Menopause Is Having a Moment. We’re Still Missing The Point.
I was 39 when my body announced, unexpectedly, that it was done with reproduction. The announcement was not quiet. It was more like a smoke alarm going off at random hours of the day and night, for several years — the kind with the automated voice that relentlessly screams at you, "Warning! Smoke has been detected. Evacuate!" What I didn't know, because no one had told me, was that I was standing at the threshold of what might prove to be the most significant initiation of my life.
What followed was not what I would want from a significant life transition. Instead of compassionate guidance, mentoring, or even celebration, I got medical testing, a transvaginal ultrasound, and expressions of pity on the faces of my doctors. It seemed I was supposed to mourn this transition as if I were already dying. My instincts told me something different: that I was missing the bigger picture. That this crossing was supposed to be honored — and ideally supported — as an entry into wisdom, clarity, and mature authority. But I had no map, no language, no community of women who had consciously walked this path before me and were waiting knowingly on the other side.
Like any turning of a new chapter of life, there is something to be grieved as we let go of our former identities. But in this case, I felt robbed — not of my fertility, which I had wanted to repurpose anyway, but of a rite of passage. That was the real loss.
For most of Western history, menopause has been either medicalized, pathologized, or ignored. It is finally having a cultural moment. Nineteen states have introduced menopause-related legislation; eight bills are now law. With a projected $24 billion market for menopause products and services by 2030, the hunger for a different experience of menopause is clear. But we are still missing the most important point: that this transition is not just a women's health issue. It is an initiation into a stage of life our entire society depends on.
Most cultures in human history have understood that major life transitions don't complete themselves. They require a psychosocial container, a structure that says: you are crossing a threshold, and we see you.
The anthropologist Arnold van Gennep called this structure a rite of passage – separation from the old identity, a liminal period of dissolution and transformation, and incorporation into a new role within the community – and found it across dozens of societies in the early 20th century. Births, marriages, deaths, even graduations and retirements; all are widely marked, witnessed, held within a structure that says, you are becoming something new. Menopause is conspicuously absent from that list, at least in the contemporary West.
Van Gennep's student Victor Turner called the threshold itself the betwixt-and-between – a necessary dissolution in which the old self is shed before the new one forms. The danger, Turner argued, is what happens without a structure to hold it. He saw this as a particular vulnerability of modern societies; people get stuck in the threshold. They wander between identities with no map and no one to tell them the wandering is the point.
This is the undiagnosed condition suffered by the majority of Westerners in perimenopause. It's not a hormonal disorder or a personal failure. The failure is a cultural one. For me, it felt like a kind of purgatory I'd never heard of before. Dealing with the physical symptoms – hot flashes, night sweats, insomnia, reflux, anxiety, loss of libido – was bad enough. But walking the emotional gauntlet largely alone, with no wise mentorship and no validation of my journey, felt like I'd fallen through a manhole and found myself alone in the underworld. It turns out that was the point. My body was taking me through an initiation, whether I was conscious of it or not.
The psychologist, author, and wilderness guide Bill Plotkin has a phrase for what Western culture has become as a result of the dismantling of its initiatory structures: a "patho-adolescent society." Most people, he argues, never developmentally progress past adolescence — not because of any individual failure, but because there are no structures to carry them forward. As the writer and cultural activist Stephen Jenkinson argues, we are "awash in the aged and yet somehow lacking in wisdom"; flush with old people, but troublingly short on genuine elders. How did we get here?
In 1966, a gynecologist named Robert Wilson published a book called Feminine Forever, and with it gave Western medicine its organizing principle for menopause: estrogen deficiency. Hormonal failure; a pathological state to be corrected. The pharmaceutical industry – which, it turns out, had secretly backed his book – enthusiastically agreed, and the medicalization of menopause was underway. This framing dominated for decades, until the 2002 Women's Health Initiative clinical trial appeared to show that hormone replacement therapy carried serious health risks, findings later shown to have been widely misapplied. In November 2025, the FDA removed its black box warnings from HRT products. But the medical pathologizing of menopause still persists.
The hormonal changes of menopause are of course real, and for many women — including myself and women like me experiencing "early" menopause — medical support and HRT can be genuinely helpful. But even corrected, the biomedical model remains a fraction of the full picture. It reduces a developmental initiation to a clinical malfunction. And it has left generations of women with no story for what was happening to them except loss.
Medical anthropology offers a different story, along with compelling evidence that the biomedical framing is itself a cultural artifact, not an objective truth. Margaret Lock, an anthropologist at McGill University, spent years studying menopause comparatively across Japan and North America. What she found was striking enough to merit its own conceptual framework, "local biologies." She concluded that the same hormonal transition can be experienced radically differently depending on what a culture believes it means.
In Japan, menopause is framed as kōnenki, often translated as "renewal years" or even "second spring." Japanese women consistently report menopausal symptoms at significantly lower rates than Western women; studies suggest somewhere between 13 and 50 percent depending on menopausal stage, compared to 40–80 percent in the West. Researchers have not been able to attribute this gap to diet, genetics, or any isolated physiological variable. The evidence points instead to a mix of factors in which cultural framing plays a meaningful role, shaping how symptoms are named, valued, and disclosed. When a culture frames menopause as deficit and decline, women experience it as such. When it frames the same transition as renewal, something shifts — in the body, in the reporting, or both.
And Japan is not the only or even the most striking example. Anthropologist Judith Brown's 1982 synthesis of ethnographic research identified a pattern across several non-Western societies: that the end of reproductive capacity marks expansion instead of decline. In some cultures, postmenopausal women are freed from certain restrictions, granted greater authority, and given recognition unavailable before. Among Māori women in Aotearoa, indigenous health researcher Papaarangi Reid has shown, te Rūahinetanga — the Māori word for menopause — carries within it the meaning of a wise and important woman, a passage into new roles and responsibilities in the community. Among the Haudenosaunee, elder women — clan mothers — hold formal political and spiritual authority. They appoint and may depose chiefs, oversee ceremony, and serve as keepers of communal memory, as Seneca scholar Barbara Alice Mann has documented. Among Mayan women in the Yucatán, Yewoubdar Beyene found that menopause was neither medicalized nor feared — and that women in her study reported no vasomotor symptoms whatsoever, despite hormone profiles identical to North American women.
The pattern is hard to dismiss: the end of reproductive capacity can mark a growth of authority rather than a loss of worth. Of course, the picture is not uniformly rosy; attitudes toward menopause vary considerably within Indigenous communities, as they may everywhere. Many traditions carry their own forms of ambivalence or contradiction, often complicated by colonial legacy and globalization. But the pattern that emerges across this evidence is significant nonetheless. Where cultures have frameworks for understanding menopause as meaningful — as a threshold into a new social role rather than an exit from a valued one — the experience of crossing it tends to be less pathological, and often genuinely expansive. The fundamental transition may be the same everywhere. The container, and therefore the experience, is entirely different.
Second-wave menstrual activists like Judy Grahn argued that female bodily transitions were among the earliest forms of human ritual life, and that the menopausal transition in particular marked a woman's entry into the role of ritual keeper and memory holder. The Jungian scholar Christine Downing described this transition as a descent; a genuine underworld journey that, properly witnessed, can bring you home to your truest self. And in the work of Clarissa Pinkola Estés, whose Women Who Run With the Wolves (1992) shaped a generation's understanding of female psychology, the postmenopausal elder is not diminished but distilled, having burned away everything false. In each of these accounts, menopause holds the possibility of the arrival of the irreducible, essential self. The question is whether the culture will receive her.
Susan Sontag wrote in 1972 about the double standard of aging; gray hair reads as distinguished on a man and diminished on a woman, and men age into authority while women age out of relevance. More than fifty years later, that double standard remains largely intact. It is the cultural water Western women swim in when they arrive at the menopausal threshold, and it shapes what the threshold feels like from the inside. It is very hard to experience a transition as a promotion when everything around you is framing it as a decline.
And this is not just a concern for women. The stakes are even broader. Evolutionary anthropologist Kristen Hawkes has spent decades studying why human females live so much longer after their reproductive capacity ends than any other primate. Her research with the Hadza people of Tanzania produced what is now known as the Grandmother Hypothesis: the proposal that humans’ relatively long postmenopausal human lifespan is not an accident or an artifact of modern medicine, but an evolutionary adaptation. Postmenopausal women, freed from the demands of reproduction, redirected immense energy toward their grandchildren's survival — foraging, transmitting knowledge, stabilizing the social fabric — in ways that measurably increased the survival rates of their communities. Life after fertility, Hawkes argues, is the point. It evolved because societies needed it.
Orcas are one of only a handful of species, alongside humans, where females live decades past their reproductive capacity. Research by Lauren Brent and colleagues has shown that postmenopausal female orcas lead their pods to food sources during times of scarcity. They are the knowledge-keepers. When they die, survival rates in their pods drop. Grandmothers may safeguard and transmit ecological understanding, healing practices, cultural memory; the long knowledge of what has worked and what has failed. Western culture has built a society that discards the very people evolution designed to be its wisdom-keepers, at the precise moment when their contributions could be at their peak.
Yet elderhood, Stephen Jenkinson argues, is not a status conferred by age, it is a function. It is the work of holding the community accountable to its limits, transmitting what has been learned, and tending the longer view. That function requires cultivation. And cultivation requires initiation. When menopause goes unrecognized as a rite of passage, women are denied an initiatory process that could help them become genuine elders. And all of us are impoverished by that absence.
So what does it actually look like to treat menopause as a rite of passage, in a culture that has forgotten how? Van Gennep's three phases offer a starting place for a practical map. The first phase, separation, requires a genuine pause; a turning inward, a willingness to release the previous identity before the new one has formed. This is not self-indulgence. There is growing evidence that stress exacerbates perimenopausal symptoms such as hot flashes, night sweats, mood disturbance, and sleep problems, and that reducing stress can reduce their severity. Cycle-awareness educators Alexandra Pope and Sjanie Hugo Wurlitzer elaborate a related roadmap in their 2022 book Wise Power and in their Red School menopause program, arguing that slowing down, allowing for dissolution, and tenderly tending to the nervous system are critical parts of this initiatory process.
The caterpillar does not multitask its way through metamorphosis. The liminal phase — the threshold itself — is the hardest to hold in a culture that pathologizes dissolution, rest, and any pause from incessant productivity. This is the cellular mush stage, the chrysalis, where something new but not yet known is being forged. It asks something Western productivity culture is ill-equipped to offer: the permission to not yet be the new thing. To be between. To be, for a time, formless.
The third phase, incorporation, is where community becomes essential. A rite of passage may not be complete until the community receives the person who has crossed the threshold — witnessing their emergence and acknowledging their new role or place in the community. This is perhaps the most alarming absence in our culture, and we're all implicated. For the vast majority of us, there is no ceremony. There is no supportive witnessing or acknowledgement. There is no receiving. Women emerge from the chrysalis and step back into a world that either hasn't noticed they were gone or is faintly relieved the whole messy business is over. And some women – lacking a map, a language, the permission to pause — simply keep moving. The chrysalis never forms. The true elder never arrives.
Finding myself in the absence of a cultural container, I started listening to my body to guide me. I was fortunate enough to be able to take a few days to myself and drive to the coast of Maine where I stuck my feet in as many bodies of cold water as I could find. At the year anniversary of my last bleed — that singular moment hilariously called menopause that is a mere fragment of a much longer threshold crossing — I took myself out into the snowy winter woods of Craftsbury, Vermont. I carried out an improvisational ritual for myself amidst the quiet white sanctuary of the evergreen and hibernal trees. I was alone and cold.
And I was incredibly humbled by — yes, even grateful for — this process that had become one of the most important teachers of my life. Menopause itself was my teacher and initiator. My body was my translator.
The container of a rite of passage matters. Even an improvised one. Even an imperfect one. What I've come to understand — through years of navigating this passage largely in the dark, and through the work I now do with other women crossing this threshold — is that the elements van Gennep observed are not arbitrary cultural inventions. They are something closer to a psychobiological requirement. The body knows it is in initiation. It is asking to be witnessed, held, named. When no one answers, it carries the silence as symptom.
Before I officially hit menopause, when my symptoms were peaking and my insomnia kept me awake for much of the night, I had a dream that I'll never forget. I was walking across a field on a footpath that was lined on both sides by women wearing red. I woke up with a distinct understanding that I needed to honor my threshold crossing when the time came.
Several years after having done so, this past November I had the great privilege of attending a gathering of the Grandmothers of the Americas. Along with some 500 other women, I participated in four days of teachings offered by indigenous elders, wisdom keepers from across the Americas. They asked us to wear a different color of clothing each day; the first day we gathered it was red. I stood in wonderment as they instructed us to form two lines of women wearing red, creating a pathway for the elders to walk through.
There is a generation of women crossing this threshold right now, largely alone and in the dark, who may carry exactly what a society facing polycrises needs. The question is not whether menopause is significant. The body has always known it is. The question is whether we will build the containers to honor it — and in doing so, forge the elders our moment so desperately needs.
There are many places we can start. One comes from the word itself: the pause. My body showed me, in several uncomfortable ways, how crucial it is to step back from the relentless demands of a productivity-addicted culture during this transition. It's part of why I began leading menopause rites of passage retreats. But retreating is temporary, and a privilege many cannot afford. In June 2025, Rhode Island passed the first state law requiring workplace accommodations for menopause in 2025. Virginia's legislature recently passed a similar bill, but the governor replaced it with a version that removed explicit menopause protections and instead called for a study of menopause in the workplace. Yet even the most progressive legislation treats menopause as a medical liability. What we cannot legislate we can begin to build in our communities, through the simple but radical act of gathering people together to honor this passage rather than endure it alone.
What that looks like, even imperfectly: a participant in a recent menopause rite of passage retreat I organized described coming home "feeling profoundly shifted, rich in community, and ready to step into my wisdom years." That shift didn't require a ceremony handed down through generations. It required a container, and the refusal to let this crossing go unwitnessed. That, finally, is what a rite of passage is: people holding the path open and saying, Walk through. We see you.
- Melissa Brough, PhD, RMT
