Last year, Donna Klassen took to Twitter with the hope of finding other women talking about menopause.
In 2019, Klassen — a 54-year-old therapist specializing in reproductive mental health based in New York — had entered surgically induced menopause after having her ovaries removed, she said. She had been diagnosed with breast cancer, and a pre-mastectomy screening showed cysts on her ovaries, leading to the oophorectomy, she said. (The cancer is now in remission, she said.)
Following the surgery, “I did not feel like myself,” Klassen said. “I was somebody with no prior history of mental health issues, and I was tearful all the time. I couldn’t focus, I couldn’t remember things.”
She also had hot flashes and heart palpitations, she said. But, according to Klassen, her doctors hadn’t provided her with any information on surgical menopause to help her understand what she was going through.
On Twitter, she found a slate of menopause-focused organizations in the United Kingdom. One campaign, Pausitivity — run by journalist Elizabeth Carr-Ellis and nutritionist Clare Shepherd — created a poster outlining common and lesser-known symptoms of menopause using the hashtag #KnowYourMenopause. The poster is now displayed at more than 400 doctor’s offices in Wales and on more than 9,000 digital screens in doctor’s offices throughout the U.K., according to Shepherd.
The success of that campaign inspired Klassen to start Let’s Talk Menopause, a nonprofit organization dedicated to destigmatizing menopause, with two friends, Christine Maginnis and Samara Daly. Their first initiative — a poster campaign offering information on menopause — debuted last week in nearly 200 New York City subway stations. It’s the first campaign of its kind in the United States, according to Klassen.
Written in both English and Spanish, the posters — which will remain up through mid-November — offer a simple yet significant message for people going through menopause: “It’s not just in your head,” they read. “6,000 women reach menopause every day.”
Below the message is a QR code that links to a list of symptoms of menopause on the Let’s Talk Menopause site.
Menopause is defined as the end of a 12-month phase when a menstruating person has not had their period, but is typically used to refer to the broader transition that includes the three phases of perimenopause, menopause and post-menopause that together mark the end of a person’s reproductive years. Menopause often occurs between the ages of 45 and 55, according to the Centers for Disease Control and Prevention.
While some symptoms, like hot flashes and weight gain, tend to be familiar to people going through menopause, others — like low libido, painful sex and urinary tract infections — may come as more of a surprise, Klassen said: “Menopause is more than hot flashes, and that’s really what we want to get out there to people — that there are a whole host of symptoms, and that everyone’s symptoms are different.”
And they’re not just physical — they’re mental, too: A study from 2000 found that 38 percent of women in late perimenopause — the four-to-10-year period before menopause, when symptoms typically begin appearing — reported symptoms of depression such as irritability, mood swings and fatigue, and other studies have shown that women who have never experienced depression are two to four times more likely to experience a depressive episode during the menopausal transition.
Research shows that the onset and duration of symptoms also differ in part based on race, with studies showing Black, Latina and Native American women experience earlier onset and more intense symptoms than White women — disparities that doctors attribute to a combination of lifestyle and socioeconomic differences and systemic racism.
For Sarah Wayland-Smith, a 51-year-old artist and designer in Manhattan, the posters are a welcome way “to destigmatize menopause and to alert women to what their bodies are, or will be, going through as they enter this stage,” she said.
Wayland-Smith first started having hot flashes, brain fog and irritability a few years ago, she said, before her friends did. But once they caught up to her, they found something they had in common: “One thing we all said was that we didn’t see it coming — no one knew how hard it was going to be, even those with mothers who talked about it.”
Vanessa Dublin, a home health aide based in Brooklyn, can relate: “I just turned 50 — I want to know what [menopause] is all about,” she said. While she’s felt hot flashes, she said, she doesn’t know where she is in the menopausal transition: “I don’t know if I’m experiencing it.”
That sense of confusion is common, according to Klassen — due to the fact that doctors themselves tend to be under-informed about menopause, which creates an information gap with patients. A 2018 AARP survey of more than 400 women between the ages of 50 and 59 found that 42 percent never discussed menopause with a health-care provider, and that only 1 in 5 women received a referral to a menopause specialist.
And a 2019 Mayo Clinic study of 183 medical residents found that while about 94 percent believed it was important or very important to be trained to manage menopause, only about 7 percent reported feeling adequately prepared to do so. That’s because “menopause is not on the curriculum in most medical schools, so doctors don’t learn about menopause as a phase of life,” Klassen said.
The fact that “we still don’t have conversations about a pivotal time of a woman’s life” is “crazy, and it’s unfortunate for women who are just not getting the information and the treatment that they need and deserve,” she added.
“We need to clear up the confusion — this is a stage of life that’s natural, and it can be difficult for people, and you can get through it, and you can come out the other side feeling better,” Klassen said.
In their work to destigmatize menopause, Klassen and her co-founders are looking to the U.K., where Pausitivity and other organizations — including Rock My Menopause and the Menopause Charity, which ran a poster campaign raising awareness about menopause in malls across the U.K. throughout August and September — are creating change. On Friday, the U.K. government committed to reducing the cost of hormone replacement therapy prescriptions, which can alleviate symptoms of menopause, by making repeat prescriptions free of charge — so a person pays for only the first treatment in a cycle — and said it would create a cross-government Menopause Taskforce that will consider how menopause support and services can be improved in education, physician training and workplace support, according to Jo Lloyd, senior parliamentary assistant for Member of Parliament Carolyn Harris, who authored a bill calling for similar measures. (The bill has since been withdrawn because of the government’s own commitments, Lloyd said.)
For Klassen, raising awareness is the first step toward achieving those kinds of culture and policy changes. Next year, Let’s Talk Menopause plans to debut a podcast and webinars that will be “focused on getting women the information they need in an accessible way so they can ask their questions to doctors and providers and have conversations around menopause that are open and honest,” she said.
Klassen and her co-founders also hope to spread their poster campaign to other parts of the United States: They’re eyeing D.C., Boston, Chicago and Los Angeles, but they also want to reach rural areas where people have less access to health care, Klassen said.
Despite those differences in access, there’s one thing that’s true across the country, she added: “Menopause care is essential health care, and that has not been part of the dialogue.”
For Klassen, arming herself with information about menopause, and getting through it with a support system, means that “I don’t have any fear anymore,” she said.
“I feel empowered and feel like I can do anything now. People need to know they can come out of [menopause] even better.”