When Barbara Mark, Ph D. was 38, she started getting hot flashes. Wondering what was going on, she checked in with her General Practitioner, who had no information for her. Dr. Mark then saw an endocrinologist, who was equally baffled as to what was going on. She was too young for menopause, so there seemed to be no explanation for the hot flashes. Spoiler: Dr. Mark was going through the menopausal transition, also known as perimenopause. It wasn't until 1976, when the First Congress of the International Menopause Society gathered, that an effort was made to define menopause, and in 1981, the World Health Organization began to formalize the definitions and expand the vocabulary to include premenopause, menopausal transition, induced menopause, and premature menopause.
Now 67, Dr. Mark, who has a Ph.D in Clinical Psychology, supports professional and executive women in navigating menopause and the menopause transition. In the spring of 2019, Dr. Mark will be bringing formal trainings into workplaces, bridging the knowledge gap, and helping erode the stigma of menopause. In honor of World Menopause Day, Modern Fertility sat down with Mark to learn about the history of the menopause stigma, how she's changing the workplace for women via menopause education, and what women in their 20s and 30s can do to prepare for menopause.
Modern Fertility: Hi Barbara, thanks so much for talking with us about this super important topic. Can you tell us how menopause and the menopausal transition impact women at work?
Barbara: There are many symptoms associated with menopause - hot flashes, an increase in anxiety - that are totally normal, but if someone doesn't know what they're looking at, and if a woman isn't able to be transparent about what she's going through, these symptoms can make it seem like she isn't able to handle the demands of her position. Her behavior may be seen as a performance issue. This can result in her being given less responsibility, and even in job loss, when the reality of the situation is that she's one hundred percent capable, and if her workplace were informed and accommodating, there's no reason why menopause symptoms should negatively impact her work life.
Modern Fertility: What resources can help women better negotiate the workplace during menopause/menopausal transition? What can men do to make this transition easier?
Barbara: The trainings I will be doing in the workplace will educate employers and coworkers about menopause, which, in many cases, men have little to no information about - they often refer to their female employees (or the women in their personal lives) as being "sick," when actually, menopause is normal and in no way associated with ill health. If people have a base knowledge about menopause, and what their coworkers are experiencing, it can ease the perception that she's not able to do her job. It also makes it easier for women to ask for that they need without feeling ashamed or like she alone has to educate her coworkers. Simple solutions like a fan at her desk, for example, to help with hot flashes, access to ice-cold water, a space to go to when she's feeling particularly anxious, or the ability to work from home on occasion, can go a long way to a women feeling supported. Everyone in the workplace benefits from being more aware of menopause and the menopausal transition - it improves productivity and overall morale in the office.
Modern Fertility: Why do you think menopause is so stigmatized, and what can we do to push back against the stigma?
Barbara: When people think of menopause, they associate it with sickness, or with growing old, and because there's a stigma against aging in our society, particularly for women - gendered ageism, menopause is perceived as bad, indicating the end of a woman's best years. Menopause is a completely normal part of a life cycle for anyone who has ovaries and a uterus, and it doesn't last forever! The menopausal transition can begin 8 to 10 years before menopause - in one's late 30's, but for some women, it can start around age 35 or 36. Menopause itself arrives when your period has been absent for 12 months in a row.
There's a long history of negative outcomes, to put it gently, for women going through menopause, especially since for so long, we knew little to nothing about it. I think if you looked closely at women who were persecuted for witchcraft throughout history, or women who were institutionalized in mental health facilities (usually by their husbands) you'd find that many of them were going through menopause, but symptoms like insomnia, mood swings, anxiety, depression, memory lapses, hot flashes and even digestive issues were interpreted very differently.
In order to help eradicate the stigma around menopause, we have to educate ourselves and others about it, especially breaking down the myths around it that hurt women, like they're becoming "crazy" and can't handle their lives and work. With information, we can support each other openly, and help others be allies to women experiencing menopause.
Modern Fertility: Finally, what can women in their 20s and 30s do to prepare for menopause and the menopausal transition?
Barbara: Because of the presence of the internet, women don't need to wait until they're actually in menopause or the menopausal transition to get information on what to expect. The North American Menopause Society is an excellent resource; you can find medical information, and also a directory of menopause practitioners - people whose job it is to help you navigate the menopausal transition and menopause with the right health care. Younger women can also prepare for menopause by finding out what it was like for their female relatives - at what age did their mothers and grandmothers, on both sides, go through menopause? What were their symptoms like, and how did they manage them?
Having information about menopause before you start experience hot flashes will help you and your health care provider mitigate your symptoms, many of which can be managed with diet and exercise. If women in their 20s and 30s are eating well and exercising, they're already living a lifestyle conducive to easing menopause symptoms.
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