My Notes

Below are the very scattered, but honest, notes I took on the various sources I found when researching. 

 

Menopause - Symptoms and causes - Mayo Clinic July 2026 

Menopause is when your period ends and is diagnosed after 12 months without menstrual period, vaginal bleeding, or spotting

Can happen in 40s or 50s

Average age is 51 in usa

Perimenopause is the months/years leading up to menopause

Lasts 2-8 years averaging 4 years 

Symptoms: 

Irregular periods.

Vaginal dryness.

Hot flashes.

Night sweats.

Sleep problems.

Mood changes.

Brain fog. 

During perimenopause there are often missed periods or irregularities

In early perimenopause periods are closer together, in later they are further apart

Causes: hormones

In your late 30s your body makes less estrogen and progesterone which regulate periods

That makes it harder to get pregnant 

In your 40s, your menstrual periods may get longer or shorter, heavier or lighter, and happen more often or less often

When you get an oophorectomy (ovary removal) then you go straight into menopause but the symptoms are often more extreme because you haven’t had years to adjust

However, if you get a hysterectomy (uterus removal) you stop having periods, but your ovaries still have their cycle so you aren’t in menopause and don’t have the symptoms

Chemotherapy radiation to the lower belly, pelvic area, lower spine, or whole body can cause menopause

About 1% of people get premature menopause before 40 from Primary ovarian insufficiency. If this happens it’s recommended that you do hormone therapy until you’re at a normal menopausal age.

Menopause: an opportunity to invest in your future health · HELM Longevity 

“Research shows that the choices we make in the years around menopause, meaning the point one year after your final period, can influence the risk of osteoporosis, cardiovascular disease, metabolic ill health, loss of function and reduced quality of life decades later.”

The time of menopause is super important for preventive care. 

Muscles = biological pension savings (you should during this time eat protein and exercise)

Bone density declines slowly after this time

Before menopause women had way lower cardiovascular disease risks than men, after the gap narrows

The WHI Study & Its Flaws: How They Defined Menopause Care

2002 Women’s health initiative study on HRT (hormone replacement therapy) linked hormones for menopausal people to a 29% increase in coronary heart disease, 37% increase in strokes, and 98% in pulmonary embolism, 24% breast cancer

68,000ish participants in the study, post menopausal women 50-79

3 options: hormones, diet, calcium and vitamen d supplement studied for 9 years

Hormones were two most common HRT regimens at the time: conjugated equine estrogen (CEE) plus progestin (synthetic progesterone) for women with a uterus, and CEE alone for those who’d had a hysterectomy

“Everybody flushed their hormones down the toilet. Patients didn’t want to take them. Doctors stopped prescribing them. Literally overnight, it just sort of stopped.” – New York City–based OB-GYN Alyssa Dweck, M.D

Notably, the press conference took place a week before the paper was published so physicians were blindsided

In the 2000s following the study, doctors were told not to bother learning about hormone therapy because you’re not going to prescribe it. 

Before: 40% of postmenopausal women used it, months later 20%, now estimated 5%

In reality, The actual increase in breast cancer risk for women on the combination therapy was small—just one additional case per 1,000 women.

Women who received estogren alone actually had a decrease in breast cancer risk
A study published in 2013 estimated that between 2002 and 2012, as many as 91,000 postmenopausal women in the U.S. died prematurely from conditions that HRT might have helped prevent. 

Associated with an overall decisive reduction in all cause mortality

But that information didn’t get spread to the public… or doctors

The population studied in the study were older than recommended for the hormones in pursuit of a better double blind

Menopause hormonal therapy (MHT) has been used successfully as a name to rebrand HRT and avoid negative connotations

Now the doses have more estrogen and less progesterone which is better

A 2022 review of 12 studies on medical menopause education found some sobering statistics:

More than 90 percent of medical residents said they felt unprepared to deal with patients experiencing menopause.

One in five family medicine residents received no menopause education

Less than 7 percent feel adequately prepared to treat menopause.

Almost half of those residents had not received menopause management training or were unfamiliar with it.

A full 67 percent said they did not adequately understand HRT.

Full article: Menopausal symptoms: what are the differences between the West and the East? 

world population of postmenopausal women is projected to increase to 1.2 billion by 2030

A variety of factors would influence the natural menopause age, including body mass index, smoking, never having given birth, socioeconomic status, race/ethnicity, war, age at menarche, genetic variation, educational level, length of menstruation, previous oral contraceptive use, and marital status

Overall mean age of menopause is 48.8 (compared to 51) Asians in particular have lower age

A survey of 1000 Singaporean women of different races, found that they all had roughly the same menopause age

Perimenopause has worse symptoms than postmenopause, but opposite for chinese women

Most common symptoms in the west: hot flashes and sleeplessness

In east: fatigue and irritability

In usa 33% of people experienced hot flashes TEN TIMES A DAY

Asian women tend to be presented with less treatment options and have less interest

Smee_H_PhD_Thesis_2025 (1).pdf  

Bodily aging is an intersectional issue between sexism, abelism, ageism

wider societal silence and stigma reinforce workplace inequalities for teachers 

Fear shame and vulnerability are defense reactions to institutionalised gender norms and 

power structures which devalue bodily deviation, particularly signs of ageing & not being the “ideal worker”

Intersectionality is how different societal disadvantages interwork on macro and micro levels

Idea of a “disembodied worker” and productivity priority 

menopause symptoms associated with women reducing hours, lower work ability and higher rates of absenteeism and presenteeism 

Smee refers to the social and biological impacts that come with menopause as “the menopause penalty”

perpetuate a gender pay and pension gap in teaching 

workplace disruptions and gender bias, perpetuate a gender pay and pension gap in teaching, 

resulting in women now needing to work longer to avoid poverty in old age (which is bad bc they’re sad and old :( )

Working part time is also common for menopausal women and thats stigmatized

Men in similar management positions still get more pay and are more likely to advance

stereotype of older workers being less competent than young workers, disproportionately 

impacts women

Men aging is associated with experience, women aging is associated with irrelevance

Black women, for instance, are more likely to report severe symptoms, and they often experience menopause earlier than white women, patterns linked to broader health inequities 

But their less likely to seek medical advice or receive appropriate care due to systemic bias and underrepresentation in medical research

However in some south asian and indian cultures, menopause is seen as a natural and liberating experience, rather than a health condition.

 

https://www.theguardian.com/society/2025/feb/23/so-hot-right-now-menopause-conference-sydney-ntwnfb 

Conference called “So Hot Right Now” about MHT 

“The menopause wars are alive and well,” says Prof Jayashri Kulkarni, a professor of psychiatry at the Alfred hospital in Melbourne

But the conference is not supported by the Australasian Menopause Society

 

https://womensmentalhealth.org/posts/gabapentin-for-menopausal-vasomotor-symptoms/ 

Gabapentin - pet anxiety med

Also good for perimenopause

 

The Role of Dietary Supplements in Modulating Menopause Onset: A Comprehensive Analysis of Nutritional and Lifestyle Influences on Menopause Timing  

Premature menopause is linked to cardiovascular issues, diabetes, and overall mortality

Late menopause = cancer

significant link between premenopausal consumption of fish oil, vitamin B-complex, antioxidant mixtures, and vitamin C supplements and a later age at natural menopause

higher consumption of red meat, prolonged smoking, and lower educational attainment were linked to an earlier onset of menopause

Menopause Legislation Report | U.S. Workplace & Healthcare Trends 

Only 20 states have introduced menopause legislation

Rhode island made history as first to mandate workplace menopause accommodations

10 states laws covering workplace accommodations, insurance coverage, and provider training

Evolution of menopause - Wikipedia 

“Few other animals have a menopause; humans are joined by just four species in which females live substantially longer than their ability to reproduce, all cetaceans (beluga whales, narwhals, orcas and short-finned pilot whales)”

 

Why did menopause evolve? | PNAS 

While it was previously believed that only 5 species (humans + some whaleish things) had menopause, new research shows maybe chimpanzees and gorillas?

George C. Williams was the first evolutionary biologist to mention it in writing, when he published a theoretical paper in February 1957 on the evolutionary basis for aging - less than a century ago

Williams gave it a few paragraphs and said “the reproductive decline is rather abrupt”

Williams also theorized that maybe after 50, new pregnancies were just too risky

D. Hamilton theorized about Inclusive Fitness, where related individuals find it beneficial to help each other in order to pass on more genes

anthropologist Kristen Hawkes researched the Hadza people of Southern Tanzania for more than a decade in the 1980s/90s. The women in their community collected sweet pea tubers to eat and while the weight of the first kid depended on the yield of the mother, the second child relied on the grandmother’s harvest. This led Hawkes to reason that the middle-aged women were choosing cooperation over breeding to ensure their genetics get passed down further. 

The Grandmother Hypothesis, helping your relatives have more babies outweighs the genetic advantages of having more yourself. 

Kibale National Park, primatologist Kevin Langergraber co-directs the Ngogo Chimpanzee Project, a long-term field study of about 200 wild chimps.

These chimps were found to spend ~20% of their lives in postmenopause. 

The research found that, contrary to the grandmother hypothesis, these grandmas did not help their youth… and instead just like stole meat. 

This discrepancy inspired a second theory, Reproductive Conflict Hypothesis. https://royalsocietypublishing.org/rsos/article/12/6/250385/235598/Avoidance-of-reproductive-conflict-and-the 

Classical theory suggests that females should reproduce until the end of their life for increased fitness, but a few species (most famously humans) stop reproducing long before death. 

Reproductive Conflict Hypothesis: There’s a point when mothers and daughters will end up competing to breed, both with resources and men. To avoid the costs of conflict, menopause may have evolved.

^but when we apply this to humans… my mom better not be 

HOWEVER, theres a third final theory because certain mountain gorillas in Uganda can live 15+ years after ending reproduction and they don’t live with their post-pubescent offspring (no grandmother) and there’s not a competition for resources. 

Nonadaptive scenario: Final theory is basically that they just… lived past when they used to and evolution hasn’t caught up

In fact, it’s not uncommon for many species to live past their reproductive years when in zoos or labs (no predator or starvation fear)

Its possible that multiple (or none) of these theories work together to explain menopause

 

The evolution of menopause in toothed whales | Nature 

Croft found that species with menopause live 40-plus years longer than closely related species of similar size that don’t have menopause.

Whales (menopause and not) all stop breeding around when their daughters reach maturity, suggesting that whales quit competing to breed when their daughters start winning out. (supports the reproductive conflict hypothesis)

But also menopause whales usually live long enough to see their grandchildren to maturity (suggesting grandma hypothesis)

“Reproductive conflict explains why fertility ends, while inclusive fitness explains the extended lifespan.”

 

(menopause mastery cite! 

menopause marks the point when the ovaries no longer possess enough functional follicles to respond to hormonal signals from the brain

 

Full article: Menopause in low and middle-income countries: a scoping review of knowledge, symptoms and management 

Data on menopause in LMIC is very scarce 

“Cultural stigma, misconceptions and healthcare provider knowledge gaps contributed to low uptake of evidence-based menopause care”

Premature ovarian insufficiency (POI) is cessation of ovarian function before the age of 40 years

 

https://en.wikipedia.org/wiki/Evolution_of_menopause 

Food sharing is important for humans and orcas (supports reproductive competition theory)

 

Menopause was a French invention at a time of revolution | Psyche Ideas 

The french invented the word “la menopause”

They believed times of reproductive change (menopause, menarche, birth, lactation, menstration) made women crazy. So that’s the whole life actually.

“They also characterised many forms of older women’s sexuality as perverse and degenerate”

French made the stigma for menopause a lot worse, because they were some of the first to study it too

The male french physicians were generalizing and catazophizing

“The generation of educated women born in the second half of the 19th century, reaching midlife between 1880 and 1930, were heavily exposed to the medical concepts of their menopause. But they were also warned not to worry about it, because that too would make them sick!”

⅓ of usa women are hystorectomied by 60

 

https://www.cnn.com/2025/12/04/world/menopause-global-ignorance-dangers-explained-as-equals-wellness-intl 

A lack of awareness will lead many to experience symptoms without knowing why

study of women in the United States and South Korea found that up to 9.4% of people (around 1 in 10) experience it between 40 and 44, while for up to 8.6% of people it happens before the age of 40. In very rare cases, women can go through menopause as early as their 20s

One, which surveyed more than 800 postmenopausal women, the majority based in the UK, found that over 90% of them had never been taught about menopause at school, and almost half said they felt completely uninformed about it. The women also shared that their doctors lacked adequate knowledge, leaving them feeling “dismissed and unsupported” after their consultations.

Research suggests, across low and middle-income countries, rates of early and premature menopause have risen and that the average age of menopause has fallen.

Menopause is premature before 40 and early if before 45

when these women are suffering with gynaecological disorders such as excessive bleeding or fibroids, they feel forced into hysterectomies, possibly under pressure from their husband or in-laws, or even doctors who may suggest the surgery as the first course of action. Research shows many women are unaware of the extent of the procedures they’ve had.

common symptoms include hot flashes, night sweats, vaginal dryness, urinary urgency, insomnia, and mood changes, including depression and irritability.

She believes what’s needed is comprehensive research, public awareness campaigns, including in schools, and evidence-based training for health care professionals.

increased risk of cardiovascular disease, osteoporosis, COPD following menopause

menopause causes a significant drop in estrogen – which works in regulating cholesterol and fat – increasing the risk of developing coronary heart disease or suffering a heart attack or stroke,

Heart disease is the leading cause of death for women worldwide

Hormone therapy is thought to help mitigate symptoms and risks associated with menopause, and treatment typically lasts between two to five years, sometimes even longer. Stopping treatment may bring back menopausal symptoms.

But these treatments are only really accessible in high income countries due to cost

There are side effects of hrt, like vaginal bleeding and really small increases of risks, but women can’t make these decisions without access to the information. 

Herbal and vitamin supplements and lifestyle changes are also common ways to manage symptoms

Aging country = more menopausal issues

“The government only knows women as a reproductive person, not post-reproductive. She’s not a woman, or she is only defined by her uterus,” says Rajput.

“The perception around menopause needs to change. And a large part of that comes with awareness,” says Delanarelle of the UK NHS trust. She believes that teaching teenage girls about menopause in school can make a difference because “as they grow up…they understand that menopause is not the end of the line for them. It’s another chapter. You’ve got a book, and menopause is another chapter.”

 

https://www.cnn.com/2025/11/10/health/hormone-therapy-menopause-fda-warning-wellness 

They took the black box warning off of hrt 

“After 23 years of dogma, the FDA today is announcing that we are going to stop the fear machine steering women away from this life-changing, even life-saving, treatment,” FDA Commissioner Dr. Marty Makary said in announcing the change.

“With the exception of vaccines or antibiotics, there’s no medication that can improve the health of women on a population level more than hormone replacement therapy,” Makary

Women’s health experts praised the move to update the boxed warning to reflect newer scientific evidence around menopausal hormone therapy but said individualized discussions of risks and benefits will still be needed.

The black box warning, or boxed warning, was added after a large government-funded study, the Women’s Health Initiative, found in 2002 that women taking estrogen pills after menopause had some higher health risks compared with women who took a placebo. The study participants had an average age of 63, so many were past menopause when they started the therapy.

“Chronic illnesses like heart disease, Alzheimer’s, osteoporosis, cancer, they are diseases of aging, and one reason is the loss of hormones.”

They won’t give you cancer, but they can protect you from it

 

https://www.usatoday.com/story/life/health-wellness/2026/06/22/menopause-laws-hormone-therapy/90560590007/

Menopause laws increasing in frequency

https://mlrb.net/menopause-death-rate/ 

Menopause death rate does not refer to a number (like heart disease would) but rather is about the increase of potentially deadly diseases caused by an estrogen decline from menopause.

There are estrogen receptors throughout the body and without estrogen these tissues lose their crucial support, leading to a cascade of physiological changes. For instance, estrogen helps maintain blood vessel elasticity, regulates cholesterol, and supports bone formation. Its absence contributes to arterial stiffening, unfavorable lipid profiles, and accelerated bone loss.

Increase in LDL (bad cholesterol) and lowering of HDL (good cholesterol)

Higher blood pressure (less blood vessel elasticity)

Osteoporosis

20-30% of older adults die within one year of a hip fracture due to complications like pneumonia, blood clots, or surgical complications.

Insulin resistance and weight gain increase risks of type 2 diabetes which increases risk for heart disease, kidney disease, nerve damage

 

https://mlrb.net/menopause-7-stories/ anecdotes

Women Share Their Menopause Stories | Real Experiences & Symptoms | MenoHello 

"Looking back, I lost a lot of time to symptoms I didn’t understand."

Emily, age 57

It's nearly impossible to say when perimenopause actually started—probably somewhere in my mid-40s. For years, I experienced weird joint pain, tiredness, and brain fog that affected my work. I blamed it all on being overwhelmed with three young children, a demanding job, and endless responsibilities at home. I thought I was just a tired, stressed-out mom.

Looking back, I lost a lot of time to symptoms I didn’t understand. Exercise and HRT have been lifesavers for me, along with magnesium and omega supplements.

"I felt depressed and started having anxiety that I never had before."

Melissa, age 54

I was 46 when things started changing, though I didn’t have the language for it at the time. I just knew I wasn’t okay. I felt depressed and started having anxiety that I never had before. My hips hurt, I started gaining weight, and I felt hot all the time

Once I started HRT it helped with everything. I started feeling like myself again. I only wish someone had told me earlier that what I was experiencing had a name and a treatment.

 

https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372 

Whole body hormone therapy = systemic therapy

pill, skin patch, ring, gel, cream or spray

Low-dose vaginal estrogen comes as a cream, tablet or ring- less estrogen than systemic

If you still have your uterus, your healthcare professional will likely prescribe estrogen along with a progestogen, which is a group of progesterone-like medicines. This is because taking estrogen without a progestogen can thicken the uterus lining, which can increase the risk of endometrial cancer. If you have had your uterus removed, you may not need to take a progestogen along with estrogen.

Starting MHT at 60+ or ten years after menopause can be risky (that’s what was done in 2002 WHI study)

Most beneficial for premature menopause people bc you have low estrogen for longer. 

Helps with vaginal dryness, urinary issues, hot flashes, and bone density

osteoporosis, heart disease, dementia and mood changes

 

https://idealhealthmd.com/2025/05/29/the-whi-study-how-misinterpretation-of-hormone-therapy-data-hurt-womens-health/ 

WHI launched in 1990s, estrogen and progesterone branch stopped in 2002 prematurely and just estrogen stopped in 2004. 

The average age of women in the study was 63, which is older than recommended 

One size fits all dose, when it should be on an individual basis.

the reported 26% increase in breast cancer risk translated to less than one additional case per 1,000 women per year

Lack of nuance in public messages, blanket statements

Millions were taken off HT, often abruptly and without alternatives

Estrogen-alone therapy (in women without a uterus) was actually associated with a lower risk of breast cancer and all-cause mortality in the long term

Transdermal estrogen (patches, gels) carries lower risks of blood clots and stroke compared to oral forms.

Newer forms, like estradiol and micronized progesterone, offer greater safety and tolerability

 

https://www.healthline.com/health/cancer/how-long-does-chemo-induced-menopause-last#why-it-happens 

Estrogen and progesterone levels, which are hormones menopause affects, in your body may become unbalanced due to how chemo affects your endocrine system.

chemo speeds up the menopause process your body has already begun.

Like ovary removal, chemo induced menopauses causes more extreme symptoms because it happens so fast

For some people your people returns after a few years, for others it doesn’t

 

Jane's story - https://www.thefreelibrary.com/%27I+started+my+menopause+in+my+30s+but+doctors+ignored+my+symptoms...-a0814475484 

 

https://newsroom.clevelandclinic.org/2026/05/07/cleveland-clinic-releases-new-national-report-on-the-state-of-womens-health-in-the-us 

More than two in five women (42%) are unaware that menopause can affect the heart, brain and bones, and more than half (52%) say it is not discussed enough, pointing to the need for earlier, more actionable information.

 

https://womenswellnessnow.com/wp-content/uploads/2017/07/How-NIH-Misread-Hormone-Study-in-2002-1.pdf 

WHI data published in April in the Journal of the American Medical Association showed 

that women in their 50s who took a combination of estrogen and progestin or estrogen alone had a 30% 

lower risk of dying than women who didn't take hormones.

Menopause Jokes - Menopausal Jokes  

Survey shows menopause curriculums lacking in residency programs | Contemporary OB/GYN