Is Menopause All In the Mind?

Menopause is plagued by wild myths. But our attitudes about aging and sex can impact the experience of menopause.

Is Menopause All In the Mind?

Here I am doing some grocery shopping, and a little old lady is in front of me, dithering around and moving at a snail’s pace. I have about five minutes to do an hour’s worth of shopping. I smile patiently as she peers at a package of flour for what seems like hours, blocking my way with her cart. Finally, she moves. Then stops again. The rage is instant and nuclear. I look at her tiny, vulnerable ankles protruding out of those big, clumpy shoes that old ladies wear to keep themselves grounded, and I picture ramming my cart up the back of them. I’m one breath away from following through. Welcome to my menopause experience.

I am a nice woman, not generally given to running shopping carts up the back of little old ladies’ ankles. But, during menopause, I was an angry, hot, frothy mess of irritability. My friends were scared of me. I was scared of me. My best friend, also perimenopausal then menopausal, went through the whole thing without raising an eyebrow, her voice, or a sweat. The only thing she noticed was that her periods faltered, then stopped. I hated her. A part of me still does (OK, a teensy part, but still).

Menopause is a motherf*cker for lots of women. For others, she’s like a slightly annoying child, pulling at your skirts when you could do without being disturbed. Everyone experiences it differently, albeit with commonalities.

Here are some of the menopause stories women told me:

“I was in a restroom in a train station and suddenly, out of the blue, had a massive panic attack. I ran out of the stall and pushed through everyone to get outside. I was so afraid and claustrophobic and didn’t have a clue what was going on. It turned out to be a symptom of menopause.”

“I hardly noticed menopause. Emotionally perhaps, I was a little moody and sweating a bit at night. But I think mindful nutrition and not overdoing alcohol helped. And drinking lots of water.”

“Ah yes, the big M. It came and went with no real issues apart from hot flashes and night sweats for a few months. And that was it. Except, of course, since then I’m drier than the Sahara, which has caused UTIs.”

“I thought I’d escaped. I’m 60 and have had no symptoms of menopause at all. Was feeling quite smug about it all! Then I started getting urinary tract infections and the gynecologist took one look and said, ‘Wow! There’s a lot going on here.’ I had severe vaginal atrophy. Because I wasn’t experiencing anything on the outside, I didn’t think about the inside. She put me on HRT and pessaries immediately.”

“My anxiety level—which has always been high—ramped up to unbearable. I’m on antianxiety drugs now because I can’t take HRT. When I go off them, it’s a disaster. How much of it is menopause and how much of it isn’t, I don’t really know.”

That’s just a taste of the kind of experiences women have. Quite a range, ranging from a few months of inconvenience to years of misery. Regardless of where you fall on it, it’s likely your life and sex life will be impacted in some way.

The symptoms of menopause are not universal and vary among cultures. Some think the culture we live in is the most important factor in predicting what your experience of menopause will be. The Western world idolizes youth. Other cultures respect old age. We think of menopause as an ending, almost a “disease.” Other cultures think of it as a beginning, transformative. A time of freedom and respect for women.

There’s a school of thought that suggests this sense of shame and stigma that surrounds menopause in the West is making our symptoms worse. If menopause were something to be celebrated rather than feared, would it bother us less? The answer is—of course! If you get a hot flash in public and are embarrassed by it, you’re obviously going to feel it more intensely. If it doesn’t matter, you do what you do when you’re alone: ride it out until it passes. No big deal.

The Japanese word for menopause is konenki, which roughly translates to “renewal years” and “energy.” In China, the old are seen as wise and their opinions highly sought. Chinese and Japanese women are less likely to have night sweats and hot flashes. Rural Mayan women look forward to menopause because they become known as wise women and hold a place of power in the community.

Dr. Mary Jane Minkin, a professor from Yale Medical School, reviewed results from 8,200 men and women (aged 55 to 65) in North America and Europe, to find out how menopause impacted their sex lives and relationships. Guess what? The magnitude of suffering for typical symptoms like vaginal dryness, hot flashes, and weight gain varied by nationality. “In societies where age is more revered, and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome,” Minkin says. “Where older is not better, many women equate menopause with old age, and symptoms can be much more devastating.”

“How it affects you also strongly depends on where it sits in your timeline,” says UK sex therapist Victoria Lehmann. “A lot of things happen around that time. Parents die. Couples divorce. Careers end. There are sudden deaths. Some women don’t notice menopausal symptoms because there’s so much else to worry about.” Women in third-world cultures don’t have the luxury of worrying about menopause symptoms. If getting fresh water means risking your life to get to a well, a hot flash is the least of your worries.

Then there are the French. There’s a reason why there are so many books starting with “The French woman’s guide to...” French women deal with a lot of things differently than the rest of the world. For a start, age is no barrier to being “sexy” in France. Take the current French president’s wife, Brigitte Macron. At 67, not only is she 25 years older than her 42-year-old husband, but she’s still rocking miniskirts and leather trousers. Marie de Hennezel sums up the French attitude to aging in her usual graceful style: “The heart does not age. An inner youthfulness can be sexier than youth itself.”

The second thing French women do is they don’t talk about menopause or even acknowledge it. They haven’t quite managed to change the laws of nature—their periods do actually stop (mon dieu!)—but most won’t even discuss menopause with their close friends. Julie Parker, who is married to a Frenchman and has lived in France for 26 years, says she knows all the intimate details of all her friends’ lives. “And yet, when I settled down hoping for cozy chats and confidences on menopause, I was confronted by raised eyebrows, Gallic shoulder shrugging, and answers that ranged from ‘I don’t remember’ to ‘I barely noticed.’” Not one out of the 10 or so women she approached was willing to discuss menopause with her, yet she knew full details of all their marital indiscretions. Another English woman, in a similar situation, reported that when a French friend went to see her doctor about dealing with symptoms of menopause, his main piece of advice was to not discuss it with her husband.

Personally, I’m not convinced that not talking about anything is a good thing in a relationship. But perhaps French women don’t need to because their symptoms aren’t as bad as ours. Why aren’t they? Because they aren’t scared to get help from their pharmacist or doctor. A French woman’s friends might not know about her dry vagina, but her pharmacist most certainly does. French women are far more open to taking hormone replacement therapy (HRT) and bioidentical hormone therapy.

Does knowing this help us? Is this helpful to the average Western woman struggling with symptoms, to be told it’s all in her mind? That if we had a little more French va-va-voom and confidence in our sexual allure, we’d manage menopause better? That if we lived in a less youth obsessed culture, we’d have a better time of it? Probably not. I was healthy, the right weight, still felt sexy, and had good sexual self-esteem when I went through menopause at 48 and that didn’t stop me from having ghastly hot flashes, dry skin, a dry vagina, and painful sex.

There’s no way my menopause was imagined. A more logical theory is that the world divides into women who experience lots of menopausal symptoms and those who experience only a few. Diet and culture play a part, as does lifestyle, genetics, and our general health and attitude, as well as how we measure our worth in society and how society views us. It’s a combination of a lot of factors.

The French don’t get everything right. Rather than clam up, I think we need to talk more about menopause. I’ve taken extraordinary delight every time I’ve written the words “dry vagina” in this chapter. We need to normalize the term. Say to our friends, “God, my vagina’s so dry today. I just know I’m on the verge of another damned UTI!” the same way we say, “I feel so congested. I feel like I’m getting a cold.” If women stop being embarrassed by what is a natural bodily function, you never know, the rest of society might follow suit.