It’s easy to get caught up in the current buzz around perimenopause, a term that’s become a household word for many women in their 30s and 40s. Brain fog, weight gain, hair loss, and insomnia are often cited as the tell-tale signs, leading to a surge in discussions about women’s health. But is this newfound “perimenopause awareness” truly a step forward, or are we falling for a narrative that might be doing more harm than good? Patricia Bencivenga and Adriane Fugh-Berman, from Georgetown University Medical Center’s PharmedOut project, delve into this question, arguing that while acknowledging women’s struggles is crucial, framing perimenopause as a debilitating condition can have unintended consequences. Adriane defines perimenopause broadly as “the time around menopause,” noting its “squidgy” definition, which sometimes stretches to include women in their 30s. Both agree that the conversation around perimenopause has significantly shifted, with Google search trends showing a sharp rise in interest around 2023. This increased attention has led many women to attribute a wide range of symptoms, from daily fatigue to more serious health concerns, to perimenopause, sometimes without exploring other potential causes.
The core of Bencivenga’s argument, as expressed in her thought-provoking essay, is that this perimenopause narrative risks reinforcing an age-old stereotype: that women are inherently “erratic and unstable” due to their hormones. From puberty to pregnancy, and now perimenopause, society has often reduced women’s experiences to hormonal fluctuations, hindering their perception as “stable and secure people.” This narrative can be disempowering, stripping women of their agency and providing others with a tool to dismiss their thoughts and feelings. Adriane highlights the difficulty in separating perimenopause symptoms from those of stress, depression, or simply the natural process of aging. Many of the issues attributed to perimenopause, such as weight gain and thinning hair, are common aspects of getting older. Midlife, in particular, is often a demanding period filled with professional stress, family responsibilities, and caring for both children and elderly parents. Blaming hormones for these challenges might oversimplify complex realities and distract from addressing underlying issues.
The rise of the “perimenopause movement” has also created a burgeoning industry targeting women experiencing these symptoms. Beyond traditional pharmaceutical companies, a diverse range of players, including telehealth platforms, compounding pharmacies, and influencers, are now promoting various products and services. Women are bombarded with advertisements for “goops and creams,” supplements, compounded hormones, expensive medical consultations, specialized workouts, and even books and documentaries, all promising to alleviate perimenopausal discomfort. While these offerings may provide some comfort, Bencivenga and Fugh-Berman caution against the lack of evidence supporting many of these solutions. The danger isn’t that women are seeking relief from genuine suffering, but that they might be investing significant time, energy, and money into unproven remedies, potentially delaying the diagnosis and treatment of more serious underlying health conditions. Bencivenga recounts a Wall Street Journal reporter’s experience of attributing a persistent itch to perimenopause, only to discover it was a symptom of cancer, highlighting the critical importance of a thorough medical investigation.
This current focus on perimenopause isn’t entirely new; it echoes historical trends in how menopause has been framed. Adriane observes a cyclical pattern, noting how hormones were aggressively marketed to women in the 1960s as a fountain of youth, only to fall out of favor due to links to uterine cancer, before re-emerging in the 1980s and 90s as health-promoting agents. However, the Women’s Health Initiative (WHI), a pivotal randomized controlled trial, later revealed that the harms of hormone therapy for chronic disease prevention often outweighed the benefits. The only symptoms consistently proven to be associated with menopause and responsive to hormones are vasomotor symptoms (hot flashes and night sweats), and vaginal dryness. The idea that hormones can cure a multitude of ailments attributed to menopause or perimenopause is “absurd” and can prevent women from uncovering the true causes of their health concerns. Adriane, having served as an expert witness in litigation concerning menopausal hormone therapy, has reviewed countless internal company documents that expose how pharmaceutical companies historically orchestrated elaborate marketing campaigns, often through ghostwritten articles in medical literature, to shape physicians’ and patients’ perceptions of menopause, sometimes downplaying serious risks like breast cancer.
The narratives surrounding perimenopause and menopause are further shaped by media, including documentaries. Bencivenga and Fugh-Berman express concern about films like “The M Factor” and subsequent perimenopause documentaries, which they argue contribute to the “medicalization” of a normal life transition. While these documentaries may encourage healthier lifestyles, they often instill undue fear and anxiety by presenting extreme cases and misinformation. Adriane recounts how “The M Factor” contained so many unsubstantiated claims that its continuing medical education accreditation was revoked. The perimenopause film, while making fewer claims, still relied on “scary stories” to illustrate its points, potentially leading women to believe that severe symptoms are the norm. The reality is that most women navigate perimenopause and menopause with mild or no significant issues. Even temporary changes in focus and attention during this period often resolve naturally. Both experts caution against the misapplication of hormone therapy, particularly in younger, perimenopausal women, where the long-term risks are less understood and the benefits may be overhyped in the absence of robust evidence.
The conversation ultimately circles back to the dangers of misinformation and the importance of critical thinking. When faced with social pressure and aggressive marketing, it’s easy for women to assume that a myriad of symptoms are solely due to perimenopause and that a specific product will provide the magic cure. When asked what to say to a woman who believes a cream from an influencer makes her feel better, even if it might just be aging, Fugh-Berman advises caution. If a product is harmless and provides comfort, the only loss might be monetary. However, if the product carries risks or prevents a woman from seeking appropriate care for a more serious condition, then awareness of those risks becomes paramount. The historical context of hormone therapy, the concerted efforts of women’s health activists to ensure evidence-based care, and the concerning trend of reversing progress by, for example, downplaying the risks of hormone therapy or using outdated terminology like “hormone replacement therapy,” all underscore the critical need for informed decision-making. Women deserve accurate information and support during these life transitions, without being subjected to fear-mongering or the pressure to medicalize a natural process.