With little known about menopause, many have suffered. Is that changing?

There was a period about two years ago when I feared my mental health was deteriorating.

On several occasions - always while traveling - I experienced panic attacks usually triggered by claustrophobia that were paralyzing and debilitating. While I had experienced severe claustrophobia before in brain MRIs, for example, this sudden and dramatic reaction to merely uncomfortable situations - like being in the back of a hot plane experiencing mechanical issues, for example - was completely out of the norm for me.

My doctor prescribed me some anti-anxiety medication for emergencies, but I had no idea why there was this sudden change in my mental and psychosomatic response.

It wasn't until months later when I happened to read that heightened anxiety was just one of the many common symptoms of perimenopause that I started to put the puzzle pieces together. Until then, I had no idea that perimenopause - the stretch of time before menopause when estrogen and progesterone levels can change - could impact your mental state.

Unfortunately, my experience is not unusual. Only in recent years has there been a wider public conversation about the effects of menopause and perimenopause, the latter I had never even heard about until my late 40s. Flawed research and limited supply of available treatment have also added challenges.

One 2024 survey by the state of Michigan found 60% of women respondents had little to no knowledge of menopause and perimenopause and many had not talked about it with their health providers.

Last year, I attended an event at Langston Hughes Performing Arts Institute called "Glowing Through It," focused on raising community awareness of menopause and featuring the film "The M Factor: Shredding the Silence on Menopause." When one of the speakers, Dr. Margaret Towolawi, described her own panic attack on a plane (she thinks likely due to perimenopause), I felt a jolt of recognition and validation.

Towolawi, the founder of Nurture Well Center Direct Primary and SkinStatMD located in Shoreline, is a double board certified family physician and lifestyle medicine physician. She is also a certified menopause clinician by The Menopause Society.

She said in an interview last week that even though she went to the University of Washington, one of the country's best medical schools, she didn't remember learning much about menopause. She said that at the beginning of her training, it was explained as "your period stops" and that was the extent. Later, when she trained in family medicine, which had a big component of women's health, she said she remembers menopause as just "something that happens. She was taught there were hot flashes, and there used to be hormone therapy for treatment - but that you didn't use that anymore because of breast cancer and blood clots - and that was about it.

Only later, when she started experiencing perimenopause symptoms herself, did she begin to learn much, much, more and become an evangelist for helping people experiencing symptoms to understand what they were going through and how they could find relief.

Towolawi was not alone in her experience of not learning much about menopause. A 2019 Mayo Clinic survey found that only 7% of ob-gyns felt adequately prepared to manage women experiencing menopause.

The therapy Towolawi was told was not done anymore is called hormone replacement therapy, which was prescribed beginning in the 1960s and used by 15 million women in the U.S. by the 1990s, Yale School of Medicine reported. But in 2002, the Women's Health Initiative published a flawed study reporting that HRT increased the chances of breast cancer, stroke and heart disease, and HRT use plummeted. Despite follow-up studies that showed huge issues with the initial research, public and medical support for HRT did not come back until the past few years and in particular, in November after the FDA removed a so-called "black box" warning on HRT, which is the most serious warning on medication and highlights dangers and risks.

Towolawi said, "Lots of fear mongering led to this downstream effect of women not having options. Women saying, ‘OK, just kind of grin and bear it. Yeah, everybody goes through that, it'll pass.' "

Because of flawed research, generations of women were denied critical health care that could improve their health and quality of life. It makes me furious to think about generations of women like my mom, who not only suffered unnecessarily through menopause but are also now experiencing conditions like osteoporosis, a debilitating illness that researchers have found that HRT can help to protect against.

But as a consequence of the surge of people wanting to use HRT, now there's a shortage of estradiol, or estrogen, often administered in the form of a patch. The shortage is causing a lot of anxiety for the millions who now rely on the medicine to manage what can be debilitating symptoms.

After seeing a menopause specialist early last year, I started taking HRT as well, and while I've learned that when it comes to perimenopause things can always get worse, for now, the worst symptoms I was experiencing are gone. But I, too, received a notification at one point that the patches were out of stock.

Towolawi said she has experienced the shortages too, but has found workarounds for her patients through using smaller pharmacies and sometimes other delivery modalities, like topical gels.

So much of what women have learned about menopause historically has been through word of mouth, but things are changing, Towolawi said. Facebook groups like Mainstreaming Menopause, founded by longtime Seattle resident Danyale Thomas, for example, have helped people like me learn from others who are going through the same thing. There are now films, podcasts, YouTube channels and books that help to raise awareness about a transition that half of the planet will experience if they are lucky to live long enough.

Towolawi said this is an opportunity to reframe how we approach menopause, from this scary thing to getting educated. "This is biology. This is a metabolic shift in our body, she said. "The bone changes, the mood changes, the hair changes, the gut changes … So we can make those healthier habits, and that can set us up to succeed."

Copyright 2026 Tribune Content Agency. All Rights Reserved.