Demystifying Menopause

We talk with Jill Angelo, CEO of genneve, an online clinic for women in menopause.

Why and how is menopause stigmatized today?

That’s a great question. The “why” goes way back in history, when menopause was associated first with anxiety, hot flashes and these other outward visualizations of what hormonal changes do in a woman. Way back in history, there was no way to explain it. And so when you look at the historical analysis of menopause, women were just kind of cast aside because their behavior changed or unexplainable things were happening to them at a certain age. And if you speed it up to modern times, menopause is stigmatized because it’s also attached to aging and a woman’s next chapter of not being in the reproductive years of her life. In cultures or societies where value is placed on women in their ability to be reproductive or to be beautiful and young, menopause has a stigma associated with it because it doesn’t represent those things. And we haven’t yet transitioned to the notion of menopause being a really freeing moment in a woman’s life or being the kick-off to the second half of life. I think we’re in an interesting moment of change in society, but unfortunately we have a lot of history that we have to erase or at least start to morph over time.

When did the research surrounding menopause take on a more modern and positive approach?

We’re still yet to come into the positivity part, but if you were to look at when people started to truly take a serious view at medical care for this part of life, it would have been in the 1930s. They still defined menopause as a deficiency disease, but the first estrogen replacement therapy options became available. So in the 1930s and 40s, which isn’t that long ago, we began to have some of the first prescription treatments for menopause and then in the early 1990s the Women’s Health Initiative proved that those prescription therapies were associated with cancer, so it really set us back for a long time, even though those reports and findings have been challenged because they tested it in women 65+ versus women who are actually going through menopause in their 40s and 50s. So I think that notion of positivity, not only as it being something that is freeing for women but even how we’re medically supporting it, we still have so much work to do. I have to say 2019 was an interesting year around starting to change the perception around menopause, and it often starts with celebrities or people who are in the public eye redefining the notion of what it means to be a woman in midlife. Until you start to see examples of women thriving and being at the top of their game at this stage of life — it takes those kinds of symbols for a societal change to adjust around something that has been a negative for so long, and we’re just starting to see some of that. 

In my research leading up to this interview I read that only 7% of women are getting the help they need to manage menopause symptoms and surveys have found that 48% of general practitioners have no training in menopause management. So the sheer number of women who have or are going to experience menopause compared to the resources is completely absurd.  

Right, we have a lack of care in the medical field. There is little to no education — the only practitioner who receives education around menopause are OBGYNs. And in the U.S. the average age of an OBGYN is 55 years old — we’re retiring them faster than we’re graduating new ones — so there is this shortage of care. Many women have doctors who just don’t understand it or have limited knowledge and experience working with menopausal symptoms and correlating what’s happening in a woman’s body to the hormonal shifts in her body. So oftentimes a lot of the women that come to Gennev, their number one thing is, “Just tell me I’m not going crazy, this is normal?” and number two is, “I just want someone who gets me. Where do I find that kind of practitioner who can help me?” And so that’s really what spurred our whole mission to start Gennev and to build this online clinic for women in menopause. 

And yes to your point exactly around the size of the population. It is pretty crazy that we don’t have more care because this is half the population that goes through this. I think it goes to show that women are masterful at doing the best they can and/or suffering in silence. 

How much or little do we know about menopause? Are there still gaps in knowledge and what are some of the biggest myths in this space? 

I think for gaps in knowledge, #1: there are 34 different symptoms of menopause that so often go treated individually versus looking holistically at what’s happening in the body. Oftentimes women will be on an antidepressant or something that is not correlated back to the overall hormonal change that’s happening in her body that could be better addressed with an estrogen patch or a localized version of estrogen. So understanding the correlation and the range of symptoms that hormonal changes can address is point number one that’s not being met today. 

#2: A big myth and/or fear exists around estrogen therapy or hormone replacement therapy (HRT). I mentioned earlier, back in the early 90s there was the Women’s Health Initiative, which was a big study that really cast a lot of fear and doubt on using HRT because of its potential correlation to cancer, but if you’re using it later in life, that correlation is much higher than if you’re using it in the early stages of onset menopause. 

#3: And the third one is really just this notion of normalizing it. Again, the majority of women that come to Gennev think that they’re going crazy or that something is seriously wrong with them when in fact, this is a very much normal part of life. We’ve just got to normalize it and help people realize that this is very normal. It’s very natural, it’s organic and it’s something that women can actually thrive through versus suffering so much by themselves. Those three core things are probably key myths or issues in trying to improve this whole part of woman’s life. 

I was reading an article about some of the misunderstandings or misconceptions about menopause and it states that, technically, menopause is just one day?

Yes, it is. Perimenopause is this timeframe leading up to that day where a woman has no longer had a menstrual cycle for 12 consecutive months. And so that perimenopausal time of life is probably some of the most disturbing in terms of symptoms because that’s where women are experiencing the most change in terms of changing menstrual cycles, sometimes it’s unpredictable, sometimes flow is very heavy, sometimes it’s very painful. We also see changing anxiety patterns, changes in sleep, hot flashes or night sweats. She can have immense periods of pain that can even lead to heart palpitations and so some women are concerned that they might be having a heart attack. 

Women during perimenopause go through such major changes, and we don’t prepare women for it. Those symptoms are oftentimes not only big changes but they’re surprises for women, and that period of perimenopause can be anywhere from 2 to 10 years. When a woman hits that one-year anniversary of no periods for 12 consecutive months, she’s hit menopause and now from there on out she’s in post menopause. Post menopause, essentially, is the whole second half of life in some ways. There are symptoms that can continue in that period of life, but will certainly decline over time. 

What we’re trying to do at Gennev is really help women understand where they’re at in this journey, and then how best do they take care of themselves and/or put preventive measures in place so that the post-menopausal phase of life is good and healthy. 

And how early can perimenopause begin?

You could start seeing that in your early 40s and continue through those types of changes into your early to mid 50s. Some women will go even 6 to 8 months consecutively with no menstrual cycle and then, boom, it comes back again. That’s very common, and that’s what makes that perimenopause timeframe frustrating for women because there’s just little to no certainty and what’s even more, there’s no one-size-fits-all for perimenopause or for women in menopause. Every woman is individual. 

How would you articulate the pros of menopause?

Obviously there’s freedom from having your menstrual cycle. Women who are on the other side of it talk about that frequently. We’ve also seen this notion of increased creativity and confidence — women doing new things on the other side of menopause. In the U.S., the highest rate of women starting their own businesses are women 50 plus. Women come to this point in life where they’ve got the social capital, they’ve got maybe the financial capital, they’ve got the confidence and they’ve got the freedom to actually go do the thing that they want to do.

If you were to say what’s one word that represents women in the second half of life or beyond this menopausal period of life, it’s freedom, in so many different ways. You’re seeing it in women really at the top of their game. I think that’s where the positivity comes. The more that we can help empower women to take control of their health and the changes they’re going through during menopause, the more that it sets them up for that positive change down the road. 

I’d love to dive into your story and what events or experiences have led you to where you are today.

So my background has been in technology. I’ve had 20 years in the tech industry working at big tech companies. I started at a software company that we took public, Microsoft acquired us and then I worked at Microsoft for 15 years. I love how technology improves people’s lives. So I’ve seen real-world applications of that whether that be in developed markets or developing markets. I’ve worked around the world in that capacity, but my personal interests were always in women and girls development. Philanthropically, that’s where I’ve spent my time. So when I started Gennev in 2016 it really brought my passion around women’s welfare and women’s development together with my background in business and technology. 

I see a real opportunity to change the way women experience menopause. What really drove me to menopause is that number one, no one was doing anything about it, so that kind of got under my skin like, “Wow, this is something that has been around since life began and yet no one’s really addressed it in terms of helping women thrive through it?” And number two, I was seeing women starting to hit their stride or get to the top of their game — whether it’s career wise or being more independent from their family or just coming into their own — and their confidence was being impacted because of the impacts of menopause. So that’s what really drove me to start Gennev because I was like, there’s a better way to figure this out and I bet we can leverage some notion of technology to try to bring more support to millions of women around the world. 

What’s your definition of intimacy?

My definition of intimacy can be anything from holding hands, having an intimate conversation to giving a back rub or having sex. My definition of intimacy has really broadened over time now that I’m doing what I’m doing simply because you need different forms of intimacy, whether it’s more emotional or more physical, as you get older and as the body changes. It really can refer to a lot of different acts and/or experiences.

Outside of the topic of menopause and more just from your personal experiences, I’m wondering what lessons you’ve learned that have helped you better understand yourself or others in the context of relationships.

The most important thing is communication. It’s being able to talk with your partner—and feeling comfortable doing it—about what you need, what you want, what feels good, as well as being able to ask them what they’re thinking and what their needs are.

In my younger relationships, I think I always felt like I was supposed to do something or be something specific. There’s a freedom that comes with age and experience. You learn a lot through “the failed relationships,” both physically and emotionally. Now, I have the wonderful opportunity to apply those lessons to my marriage.

In addition to the open and comfortable conversations, more than anything else, I think we also just care for and respect each other so deeply. I care just as much about his needs as I do my own, and that’s something that has not only evolved over time with age and experience but also with finding the right kind of person and partner. I think that my ability to feel satisfied or to feel loved has come through finding that person—and it took quite some time for me. And that’s okay.

I think people tend to force things. We think that we have to get it right—immediately. 

I needed time to evolve, not only as a woman but in my relationships. So, I guess the biggest lesson is to take the pressure off yourself and let things unfold. Let time run its course. Whether it’s sexual fulfillment or emotional fulfillment, it requires time. It doesn’t just happen because you are a certain way and you can’t manufacture it. It needs to evolve over time. 

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