Tamsen Fadal: You Are Not Going Crazy… Your Hormones Are Changing! (THIS is the GUIDE to Navigate Menopause & Take Back Control of Your Mind, Body & Life)

When Silence Becomes Harm: Rethinking Menopause as a Midlife Chapter

Menopause has for decades occupied a silenced corner of medical discourse and popular conversation. In a wide-ranging conversation with a leading journalist and author who has made this topic her cause, the contours of that silence fracture: menopause is not a single moment but an extended, often bewildering season of life that can last years, touch careers and marriages, and demand new kinds of care.

Unpacking a misunderstood timeline

The biological timeline of reproductive change is less abrupt than the popular imagination suggests. Before menopause — the clinical moment marked by 12 consecutive months without a period — many people live through perimenopause, a four-to-ten-year period of hormonal volatility that brings unpredictable symptoms. Those years are often when lives are busiest: careers peak, family responsibilities expand, and the emotional labor of supporting others increases. Treating that stretch as a minor footnote underestimates its scope: for some, it is a third or even half of adult life.

More than hot flashes: the symptom map

Hot flashes and irregular periods capture attention because they are visible and familiar. But the full list is longer and sometimes devastating. Brain fog, insomnia, mood swings, joint pain, weight redistribution, skin changes and a diminished libido are all common features. Brain fog, in particular, carries a different kind of terror: it looks and feels like cognitive decline, provoking fears about dementia or early-onset illness when the real cause is hormonal shifts. For women who pride themselves on professional competence, these invisible changes can be especially isolating.

When biology intersects with work and relationships

Midlife women are often at the height of their careers, yet the timing of perimenopause collides with professional expectations. Employers rarely recognize a need for accommodation, and doctors do not always offer a clear diagnosis. That double invisibility opens the door to misinterpretation: colleagues and partners may label mood changes as personality flaws, and women may internalize shame or self-doubt. The consequences are practical and relational — missed promotions, snapped conversations, and, in some cases, separations that have roots in misunderstood symptoms.

Sexuality, intimacy and the 'off switch'

A particularly painful report is the sudden loss of libido and the physical discomfort of sex. Vaginal dryness and generalized bodily sensitivity turn intimacy into an ordeal rather than a source of closeness. Partners often interpret withdrawal as rejection, fuelling resentment and confusion. When biology is framed as a moral failing or an emotional choice, relationships suffer avoidably.

Diagnosis, treatment and the shadow of fear

Medical responses are uneven. Many clinicians are undertrained on perimenopause and menopause; a large share of medical education assigns it fleeting attention. That gap leaves patients to cobble together care or to be offered palliative prescriptions like antidepressants without addressing root causes. Historical scares have also left a mark: headlines from past hormone studies discouraged many from reconsidering menopausal hormone therapy even when it can be an effective, life-restoring option for eligible patients.

Options and individualized care

Treatment is not one-size-fits-all. Hormone therapy — typically estrogen with progesterone, and sometimes testosterone or localized vaginal estrogen — can dramatically improve sleep, mood and sexual comfort for many. Lifestyle changes are a complementary and powerful set of tools: prioritized sleep, strength training to protect bone health, anti-inflammatory eating patterns, and intentional stress management all mitigate symptoms and the long-term risks associated with untreated hormonal decline, including cardiovascular and bone disease.

Community, language and the act of naming

One of the simplest interventions is social: language changes everything. Naming perimenopause and menopause takes away the mystique that has kept people silent and ashamed. Community — groups of peers who share symptoms, advice and strategies — provides practical relief and emotional validation in ways that isolated conversations cannot. Men and partners are part of this ecosystem too; informed allies can soften the relational toll and help women translate symptoms into care strategies instead of blame.

What younger women can do now

Preparing for perimenopause is less about trying to stop the biological change and more about building reserves. Strength training to protect bone density, consistent sleep routines, nourishment that reduces chronic inflammation, and a baseline understanding of heart and brain health are prudential investments. Even a bone density check in midlife establishes a reference point that can change clinical decisions later.

A broader cultural reckoning

Menopause exposes broader structural biases: ageism and sexism combine to deprioritize midlife women in medical research and public policy. The result is a feedback loop — fewer studies, less training, and continued misunderstanding. The remedy is cultural and institutional: normalize the vocabulary, expand clinical training across specialties, and recognize perimenopause as a public health moment rather than a private failing.

Final thought: Treating menopause as an endpoint keeps millions in the dark; naming it as a chapter, with its specific needs and remedies, opens the possibility of an informed, dignified midlife that can feel, for many, better than what came before.