The Menopause Truth Generations of Women Were Never Taught

When I was two years old, my mother went back to work and my grandmother took care of me. Grandma used to tell me that I saved her life, and for the longest time, I had absolutely no idea what she meant.

My grandmother was born around 1914, and when she started taking care of me while Mom was at work, she would have been in her mid-forties. She grew up during the Great Depression, my grandfather was in the Navy, and Grandma basically took care of the household and three kids. By the time I came along, all of her children were grown and had lives outside the house, and the time we spent together when I was a toddler became the beginning of a very close relationship that lasted throughout her life.

We communicated regularly, and I always had a special place in my heart for her—not just because she was my grandmother, but because she was my friend and had been one of my caregivers during those early years. I know she struggled with her weight and was always on some kind of diet. I remember her being upset with my grandfather a lot, and I remember that she cried a lot.

For most of my life, those were simply a few things among many that I remembered about Grandma. I never thought much about what might have been happening in her body at that stage of her life because I didn’t understand the larger hormonal story of being a woman. I knew about periods, pregnancy and menopause as separate events, but I had never really considered how dramatically our hormones change throughout our lives as women. Maybe there is a woman in your own family who makes more sense to you now too: a mother who seemed unusually emotional for a while, an aunt who barely slept, a grandmother who was forever dieting, or someone whose patience seemed to disappear for reasons nobody understood.

I started experiencing perimenopause myself in my mid-forties, and that eventually gave me another reason to look back at my grandmother differently. I am not trying to diagnose her decades after her death or blame every emotion she experienced on hormones. Life is complicated, relationships are complicated, weight can be hard to shed, and sadness is sometimes just sadness. But knowing what I know now about the female hormonal experience, I cannot help wondering how hormonal change may have been occurring right alongside everything else she was experiencing.

Which leads me to a much bigger question: Why didn’t I know more about menopause except that it was eventually going to happen? I knew periods started, babies could happen, periods eventually stopped, and apparently somewhere in there I was supposed to figure out the rest. I suspect a lot of women were handed roughly the same educational outline. Apparently the curriculum was: periods, pregnancy, menopause. Here’s a diagram. Good luck out there.

Health Class Gave Us the Milestones

Think about what most of us learned about being female. At some point, usually in a painfully awkward health class, we learned that puberty was coming, our breasts would develop, hair would appear in new places, and we would start menstruating, which meant we could grow a baby. There were embarrassing diagrams, uncomfortable giggling, and at least one teacher desperately trying to get through the reproductive system before the bell rang.

Then came the basic life trajectory: we would have periods for years, maybe someday have a baby, and eventually get older and stop having periods. Those were the milestones, but that health class left out a fairly significant part of the story. Nobody explained that puberty, pregnancy, postpartum and the menopausal transition are enormous hormonal events that can influence not only the reproductive system, but also the brain, mood, sleep, energy, bones, muscles, body composition and the way we experience ourselves and the people around us.

The truth is, generations of women were taught the female milestones without being taught the hormonal story happening underneath them. We learned when women bleed, and we learned that eventually we stop bleeding, but we didn’t learn nearly enough about why our entire bodies can feel different when our hormones change. In fact, I don’t remember anyone even saying the word hormones back then. Think about how much you knew about menopause at 25 or 30. Would you have connected a future change in sleep, anxiety, concentration, body composition or mood to hormones, or would menopause have simply meant hot flashes and no more periods?

Puberty: When the System Switches On

Without turning this into a biology lesson, puberty doesn’t really begin with our first period. It begins when the brain starts sending signals that tell the ovaries to increase production of reproductive hormones, including estrogen. Those hormonal changes reach far beyond menstruation because body composition changes, bones are developing, the reproductive system is maturing and the brain is developing while all of this is happening.

We all understand the hormonal teenage girl. Then she becomes an adult, and suddenly every change in mood is treated like a personality problem instead of something the body experiences naturally as part of female biology. Hormones did not stop mattering when puberty ended; we simply moved into the next hormonal chapter without anyone explaining that part very well either.

The Hormonal Years We Barely Talk About

For decades after puberty, estrogen and progesterone rise and fall throughout the menstrual cycle while the brain and ovaries continue communicating with each other. Ovulation occurs, progesterone rises afterward, hormone levels fall if pregnancy does not occur, menstruation begins, and the cycle starts all over again. Some women barely notice those shifts, while others notice changes in appetite, energy, sleep, mood, breast tenderness, weight, headaches, concentration, cravings, digestion or physical performance depending on where they are in their cycle.

Sometimes your body sent the memo before your calendar did. Maybe you suddenly wanted every carbohydrate in the kitchen, your breasts hurt, you were exhausted for no obvious reason, or something that normally wouldn’t bother you suddenly made you cry. We learned to recognize some of those patterns in ourselves, but many of us never really learned what was driving them. Describing the female hormonal experience as “she gets a period and bleeds every month” is a little like describing an orchestra by saying someone occasionally bangs a drum.

Pregnancy: An Entirely Different Hormonal World

Pregnancy, for women who experience it, creates another massive hormonal transition. Estrogen and progesterone rise dramatically while other hormones change to sustain the pregnancy, support fetal development, prepare the body for birth and eventually support breastfeeding, and then another profound shift begins after delivery. If you have experienced pregnancy, you may remember how dramatically different your body, appetite, sleep, emotions or even your sense of yourself felt, followed by another round of hormonal changes after the baby arrived.

Pregnancy is not part of every woman’s story, and it was not part of mine, but it is another powerful example of something I wish we were taught much earlier. Reproductive hormones are not operating in some isolated female zip code; their effects reach throughout the body. Whether pregnancy is part of your story or not, another major hormonal transition eventually arrives if you live long enough to reach it, and most of us received considerably less preparation for that one.

Perimenopause: The Part Somebody Really Should Have Explained

For many women, perimenopause begins sometime in their forties, although it can begin earlier or later. Ovulation becomes less predictable, and estrogen and progesterone can fluctuate significantly before eventually settling into a different hormonal pattern after menopause. One of the challenges is that hormones that followed a relatively familiar rhythm for decades may suddenly become far less predictable.

Women may experience disrupted sleep, anxiety, depression, irritability, changes in concentration, forgetfulness, brain fog, joint and muscle discomfort, sexual changes, body composition changes, weight gain and other symptoms during the menopausal transition. That means the woman standing in the kitchen wondering why she walked in there may not suddenly be losing her mind, and the woman who has always handled twenty things simultaneously but suddenly cannot retrieve an ordinary word may not be imagining it. If you are waking up at 3 a.m., staring at the ceiling for two hours, crying more easily and then wanting to throttle somebody by breakfast, there may be more going on than you suddenly becoming an unpleasant person.

This is the part that makes me think about my grandmother crying and how often I remember her being upset with my grandfather. I don’t know whether perimenopause caused either one, and I don’t need to make that claim, but I know hormonal changes could have been happening right alongside whatever else was happening in her life. As a child, I assumed that if Grandma was angry with Grandpa, Grandpa must have done something bad. Maybe he did. But maybe sometimes Grandpa was simply the nearest available human.

None of this means hormones excuse treating people poorly, and it doesn’t mean every emotion or physical change in midlife should be blamed on perimenopause. It means biology can be part of behavior, and understanding that gives us context we may not have had before. If you suddenly feel different, that deserves curiosity, but new, severe or persistent symptoms still deserve attention rather than being automatically filed under “menopause” and ignored.

Why Does One Woman Sail Through While Another Gets Flattened?

Isn’t it odd how one woman can move through perimenopause with relatively few symptoms while another feels flattened by it? Saying some women simply “handle menopause better” makes it sound like a test of toughness when the reality is much more complicated. Maybe your sister tells you menopause was no big deal while you are sleeping four hours a night and wondering who took over your body. Or your closest friend barely noticed the transition while yours affected your mood, energy, weight, relationships or how you felt in your own skin.

Genetics, physical and mental health, sleep, stress, lifestyle, relationships, life circumstances and social support can all influence the experience, and some women may simply be more sensitive to hormonal fluctuations than others. Researchers are also exploring how sensitivity to hormonal changes across different reproductive transitions may relate to later experiences. That does not mean one experience automatically predicts another, but it is another reason our hormonal history deserves to be treated as part of our health history rather than a collection of unrelated female events.

I recently wrote about my own long-term use of birth control and the questions it raised for me about hormones, the microbiome and what we understand about their effects throughout a woman’s life. Puberty, menstruation, birth control, pregnancy and menopause may look like separate chapters, but they all belong to the same larger hormonal story, and that story can affect our health and wellness in ways many of us were never taught to consider.

Then there is life itself, because perimenopause has impeccable timing. Apparently the endocrine system does not check the family calendar first. It often arrives when careers, marriages, children, aging parents, grief, changing identities and other responsibilities are already demanding plenty from us. Maybe you are caring for an aging parent while trying to keep up at work, your kids are leaving home, your marriage is changing, you are grieving someone, or you simply have more on your plate than ever before. Then your sleep changes, your patience disappears or your body suddenly stops responding the way it used to, and you are supposed to figure out which part is life and which part is hormones.

That makes me think about my mother too. My parents divorced, and after a few years of living with my mom, I ended up living with my dad around the same time my mom would have been moving into perimenopause. Because I was no longer living with her, I wasn’t there to see what she experienced day to day, and we never talked about it later either.

Looking back now, I wonder how she would have known what belonged to perimenopause and what belonged to everything happening in her life. She was going through a divorce, her children were no longer living in her home, she was becoming a sole supporter after being out of the workforce for years while raising kids, and her life was changing at roughly the same time her hormones may have been changing too. If she had been sad, anxious, irritable, sleeping poorly, forgetful or simply not feeling like herself, would anybody—including her—have considered perimenopause, or would it all have been attributed to the divorce, losing us kids and everything surrounding it? Hormones don’t politely wait until the rest of life settles down before they start changing.

We also have a tendency to turn women’s physical experiences into character judgments: she’s moody, difficult, forgetful, overreacting or “letting herself go.” And sometimes we do it to ourselves. Your sleep falls apart, your body changes, your jeans stop cooperating, and somehow the conclusion is that you suddenly developed a discipline problem. Before deciding that you need to try harder, maybe a better question is: What changed?

Generations of Women Who Never Had the Conversation

My grandmother did not teach my mother about menopause, just as her mother apparently did not teach her, and I cannot fault Grandma for failing to pass along an understanding she may never have been given herself. Truthfully, it wasn’t only my mother’s side of the family that didn’t talk about it. Menopause was not something any of the women around me talked about.

Maybe they actually thought they were going crazy. Or maybe some of that silence came from shame. Imagine your body changing in ways you cannot explain or control while nobody around you seems to understand what you are talking about either. It would be pretty easy to decide that you were the problem—that you weren’t coping well enough, disciplined enough or strong enough. We were expected to understand the bodies we were given without ever being handed the manual, and then somehow feel bad when we couldn’t figure it out. Apparently my family’s menopause plan was to survive it quietly and tell absolutely nobody coming behind you.

But if you are lucky enough to still have your mother, grandmother, aunties, sisters or other older women in your life, now is the time to ask them what they experienced. Ask what changed, what surprised them, what they struggled with and whether they had any idea that hormones might have been part of what they were experiencing. Their answers may teach you something about them, but they may also help you understand something about yourself that nobody thought to pass along.

Writing this makes me realize I need to take my own advice. My mother is still here, and even though we never had these conversations when I was younger, I can still ask her what she remembers now. The conversation may not have happened when it would have helped me most, but that doesn’t mean it is too late to have it.

This Is What I Want to Pass On

If you are younger and menopause still feels like something that belongs to some distant future version of you, this is exactly when I wish someone had explained the hormonal story to me. Puberty was not simply the day your period started. Your reproductive hormones communicate with far more than your uterus, and if pregnancy becomes part of your story, that is another extraordinary hormonal transition throughout your body and brain. If you are approaching your forties—or already there—knowing that perimenopause may affect far more than the timing of your periods gives you something many of us never had: context for what you may be feeling in your own body.

Most of all, if something changes, don’t immediately turn it into a personal failing. If your sleep changes, investigate it. If your mood changes, pay attention. If your body composition changes, get curious. If anxiety suddenly feels unfamiliar or words that used to be part of your vocabulary instantly seem to disappear somewhere between your brain and your mouth, ask why instead of simply deciding that this is what getting older looks like and there is nothing you can do about it. Learn, ask questions and get help when you need it rather than assuming menopause explains everything—or assuming none of it could possibly be menopause.

Our bodies are giving us information all the time, and hormones are part of that conversation. Understanding them gives us context, but it should also make us more curious about what our bodies are communicating rather than less. That is one of the biggest lessons I learned while writing The Awakened Body: listening to the body is not simply noticing that something feels different; it is becoming curious enough to learn what that difference might mean and informed enough to know which questions are worth asking.

I wish my grandmother had been given this information, and I wish she could have passed it to my mother so my mother could have passed it to me. They couldn’t give me what they did not know, but I know more now, and I have women to tell. What we learn about our bodies shouldn’t stop with us; we can keep sharing what we learn.

Grandma used to tell me that I saved her life, and I now choose to believe she meant that taking care of me gave her something else to focus on besides herself at a time when she may have needed that badly. I was too young to understand what she was carrying physically or emotionally, and she may not have fully understood it either. All these years later, her story made me curious about what women experience during these major hormonal transitions and how much previous generations simply endured without context.

If sharing what I have learned helps another woman understand her body sooner, ask better questions or feel less surprised by what is happening, then maybe something important that failed to travel through generations of women in my family is finally being shared now. And maybe the next woman won’t have to stand in the middle of it wondering what the hell happened because someone finally thought to tell her.