We Can Do Better by Women Experiencing Menopause

Until recently, the only thing as stigmatized as going through a menstrual cycle was losing the ability to have one. When it was acknowledged in popular culture, menopause was often the butt of a bad joke—like in this 2009 Jack in the Box commercial, which told menopausal women to drink smoothies during hot flashes so they don’t “go all street-rat crazy.”

A decade and a half later, the trope ascribed to women about being “hormonal” has not gone away. But we are in a different place when it comes to taking women’s needs seriously. Earlier this year the cover of the New York Times magazine declared, “Women Have Been Misled About Menopause.” Public figures from Michelle Obama to Oprah Winfrey to Shania Twain have gone on the record about their own menopause journeys. Even the research on menopause is transforming, pivoting from a narrow analysis of hormone replacement to a broader and more nuanced look at how to support people during an important phase of life.

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With this attention has also come a commercial gold rush. More than half a billion dollars were invested into menopause startups in recent years based on what analysts project as a major opportunity to make money. Today the marketplace is buzzing with menopause inventory, promising a range of benefits to a generation of women who’ve long been gaslit into believing their problems didn’t have solutions—or really weren’t problems worth solving at all. Where their needs were once ignored, menopausal women are now being wooed with luxury cooling bed linens, hormonal balancing teas, celebrity-backed vitamins, and wellness supplements. Even one of the industry’s most trusted manufacturers of at-home pregnancy tests rushed to launch a new menopause test, stirring controversy about its clinical validity.

As the noise around menopause gets louder, the thing women would benefit from most—trustworthy, credible menopause care—risks being drowned out.

Until they experience it for themselves, many women remain unaware that going into menopause is not a flip of a switch. It is a journey that can be erratic and last for years. The symptoms are not limited to hot flashes and night sweats. And the experience can be radically different from one woman to the next: smooth for some, debilitating for others.

Read More: How Menopause Affects Cholesterol—And How to Manage It

As the Chief Medical Officer of Maven Clinic, an online platform that connects people with women- and family-focused medical providers, I oversee the care of women and families across the world. Among 7,000 women who sought care from our menopausal specialists in recent months, the variation and vastness of experience was stark: we observed dozens of distinct menopause symptoms, ranging from “brain fog,” insomnia, and weight gain to incontinence, painful sex, and heart palpitations. Of all the women surveyed, only 2% reported that they had no symptoms at all.

The data indicate that most people transitioning through menopause are likely to benefit from medical assistance to address these symptoms. But the specific degree of need has been hard to estimate. In the global medical literature, the reported prevalence of bothersome menopause symptoms varies widely from 18% to 98%, depending on who is asked. And historically, the medical establishment has done little to improve our limited understanding. Fewer than one in five gynecologists receive formal training in menopause. Menopausal women rarely get asked about their symptoms in clinical settings and the ample opportunities to help get missed.

Hormone replacement commands the lion’s share of attention, but non-hormonal treatments abound as well. For example, gabapentin, a medication most commonly used for nerve pain, in low doses has also been consistently shown to be safe and effective at resolving some of the most bothersome menopause symptoms. For one of our recent patients at Maven with severe night sweats, changing her shirt every hour or so became routine—and sleeping through the night became a distant memory. But once her provider prescribed her gabapentin (and tracked her nightly t-shirt count to make sure it was working, from five to three to two to one), she finally got long-awaited and much-needed rest.

For most of America, this type of personalized and affirming care remains uncommon. Around two thirds of women ages 40-64 say they’ve never talked about menopause with a health care provider. Just one in five have been referred to a menopause specialist. Due to outstanding gaps in knowledge of medical professionals, almost 75% of patients who experience severe symptoms—like challenges with sleep and sex, which rank highest in terms of impact to quality of life—don’t get treatment, even when they do seek out medical assistance.

Read More: Now’s The Time to Bring Up Menopause At Work

To date, the menopause gold rush hasn’t done much to fill these fundamental gaps in care—and women deserve so much more. Ideally, society progresses on this issue the way it has for people with physical disabilities, mental health issues, and pregnancy, among others. Just like them, women transitioning into menopause deserve workplace accommodations, dedicated benefits, and legal protections.

At minimum, though, they need genuine support, understanding, and care that guides them through the menopause experience honestly and doesn’t sell them false promises or magic pills. Menopause is not about making a specific consumer purchase any more than it is about going “crazy.” It’s about transitioning with dignity through a phase of life that is nearly as long and consequential as puberty. If we build a higher-functioning, inclusive health system that is as broad and nuanced as the people it serves, we can normalize menopause and ensure women get the care they deserve.

Shah is the Chief Medical Officer of Maven Clinic, one of TIME’s Most Influential Companies of 2023.

Contact us at letters@time.com.