says. "The issue has been, obviously ... that health care industry is an industry, and there's been this sense of 'OK, well let's sell this to as many people as we can.' "
Which, she says, leads some women who are managing their menopause just fine to wonder if they're missing something.
"I've actually had patients come in and say, 'I think there's something wrong with me — I'm not having terrible menopause symptoms, and aren't I supposed to have those?' " Pregler says.
One would certainly think so, given the proliferation of ads for everything from hot flashes to waist-level weight gain (sometimes sardonically labeled the menopot), to dryness that makes intimacy painful, maybe even impossible. There's a supposed remedy for every complaint.
And therein lies the problem, says Utian. Companies have realized that there is big money to be made from a baby boomer demographic in full menopausal flush. In many instances, he says, we're looking at "multibillion-dollar markets." So there are lots and lots of ads that target women in menopause — some legitimate, he says, most not.
In September, the North American Menopause Society issued a report on what works and what doesn't for hot flashes and other symptoms. Aside from hormone therapy, the doctors said there's evidence of benefit for just two treatments — cognitive behavioral therapy and clinical hypnosis. They also said that SSRI antidepressants may help, but over-the-counter and herbal remedies do not.
Utian says the former reluctance to mention menopause has given way to a very different attitude. "Instead of women whispering the word 'menopause,' " as they did a couple of generations earlier, "the word is everywhere now." And as a result, "there's a whole cohort of organizations and snake oil salesmen and so on all trying to climb in on the bandwagon."
The challenge for women in menopause is how to separate the snake oil from what really works, safely and reliably.
AUDIE CORNISH, HOST:
Women make up more than half the world's population, and menopause is a reality of our lives. But you don't hear a lot of talk about it.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN #1: There's the big talk about the period. There's no talk about the menopause.
UNIDENTIFIED WOMAN #2: It's like an adventure every day. You kind of don't know, really, what's going to happen.
UNIDENTIFIED WOMAN #3: As a grown woman, you would think that this would be common knowledge.
CORNISH: Well, it's becoming common knowledge in big business, if that that ad from Poise products is any indication. This year in our Changing Lives of Women series, we're exploring aging, and NPR's Karen Grigsby Bates has this look at where menopause fits in.
KAREN GRIGSBY BATES, BYLINE: Menopause is more than just saying bye to your menstrual period. It's systemic and affects a lot of things - metabolism, memory, mood and body temperature, to name a few. Despite that, there's been little mention of it in popular culture with a few memorable exceptions. In 1975 - four decades ago - the popular sitcom "All In The Family" took on menopause when Edith Bunker became panicked by her mood swings and hot flashes. Nobody told her what to expect.
(SOUNDBITE OF TV SHOW, "ALL IN THE FAMILY")
JEAN STAPLETON: (as Edith Bunker) When I was a young girl, I didn't know what every young girl should know. Now I'm going to be an old lady, and I don't know what every old lady should know.
BATES: Two decades later on "The Cosby Show," Clair Huxtable told her daughter and America menopause was no big deal.
(SOUNDBITE OF TV SHOW, "THE COSBY SHOW")
TEMPESTT BLEDSOE: (As Vanessa) Hi, Mom.
PHYLICIA RASHAD: (As Clair) Hi.
BLEDSOE: (As Vanessa) So how'd your doctor's appointment go?
RASHAD: (As Clair) Oh, I am healthy, I'm in great shape, and I'm beginning menopause.
BATES: Matter of fact. Fast forward to now. Dr. Hilda Hutcherson is a professor of obstetrics and gynecology at Columbia University's medical school, and she often treats women in menopause. Doctor Hutcherson says the old taboo around menopause has largely dissolved. Instead of whispering about it as her mother did...
HILDA HUTCHERSON: My girlfriends and I talk about it all the time. We compare notes. How are you dealing with your hot flashes, and how are you dealing with your sexual changes and desire? It's so much easier to talk about all of those things now.
BATES: Ironically, it took a former leader of the United States Senate talking about a little blue pill to make things easier.
(SOUNDBITE OF ARCHIVED RECORDING)
BOB DOLE: You know, it's a little embarrassing to talk about ED, but it's so important to millions of men and their partners that I decided to talk about it publicly.
BATES: Erectile dysfunction, or ED, had a powerful spokesman early on in Bob Dole, who introduced the country to Viagra. That 1998 ad broke through people's reserves. It made many folks more comfortable being a bit more upfront about midlife changes like ED. Menopause, though, has taken longer. For one thing, even medical professionals didn't know much about it. Dr. Wulf Utian is a founder of the North American Menopause Society, or NAMS. Back in 1967 when Dr. Utian began researching menopause at the University of Cape Town in South Africa, there wasn't a lot to go on.
WULF UTIAN: There was actually one line in a medical textbook which said that menopause is physiological amenorrhea, which meant it's a normal loss of periods, and there's nothing else to say about it.
BATES: Today, says Dr. Utian, there's plenty of talk about menopause for at least one obvious reason.
UTIAN: There's big money to be made in many of the markets. We're talking about multibillion-dollar markets. And so there's all sorts of stuff being sold to women. You only have to type the word menopause on a Google search, and a wealth of stuff comes up.
BATES: Some of that stuff includes vitamins and herbal remedies for hot flashes and tech devices designed to strengthen slack pelvic muscles. There's even a new drug to make intimacy friction-free, and it's advertised on prime time TV. That's a huge change.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN #4: If sex is very painful during menopause, why not do something about it? Ask about Osphena.
BATES: That it took so long for women to talk in public about sex and aging is odd since we're talking about the generation that launched the sexual revolution. These were the first women who would separate sex from childbearing. Their Bible was our bodies, ourselves. But for many, menopause was still a puzzle.
JANET PREGLER: My name is Janet Pregler. I'm a professor of clinical medicine at the David Geffen School of Medicine at UCLA, and I'm also the director of the Iris Cantor UCLA Women's Health Center.
BATES: And Dr. Pregler believes a lot of what's advertised to menopausal women exists because a normal life process now is being treated as if it were a disease that needs to be cured.
PREGLER: Many of these things are important and do give relief to a small number of women.
BATES: But she says not everyone needs them.
PREGLER: The health care industry is an industry, and so there's been this sense of OK, well, let's sell this to as many people as we can.
BATES: So you're getting a blitz of ads for everything from cooling towelettes that soothe flushed skin to drugs that retard bone loss. And, says Dr. Pregler, prevalence of those ads worries some women who are aging well and who feel just fine.
PREGLER: I've actually had patients come in and say, I think there's something wrong with me. I'm not having terrible menopause symptoms, and aren't I supposed to have those?
BATES: The answer is, not necessarily. What's tolerable for some women in menopause may be unbearable for others. And figuring out how to relieve some of the side effects of menopause safely and reliably is still a challenge for the healthcare industry. In the meanwhile, you'll continue to hear ads like this.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN #5: Is this a symptom or, oh, Lordy, help me. I am so hot.
BATES: Karen Grigsby Bates, NPR News. Transcript provided by NPR, Copyright NPR.