Dr. Stacy Sims, MSc, PHD, is a forward-thinking Stanford-based exercise physiologist and nutrition scientist who aims to revolutionize exercise nutrition and performance, especially for women. She is also the co-founder and chief research officer of OSMO Nutrition, a sports nutrition company that develops products that work with the body's systems to optimize athletic performance. Dr. Sims is in high demand in the sports nutrition, performance, and active women's universe for her “Women Are Not Small Men” lectures and is a regular featured speaker at professional and academic conferences, including those by USOC and USA Cycling.

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The Stats. The Stigma. The Silence.

How we think and talk about menopause matters.

Life expectancy for women is about 81 years, and the average age at which women hit menopause is 51. In other words, nearly 40 percent of your life is likely to happen after menopause. Factor in those five to seven perimenopausal years when your hormones start to go haywire and you could easily be living half, if not more, of your life on some part of your menopause journey.

When you look at it that way, it’s all the more upsetting how negative all the messaging around menopause is and has been for centuries. In the time of Hippocrates, menopause was described as “climacteric syndrome,” which was understood to be the stage of a woman’s life when she had a weakened uterus, was losing power, and was no longer of much use to society.

The Puritan times weren’t much better. If you pore through the historical archives on the witch hunts and identify who was killed at the stake, you find that peri- and menopausal women were primary targets. They were “mad with menopause,” or they were using herbs and other natural medicines to help treat other women (so they had to be witches), or they were simply “old crones” who needed to be eliminated for the betterment of society.

Menopause finally surfaced as a recognized medical condition in the 1880s, but the terminology didn’t improve. It was described as the “death of the womb.” The “experts” of the time also believed that when a woman stopped menstruating, she was no longer able to release “toxins,” and it was those toxins that would build up and induce symptoms of high heat in the body, profuse sweating, craziness, and “hysteria.” The response of the medical community was to call women insane and lock them up.

Things didn’t really get much better even in what we would consider modern times. In the early twentieth century, Sigmund Freud and his followers argued that menopause was a neurosis—again implicating menopausal women as insane. The lack of hormones and the aging process were causing women to go crazy. Even into the latter half of the twentieth century, physicians argued that at ages 45 to 50 women were prone to developing hysterical fits. (Don’t worry if reading all this is actually giving you hysterical fits . . . that’s a natural and healthy response!)

Moving into the 1960s, physician Robert Wilson wrote a best-seller called Feminine Forever, which described menopause as a disease and “living decay” that should be treated so that women could maintain their youth and sex appeal, That’s pretty much what you would expect from a male-centric culture. It was never about us. It was about them.

Fast-forward to today. Though there have been vast improvements in the medical understanding of menopause is, the messaging in the United States and other Western societies, sadly, has not improved. Menopause today is still viewed as our society’s arbitrarily established dividing line between sexual, attractive, and even powerful young women and suddenly old, weak women who can no longer contribute to society.

In fact, even now, women “of a certain age” (a phrase I detest) simply “disappear.” We basically stop seeing them represented in popular entertainment. Media outlets like Vulture have even made charts showing that as actors like Harrison Ford, Denzel Washington, Johnny Depp, and Tom Cruise get older, the actresses who play opposite them do not—and in fact they are often cast opposite much younger women.

It’s no wonder women feel like their lives are over as they age—they’re being sent the message that they should just disappear or relegate themselves to the shadows. And when they do finally see some representation, it’s often a dated stereotype. Google “menopause” and look at the depictions in the content you find. Compare the depictions of a woman in her sixties with those of men in their sixties. You’ll find that there are very different perceptions of what aging is for a man versus what it is for a woman. Rue McClanahan was just 51 years old when she was cast as one of the Golden Girls! That’s what we’re shown on television and in other media: men can still be strong and powerful, maybe even more so as they become “distinguished” with age, while older women are often shown stooped over with a “dowager’s hump” rather than depicted as strong, lean, powerful, or attractive.

After menopause, women are usually dismissed. Is it any wonder that women, especially active women who want to be strong and powerful, are so reluctant to talk about menopause?

Perception Matters

How we view aging culturally and societally influences how we view it personally, and those combined views have an impact on how we actually experience menopause, physically as well as psychologically, according to a study published in Menopause online, which found that impressions of aging can affect the severity of symptoms.

Lead study author Dr. Mary Jane Minkin, a professor of obstetrics, gynecology, and reproductive health at Yale Medical School, told Reuters Health: “In societies where age is more revered and the older woman is the wiser and better woman, menopausal symptoms are significantly less bothersome. Where older is not better, many women equate menopause with old age, and symptoms can be much more devastating.”

Taking this idea a few steps further, a 2018 study published in the Alexandria Journal of Medicine found a significant and direct relationship between a woman’s attitude toward menopause and her body image and risk for depression. Women who had negative attitudes toward menopause were more likely to view themselves negatively and to be depressed. Women with more positive attitudes had better body images and lower levels of depression.

Not surprisingly, poor body image during the menopausal years also ramps up levels of anxiety and depression. A 2020 study of more than 300 women whose average age was 55, published in BMC Psychiatry, reported that 55 percent had mild to severe depression and nearly 84 percent had mild to severe anxiety. Poor body image was strongly connected to both.

The catch-22 is that a poor body image can make a person less likely to exercise. After all, if you don’t like how you look in your workout clothes, it’s only natural to avoid even putting them on, let alone going out in the world in them.

To stay active and feel and perform our best, it’s important to break the silence and change the cultural conversation—to feel empowered and more comfortable in the skin we’re in and break this negative cycle.

A Change for the Better

Menopause is a time to look forward, not back, as the dominant ethos would have us do. Though I’m not opposed to hormone therapy (more on that shortly), I reject the notion that every woman needs hormone “replacement” therapy to stay young. You do not need to recapture something that you have lost. We can use hormones in a positive way to ease the transition, but we should also view the transition itself as an opportunity and a step up—not down—in life.

This is the view in other cultures, especially the Mayan and Japanese cultures. These women go into menopause with a view of it as freeing—they’re happy to not have to deal with a period anymore and eager to start a new chapter when they won’t have to worry about getting pregnant and being hindered by the responsibilities of a younger, reproductive woman. The New Republic did a fascinating feature on the lack of directly translatable words and phrases in the Japanese language for “hot flash,” “menopause,” and related terms in English. The Japanese experience menopause very differently and—dare I say—positively. Obviously, genetics and lifestyle are factors here. It would be naive to say that it’s all in their attitude. But attitude is clearly part of this larger, more positive picture.

Changing the cultural conversation starts with each of us. As part of your quest to be an active, empowered menopausal woman, I challenge you to work as hard on your mindset and point of view as you do on your physical strength and endurance.