Menopause is still most often described as a medical event, a phase to be managed in terms of symptoms. Yet when we look carefully at the data, at the history of medicine, and at the way this transition has been named, silenced, trivialised or reduced to clichés, it becomes clear that menopause is first and foremost a cultural and social phenomenon. And it is precisely this cultural dimension that determines, in very concrete ways, how much health women lose or gain during this stage of life.

By 2030, more than 1.2 billion women worldwide will be in the menopausal transition or post menopause, according to estimates cited in scientific literature and reported by the World Health Organization. This figure alone makes it impossible to treat menopause as a niche topic. It affects half of the population and accompanies women for a long portion of their adult lives, often for several decades. And yet, the reality remains striking. A large proportion of women do not receive structured support, and many do not undertake any real pathway for managing symptoms or preventing long-term risks. Not because suffering is inevitable, but because the culture we live in has built a vacuum of information and a persistent silence around menopause.

This silence was also at the centre of a panel held in Milan on January 28th at the Centro Culturale Cadore 33, organised by the association Menopauseboost, with the participation of philosopher Gloria Origgi, author of the book La donna è mobile. During the event, one idea emerged with particular clarity.

Menopause does not lack noise, it lacks real conversation. It lacks shared language, it lacks dialogue between women, between generations, and often between patients and healthcare professionals. It is a cultural blackout that makes it difficult even to recognise what is happening in one’s own body.

Menopause is not a single point on a line. It is not simply the last menstrual cycle followed by stability. Clinically, menopause is defined retrospectively after twelve months without menstruation, but the lived experience is much more complex. Origgi uses an older and more precise scientific term, climacteric, to describe a transition that can last years, during which hormonal levels, metabolism, sleep, thermoregulation, mood, memory, attention, muscle tone, sexuality and many other aspects change. It is the most accurate description of what many women experience, an extended passage rather than a punctual event.

This transition is associated with dozens of symptoms, often reduced to the stereotype of hot flushes, while medical literature and scientific societies describe a much broader spectrum. Vasomotor symptoms, insomnia, irritability, anxiety, low mood, brain fog, palpitations, joint pain, changes in weight and metabolism, genitourinary symptoms, reduced libido, and increased vulnerability to conditions that impact quality of life are all part of this picture. The cultural issue is that many of these signals are normalised, fragmented or attributed to something else, stress, age, personality, work, a difficult period. As a result, women are left without a coherent interpretative framework and without an integrated care pathway.

This leads to a second critical point, which concerns the healthcare system itself. Menopause remains an area with a significant educational gap. Surveys and recent studies show that formal training in menopause is still limited in many medical specialisation programmes, including obstetrics and gynaecology. In other words, many women do the right thing and seek help, but encounter professionals who do not always have updated tools or a holistic view of this phase. And when a complex transition is interpreted through incomplete lenses, two equally problematic outcomes arise, minimisation or fragmented medicalisation, where isolated symptoms are treated without addressing the underlying physiological process.

During the Milan event, Origgi shared a simple but powerful example. Vestibular disorders and vertigo during perimenopause were interpreted as alarming neurological conditions or as trivial issues, without anyone connecting them to hormonal transition. This type of story is not anecdotal. It reveals a structural problem. When a phenomenon is culturally invisible, clinical recognition becomes more difficult.

The consequences of this underestimation extend far beyond daily discomfort. The deeper issue is that menopause represents a critical window for long term health. The decline in oestrogen is associated with increased vulnerability to chronic diseases. Osteoporosis is the most well known example, with women representing the vast majority of cases in most epidemiological datasets. Cardiovascular diseases remain the leading cause of death in women, and risk increases significantly after menopause, often without adequate awareness. On the neurological side, approximately two thirds of people living with Alzheimer’s disease are women, a statistic widely reported by major health organisations and increasingly discussed in scientific research, with growing interest in the link between brain health, hormonal transition and social factors.

At this point, the question becomes unavoidable. Why has a phenomenon that affects half of the population and has such a strong impact on public health remained so marginal in scientific and social discourse?

The answer lies in deep cultural layers. For a long time, menopause has been associated with old age, as if the end of fertility automatically coincided with the end of a woman’s social value. Even influential figures in twentieth century feminist thought reproduced harsh and reductive narratives of menopausal women, portrayed as irritable, invisible, or no longer relevant. Today, this equivalence no longer holds. The average age of menopause is around fifty one. Women study, work, raise children, build careers, start new projects, and often have several decades of life ahead of them after menopause. Reducing this phase to decline is culturally short sighted and clinically dangerous, because it feeds delay, isolation and the idea that investing in health is no longer meaningful.

One of the most striking metaphors mentioned during the Milan event was that of the orca, one of the very few animals that continues to live for many years after the end of fertility. It is a powerful image. Post fertility is not necessarily decline. It can be a long, active, socially meaningful phase with its own role and value.

The cultural core, however, lies in what Origgi calls a transformative experience. Menopause is not only a biological change, it is an identity shift. Many women describe not recognising themselves, not only in their bodies but in how they think, feel, react, focus and relate to others. Part of this is physiology, but part is also the internalised social gaze. During the event, a difficult truth emerged. A significant portion of identity is shaped by how we are seen, and when that gaze changes or fades, many women experience a crisis not because of individual fragility, but because of a cultural structure that has tied female value to desirability, youth and constant performance.

This speaks strongly to the generation of women currently entering perimenopause. Many were educated with the idea that they could do everything, a powerful message that often turned into a burden. Constant performance leaves little room for vulnerability, care or asking for support. Real symptoms are hidden under other explanations, stress, work, being busy, and menopause remains unnamed and therefore unmanaged.

Yet this very transformation can open a space of freedom. During the Milan conversation, a different perspective emerged. Menopause can become a moment in which women rethink their place in the world, change direction, invest in new forms of fertility, creative, intellectual, relational, professional. It can be experienced as loss, but also as a gain in authority and focus, and as an opportunity to recalibrate priorities and health. This is not motivational rhetoric. It is a cultural invitation to move from a narrative of decline to a narrative of transformation, one that is more accurate and more useful.

If menopause is a cultural issue, then the solution cannot be only clinical. It requires evidence based information, widespread education for healthcare professionals, sustained research, less caricatured public representation, and above all spaces where women can speak to each other without shame, simplification or isolation. It also requires shifting the social question, not “how can I avoid looking menopausal”, but “how can I go through this phase with knowledge, care and power”.

As Michela Taccola, founder of Menopauseboost, said during the January 28th event in Milan, “menopause has finally emerged from silence and from a reductive narrative. Now the challenge is in our hands, to transform noise into dialogue, and dialogue into conscious choices for our health and for the future life of women in transformation”.

For those who wish to explore the cultural dimension beyond the medical one, La donna è mobile by Gloria Origgi is a highly recommended read. The book weaves together philosophy, history of science and social reflection, helping us understand why talking about menopause today is not only about hormones, but about how society constructs, or denies, the value of women across the different stages of their lives.

Sources:

World Health Organization
https://www.who.int/news-room/fact-sheets/detail/menopause

United Nations, World Population Prospects
https://population.un.org/wpp

International Menopause Society, Global Consensus Statements
https://www.imsociety.org

North American Menopause Society, Position Statements
https://www.menopause.org

Avis NE et al., Menopause, 2015
https://journals.lww.com/menopausejournal

British Menopause Society, Education and Training Reports
https://thebms.org.uk

Mosconi L, The Menopause Brain, 2021
https://www.hachettebookgroup.com

International Osteoporosis Foundation
https://www.osteoporosis.foundation

European Society of Cardiology, Women and Cardiovascular Disease
https://www.escardio.org

National Institutes of Health, Revitalization Act 1993
https://orwh.od.nih.gov

World Economic Forum, Women’s Health Gap
https://www.weforum.org

Harvard Business Review, Menopause and the Workplace
https://hbr.org

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