We’re Treating Menopause Like a Medical Problem. That’s Costing All of Us.
Something is shifting in how America treats menopause. Across the country, states are passing menopause legislation, the FDA has reversed two decades of hormone therapy policy, and the global market for menopause products is projected to reach $24 billion by 2030. And we're still missing the point.
Every bill, every supplement, every hormone therapy prescription treats menopause as a medical concern to be managed. That framing is not wrong; the biology is real, and medical support matters. I have benefited from hormone therapy after an early menopause at 43 and am grateful for the increased focus on menopausal health. But it is still tragically incomplete. Menopause is a significant developmental event — not just a medical one. And the failure to recognize it as such is costing all of us.
In 1966, gynecologist Robert Wilson published Feminine Forever — secretly backed by the pharmaceutical industry — giving Western medicine its organizing principle for menopause: estrogen deficiency, hormonal failure, a pathological state to be corrected. This framing survived even the 2002 Women's Health Initiative trial, whose findings were later shown to have been widely misapplied.
How we frame menopause shapes how people experience it. Medical anthropologist Margaret Lock found that Japanese women report menopausal symptoms at significantly lower rates than Western women — a gap attributable not to diet or genetics but to what their culture believes menopause means. Among Mayan women in the Yucatán, anthropologist Yewoubdar Beyene found something more striking. Women with hormone profiles identical to North Americans reported no hot flashes whatsoever. In Māori and Haudenosaunee scholarship, Indigenous writers such as Papaarangi Reid and Barbara Alice Mann describe postmenopausal women as occupying roles of wisdom and authority. Anthropologist Judith Brown found the same pattern: when menopause signals elevation rather than irrelevance, the transition tends to feel like one.
Meanwhile, in the West, Rebecca Mead observed in the New Yorker that perimenopause can feel like "the beginning of a cultural diminishment — not only in the eyes of others but also, alarmingly, in one's own." And we wonder why we report menopausal symptoms — known to worsen under stress — at higher rates than people in cultures that treat this transition differently.
The stakes are significant for all of us. Evolutionary anthropologist Kristen Hawkes spent decades studying the Hadza of Tanzania, asking why human females live so much longer after their reproductive capacity ends than any other primate. Her answer became the Grandmother Hypothesis: this extended postmenopausal life evolved because societies needed it. Freed from reproduction, postmenopausal Hadza women redirected immense energy toward their communities in ways that measurably increased survival rates. Postmenopausal female orcas — one of only a handful of species with a comparable lifespan — lead their pods to food during scarcity. When they die, pod survival rates drop.
The logic holds whether the community is foraging on the Tanzanian savanna or navigating a polycrisis in the 21st century West. Postmenopausal people carry accumulated knowledge, long perspective, and freedom from reproductive demands. Evolution developed this capacity, but we are squandering it. As Stephen Jenkinson has observed, we are "awash in the aged and yet somehow lacking in wisdom."
The solution is not just more legislation or better medical care, though both matter enormously. Every other major life passage gets witnessed. Births, marriages, deaths, graduations: we show up, we mark them, we acknowledge that something significant has changed. Menopause gets none of that. People move through one of the most significant transitions of their lives largely in silence — expected to perform normally throughout, often experiencing diminishment more than development.
When cultures treat this transition as meaningful — as a threshold into greater authority and respect rather than a slow fade into irrelevance — people experience it differently, and what they contribute afterward looks different too. We have the research; we don't have the culture.
Rhode Island's workplace accommodation law is a start. But we don't have to wait for legislation. A participant in a recent menopause support program described returning home "feeling profoundly shifted, rich in community, and ready to step into my wisdom years." That shift didn't require anything elaborate. It required people showing up to mark the transition, and to take seriously the possibility that menopause is part of how we develop a culture of wise elderhood.
The people moving through menopause right now may carry exactly what a society facing compounding crises requires. The question is whether we will build a culture that acknowledges them beyond their consumer or employee value — and stop diminishing the people we can least afford to ignore.
— Melissa Brough, PhD, RMT
