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.