Some 65 million Americans count themselves as members of Generation X—more than half of them are women. Many of those latchkey kids who were left to fend for themselves after school in the ’80s are now fending for themselves through perimenopause and menopause. Without much of a road map from their mothers or guidance from their doctors, Gen X women are approaching “the change” with the scrappiness you might expect from girls who were once their own babysitters.“The typical ob/gyn doesn’t really get any formal hormone training,” says Dr. Maureen Whelihan, a member of the Menopause Society and a gynecologist who specializes in sexual medicine at Florida Woman Care in Palm Beach County, Fla. “But if doctors simply dismiss women and say that their symptoms couldn’t possibly be related to menopause or perimenopause, women are not going to put up with that because a million other pieces of information they’ve reviewed online tell them otherwise.”Knocking down doorsMeredith Burris can relate. She diagnosed her own perimenopause through Internet research and discussions with her contemporaries in Facebook groups. “I feel like our generation is the first one to discuss it,” she says. “We have social media. We have text chains with our girlfriends. People in the past didn’t have that.” Two years ago, when Burris was 46, she was dealing with intractable back pain, insomnia, hair loss, weight gain around her middle, and had what she calls “rage symptoms—just an increased inability to cope with my kids,” says the Atlanta-based attorney. Empowered by her online discussions, Burris took her complaints to her gynecologist, who said, “This is just a part of life” and offered no solutions, Burris recalls. So she took to telehealth. The telehealth for menopause sphere, comprising boutique operations like Winona, Gennev, Alloy, Evernow, and scores of others, is increasingly absorbing perimenopausal women dismissed by their doctors IRL. But Burris didn’t go to a platform specializing in menopause. Still, she got what she thought she needed—a prescription for low-dose birth control. The pills brought relief, but birth control contains a far higher dose of hormones than what’s needed to relieve perimenopause symptoms. “The hormones we give in menopause are about a fifth to an eighth of a birth control pill,” Whelihan says. “That’s all it takes to get rid of hot flashes and the other stuff.”All those extra hormones sapped Burris’s libido. When she told the teledoc that her marriage wouldn’t withstand this side effect and that she wanted to switch to HT, the doctor said then-46-year-old Burris would have to wait until she was 52 (the other side of menopause). Uninformed physicians“You’re killing me,” Whelihan says when she hears of doctors withholding HT from symptomatic women until they’ve gone 12 consecutive months without a period. “You don’t have to wait till you fit this arbitrary definition to seek treatment. That just means it’s time to find a new doctor.” And Burris did. The third doctor was a member of the North American Menopause Society and a listed provider at menopause.org. Two years and three doctors later, Burris got a prescription for HT. Docs who are uninformed about perimenopause and menopause symptoms and how and if to treat them are all too common. According to a 2023 study in Menopause, just 30% of ob/gyn medical residency programs include menopause instruction. Medicine started backing away from menopause care some 20 years ago. Setting the record straightThe Women’s Health Initiative (WHI), a huge nationwide study sponsored by the National Institutes of Health, was a series of clinical trials and observational studies that ran from 1991 to 2005 and examined the major causes of illness and death among postmenopausal women. In 2002, a WHI randomized controlled clinical trial of combination hormone therapy (HT) containing estrogen and progestin came to a screeching, premature halt when it was found to increase risk for heart disease, stroke, blood clot, and breast cancer in menopausal women.The research findings were all over the TV news as middle-aged women watched in horror and doctors scrambled to take their patients off of the drugs. Prescriptions plummeted. Over the coming decades, women suffered through hot flashes, insomnia, anxiety, depression, weight gain, vaginal dryness, painful sex, lost libidos, lost hair, brain fog, and joint pain. Meanwhile, mounting new research called the WHI findings and its study design into question. The study had in fact found only very small increases in risk for these conditions. What’s more, the majority of women in the study were between the ages of 60 and 69—not the target age for initiating HT. They were more than 10 years into menopause when they started HT, and they were in an age group that was already at higher risk for these health problems. In the years since then, new research has cast HT in a new light. Simply put, depending on the type and dose of HT you use, it could lower your risk for a number of diseases.A 2024 study in Menopause that analyzed 13 years of medical records of a staggering 10 million older women found that those who were still on estrogen-only HT after 65 were 20% less likely to die during the study period than those who had never taken or who had quit taking it. They were also less likely to have breast, lung, or colon cancer, blood clot, heart disease, or dementia.On the other hand, combo HT, which contains estrogen and progestogen (progestin or progesterone), in this same scenario was linked to a 10% to 20% increase in breast cancer risk. But using low-dose transdermal or vaginal estrogen+progestin reduced that risk. What’s more, women who used estrogen+progestin saw significantly reduced risk for uterine cancer, ovarian cancer, heart disease, and blood clots. Women who used estrogen+progesterone saw reduced risk only for congestive heart failure.It was new data like this that prompted the North American Menopause Society to rewrite its stance on HT. It now says that if you start it before age 60 and within 10 years of your last period, and you don’t have health problems that would preclude taking hormones, then risks are generally lower.That’s not to say that HT is without health risks. The risk-benefit ratio is different for every woman and depends on many factors. Besides the type of HT and the dose, your individual risk depends on your family history, overall health and medical history, how old you are, and how long you use it. Still, HT still hasn’t fully recovered from the bad press. And doctors by and large haven’t caught up either. Menopause influencersWhere uninformed or outdated personal doctors fall short, menopause influencers on social media are stepping in to fill the void. Author, podcaster, and social media maven Dr. Mary Claire Haver, @drmaryclaire, has 2.2 million followers on TikTok and another 1.7 million on Instagram, platforms where she routinely debunks myths about menopause and hormone replacement therapy. Haver, an ob/gyn who runs the Mary Claire Wellness Clinic for women in perimenopause and menopause, says that her Gen X patients are a far cry from middle-aged women she saw in her early days of practice. And her response to them is different, too. Twenty years ago, a woman of a certain age complaining of anxiety, depression, insomnia, heart palpitations, and weight gain might walk out of her office with a prescription for an antidepressant, diet recommendations, and referrals to cardiology and psychiatry. Neither the doctor nor the patient “would connect the dots that it was menopause,” says Haver, the author of The New Menopause: Navigating Your Path Through Hormonal Change With Purpose, Power, and Facts. “What’s happening now is women have all these educational platforms, they’re coming in and saying, ‘This is probably my perimenopause. I recognize you don’t have training in this, so here’s an article,’” Haver says. At Whelihan’s clinic in Florida, she’s seeing those types of proactive, well-informed patients too. “A third of my hormone consults are Generation X women in perimenopause. They aren’t even in menopause yet,” she says. “They’re getting the message from bloggers, podcasters, and social media that you don’t have to feel like this.” Skipping the middlemanAlicia Anderson, a mythologist in Las Vegas, knew she had to be proactive. Living in a rural area a good hour from her doctor, Anderson didn’t want to waste a trip when she wasn’t sure how much her doctor would know about HT and menopause anyway. She went directly to Alloy, a telehealth menopause clinic, when her perimenopause symptoms were more than she could handle. “The Alloy folks knew what they were doing, but when I sent their information back to my doctors—both the GYN and primary care—I felt like I was educating them.” Gen X is speaking upFor Anderson, social media was a lifeline on her journey to HT. Among those who guided her online, she cites @Maxinemakesit, who’s well known on Threads for her “Dear Menopause Friends” posts. Already on the other side of menopause at age 49, the changes started for Anderson before they did for any of her friends. So without gal pals to offer guidance, she says, “Social media has been really helpful. It showed me that this wasn’t just me. This was a pretty standard situation.” With any luck, Gen X’s openness about menopause may smooth the transition for millennials when their turn comes, “so that our kids don’t go through all the shame, confusion, and misinformation,” Haver says. “People’s menopause experiences were happening in silos. There was so much shame. Then comes Gen X. They started talking about it in all their Facebook groups, and now they aren’t afraid to talk about it at book club and dinner parties.”
