For decades, menopause and the preceding period of perimenopause have been topics shrouded in silence and ignorance, leaving millions of women to suffer through confusing symptoms alone. The author shares a personal experience: sudden panic attacks that she could not explain later turned out to be one of the common symptoms of perimenopause — the stage when hormone levels begin to change. Unfortunately, such late realizations are typical, since public conversation about this natural transition has only truly ramped up in recent years.
The lack of knowledge is widespread. A 2024 survey in Michigan found that 60% of women respondents knew almost nothing about menopause. Awareness is growing at the community level: in Seattle, events like “Shining Through It” create safe spaces for dialogue, reduce isolation, and build solidarity among women, reflecting the city’s broader culture of mutual support and openness on health issues. At one such event focused on supporting women through life transitions, the author heard Dr. Margaret Tovolavi’s story of a panic attack on an airplane, likely triggered by perimenopause, which brought a sense of recognition and validation.
Dr. Tovolavi, a board-certified menopause specialist whose work is influencing local approaches by promoting modern, holistic treatments and education, admits that even training at one of the country’s top medical schools, the University of Washington — a leading medical and research center in the Pacific Northwest — did not give her deep knowledge on the topic. This mention underscores the evidence-based approach to a subject often surrounded by stigma and demonstrates how Seattle’s academic institutions contribute to public education. Early in her career, menopause was explained to her simply as “the end of periods,” and later as something taken for granted, with only hot flashes and outdated, supposedly risky, hormone therapy mentioned. It was her personal experience of perimenopause that forced her to dive deeply into the subject.
Tovolavi’s experience is not unique. A Mayo Clinic survey in 2019 showed that only 7% of gynecologists felt adequately prepared to manage patients during menopause. This gap in medical education has had serious consequences for generations of women’s health. One major factor was hormone replacement therapy (HRT), widely used since the 1960s.
In 2002, a flawed study from the Women’s Health Initiative mistakenly reported that HRT increased the risk of breast cancer, stroke, and heart disease, leading to a sharp decline in its use. Although subsequent research exposed serious flaws in the original work, confidence in HRT has only begun to return in recent years, especially after the FDA removed its most serious risk warning in November.
As a result of the “fear-mongering,” as Tovolavi puts it, generations of women were deprived of an important treatment that could improve quality of life and protect against consequences like osteoporosis. Many were forced to simply “grit their teeth and endure.” Now that interest in HRT has returned, a new problem has emerged: a shortage of estradiol (estrogen), often used in patch form, which worries the millions who depend on the medication.
But the situation is changing. Beyond individual events, Seattle is fostering discussion of women’s health through community clinics, educational programs, women’s support groups, and nonprofit activity, creating an environment where open dialogue is encouraged. Historically, knowledge was passed down by word of mouth, but today information is spread via Facebook groups (for example, “Menopause in the Mainstream”), documentaries, podcasts, and books. This helps break the taboo around a transition half of humanity will experience if they live long enough.
Tovolavi sees an opportunity to rethink the approach: from fear of menopause to education. She reminds people that this is biology, a metabolic shift affecting bones, mood, hair, and the gut. Understanding this allows for healthier habits and getting through this stage successfully, turning it from a frightening unknown into a manageable natural process.
Based on: With little known about menopause, many have suffered. Is that changing?