For most women, menopause is inevitable. Yet it’s a journey that remains deeply personal, often hidden beneath layers of silence and cultural misunderstanding. PBS’s “The M Factor: Shredding the Silence on Menopause” dives into the realities of menopause with raw honesty. It celebrates women’s strength, pushes for open conversations, and brings light to the essential roles of hormone replacement therapy (HRT), estrogen’s impact on brain health, and the culturally unique experiences of menopause that shape women’s lives.

Menopause is often thought of as “the change,” yet for many women, it’s more like a long, steady fall off a steep cliff with no real landing in sight. The symptoms—hot flashes, night sweats, irritability, brain fog—aren’t just passing inconveniences. They reshape the rhythms of daily life, intruding on work, relationships, and personal time in ways that can feel all-consuming. “I just don’t feel like myself anymore,” says Sharon Malone, M.D., OB-GYN, in “The M Factor,” capturing what so many women report as they experience this life-altering transition.

Adding to the complexity, menopause is classified as ‘premature’ when it occurs before age 40, according to the Office of Research on Women’s Health. With an estimated 165 million women in the U.S., this would translate to around 1.65 million women experiencing premature menopause. This premature onset can occur as early as the 20s or 30s, often due to necessary surgeries like hysterectomies or as a result of cancer treatments. For these women, menopause doesn’t just signal the end of menstruation but can feel like an abrupt halt to life as they know it. Kelly Casperson, M.D., a board-certified urologist at Pacific Northwest Urology Specialists featured in “The M Factor,” questions, “Why are we being so unique with one body part when we don’t behave that way with all the other body parts?” She goes on to describe the way ovaries are often viewed as separate, disposable organs rather than integral parts of a whole-body system, adding, “Full stop, sorry you outlived your ovaries.”

Her words call attention to the way health care can compartmentalize reproductive organs, overlooking their broader impact on a woman’s physical, mental, and emotional health. For some women, losing ovarian function early means facing menopausal symptoms more intensely and for longer. With premature menopause, women often experience a heightened need for support and personalized care that goes beyond treating symptoms to address the abrupt hormonal and psychological shift that can come from losing ovarian function so early. It’s a unique challenge, yet as Casperson and others in “The M Factor” suggest, it’s a reminder of the need for comprehensive care that treats each woman as a whole, acknowledging the interconnectedness of her body, mind, and sense of self.

Hormone Replacement Therapy (HRT): A Personal Choice

Hormone replacement therapy (HRT) has been both hailed as a miracle for relieving symptoms and critiqued for its potential risks. But for many women, the decision to try HRT isn’t about seeking perfection; it’s about reclaiming their lives. Imagine waking up, drenched in sweat, multiple times a night, every night. Or losing your temper over the slightest inconvenience, even as you tell yourself it’s irrational. These are the realities that bring women to HRT—not just to smooth over symptoms but to rediscover stability and joy.

Casperson explains the benefits of HRT, saying, “For most healthy women, the benefits of hormone therapy are going to outweigh the risks.” HRT doesn’t just address physical discomfort; it has the potential to lift women’s spirits, improve sleep, and support mental clarity.

Alongside HRT, a thriving supplement market offers options to support women’s health through menopause. According to the Nutrition Business Journal, the menopause supplement market is projected to surpass $735 million by 2025. Supplements such as melatonin, often recommended to improve sleep disrupted by hormonal shifts, are commonly used. Some doctors encourage trying options like melatonin or black cohosh but emphasize caution with over-the-counter (OTC) products. Many supplements may interact with prescription medications, creating unintended side effects.

Casperson stresses the importance of informed choices, advising women to consult health care providers before starting any supplement regimen. Women are encouraged to see supplements as a piece of a larger puzzle, a potential support alongside lifestyle changes and, if needed, HRT. As Casperson notes, it’s about finding relief in whatever form works best for the individual, but with guidance to navigate the often overwhelming array of options available.

In addition to estrogen, many women benefit from testosterone therapy to improve libido, mood, and energy during menopause. However, testosterone is not approved by the FDA for women despite evidence that low doses can be effective. This lack of approval means that women who seek testosterone therapy must often use male-dosed products, which complicates finding the correct dosage. As Casperson notes, “The other problem is your insurance won’t cover it because it’s not FDA-approved [for women].” This means many women are forced to pay out of pocket for an essential treatment that could enhance their quality of life.

Mary Beth Taranow, a retired operating room nurse, shares her personal journey navigating these obstacles. “I was having a lot of hot flashes, night sweats, and mood swings,” she explains. “It was affecting my work and personal life.” Taranow’s experience highlights the frustration many women feel when they can’t access tailored hormone treatments. Forced to make do with testosterone products designed for men, women face a challenging path to relief. Taranow’s story underscores the importance of broadening FDA approval and insurance coverage for treatments that could offer women the support they need.

By personalizing the conversation around testosterone therapy, Casperson emphasizes a critical issue: the gap in available, regulated care for women. For women like Taranow, addressing these systemic barriers isn’t just about access—it’s about preserving mental clarity, physical health, and overall well-being.

Estrogen and Brain Health: Protecting “You”

The cognitive changes that accompany menopause can be as unsettling as the physical symptoms, if not more. Estrogen has long been recognized as a protector of brain health, and as it declines, many women report feeling a profound change in their mental sharpness. Lisa Mosconi, Ph.D., a neuroscientist at Weill Cornell Women’s BrainInitiative, discusses the impact of menopause on brain health. She states, “Menopause certainly changes your brain,” highlighting the significant cognitive shifts women may experience during this transition.

Mosconi further explains that declining estrogen levels can lead to symptoms such as brain fog, where thoughts feel jumbled, and words are harder to recall, creating a noticeable shift in mental sharpness. She notes, “During this transition, that horrible voice that we all carry with us has gotten very loud,” referring to the internal critical voice that can become more prominent during menopause. This change can be unsettling, sparking fears of “going crazy” or even concerns about developing dementia.

Casperson addresses a common misconception, challenging the stigma of estrogen being labeled merely a “sex hormone.” She explains, “We call them sex hormones, but really they’re life hormones; they’re brain hormones.” This labeling, she suggests, has created an unnecessary stigma around the use of HRT, as if estrogen were only relevant to reproduction. In reality, hormones like estrogen are critical for overall brain health and emotional stability. They influence neurotransmitters that regulate mood, memory, and cognitive clarity, making them essential to how women feel and function beyond their reproductive years.

When estrogen levels dip, some women find it difficult to remember names, stay focused, or even finish thoughts—a frustrating experience for anyone but especially daunting for women with busy lives. HRT may offer hope here, too. Some studies show that supplementing estrogen could help maintain cognitive clarity, particularly if started near the beginning of menopause. While research on HRT and brain health is still ongoing, for some women, the possibility of preserving mental sharpness is well worth exploring.

Yet, asMalone points out, each woman’s decision is about more than the science. It’s about finding what makes her feel present and whole. For many, the choice to use HRT to support cognitive function is deeply personal. It’s less about preventing Alzheimer’s and more about feeling connected to their thoughts, memories, and personalities—their very sense of self.

Celebrating Cultural and Racial Differences in Menopause

No two menopausal experiences are the same, and across racial and cultural lines, women approach this life stage in profoundly different ways. The Study of Women’s Health Across the Nation (SWAN) provides valuable insights into how long menopause symptoms typically last across different racial and ethnic groups. According to the study, Black women report experiencing symptoms for an average of 10 years, the longest of any group, while Hispanic women experience symptoms for about 8.9 years. In contrast, white women average about 6.5 years of symptoms, with Japanese American women reporting about 4.8 years and Chinese American women about 5.4 years.

Dr. Wen Shen, an OB-GYN at Johns Hopkins Medicine, sheds light on these variations, explaining that cultural attitudes and biological factors may both play a role. “We’re beginning to understand that menopause is not a one-size-fits-all experience. It’s influenced by a complex interplay of genetics, culture, and access to care,” Shen states. She emphasizes that understanding these differences is crucial for health care providers, as it can help tailor treatment options and support.

Despite experiencing menopausal symptoms for a relatively long duration, many Hispanic women hold a complex view of menopause. Yamnia I. Cortés, Ph.D., FNP, of the University of Iowa College of Nursing, explains that “Latinas show positive attitudes towards menopause because it’s, ‘Oh, I don’t have my monthly period anymore.’ But then in conversations, when you begin to discuss the actual experience and symptoms and when they begin to associate menopause with aging…Latinas will view menopause positively, but aging negatively.”

However, Hispanic women also face elevated health risks associated with menopause, particularly in terms of heart disease. According to the American Heart Association, 43% of Hispanic women suffer from heart disease, and nearly 41% have high blood pressure. This intersection between menopause and cardiovascular health underscores the need for culturally specific care and awareness to address these risks proactively.

Dr. Sherri-Ann Burnett-Bowie further highlights that Black women often experience the longest duration and highest frequency of menopausal symptoms, particularly vasomotor symptoms like hot flashes and night sweats. “Black women, followed by Native American women, have the longest-lasting, most frequent, and most bothersome symptoms of all the groups,” she notes. Factors such as financial instability, experiences of discrimination, and “weathering”—the cumulative toll of chronic stress—can exacerbate these symptoms, impacting overall health and well-being.

Omisade Burney-Scott, creator of the Black Girl’s Guide to Surviving Menopause, speaks to the mistrust that often exists between Black communities and the medical field. “Every Black person I know has a story of mistrust with a doctor,” she says. This mistrust is rooted in a historical legacy of unethical medical practices, such as the Tuskegee Experiment, that targeted Black individuals. Burney-Scott’s work focuses on creating safe spaces where Black women can openly share their experiences with aging and menopause, fostering support and empowerment through community.

In some cultures, menopause is seen as a passage into wisdom and respect, which can influence how symptoms are perceived and managed. For example, Japanese American women, who report the shortest duration of symptoms, may experience less psychological stress related to aging, possibly due to cultural views that value elderhood. Shen elaborates, saying, “Women in cultures where aging is associated with wisdom and respect may report less distress and fewer symptoms because they’re culturally conditioned to see this stage as positive.”

These differences are not only culturally significant; they also impact how women seek care and navigate menopause. Recognizing these varied experiences underscores the need for a health care approach that meets women where they are, honoring both their backgrounds and beliefs. By creating space for these diverse narratives, we enrich our understanding of menopause, empowering women everywhere to navigate this life stage with dignity and support.

For comprehensive information and resources on menopause, consider consulting the following organizations:

By understanding the nuances of menopause, seeking appropriate medical advice, and adopting healthy lifestyle practices, women can empower themselves to manage symptoms effectively and embrace this new phase of life with confidence and vitality.