10 years of Menopause: From Taboo to Transformation

October is the month to celebrate menopause. Ten years ago, Dr. Dominique Fradin-Read was among the pioneering physicians working to demystify menopause and challenge the taboos surrounding it.

With the support of public figures such as Gwyneth Paltrow, and through an interview on Goop, menopause began to be discussed more openly. It was increasingly viewed not as an end, but as a new chapter in a woman’s life—one offering new opportunities to embrace health, vitality, and life, rather than the limitations and stigma traditionally associated with menopause.

In this month’s blog, Dr. Dominique Fradin-Read looks back at what has happened since the cultural conversation around menopause began nearly a decade ago. She explores the major advances in science, drug development, and medical care that have transformed our understanding of menopause—and how these changes are creating new opportunities for women to approach this stage of life with greater knowledge, confidence, and choice.

We could frame the last decade as a three-stage evolution:

2015–2018: Break the taboo → “Menopause should be talked about.”
2018–2023: Empower women → “Menopause is a new chapter, not an ending.”
2023–2026: Transform the medical approach  → “We now have more science, more treatment options, and a more personalized approach.”

What happened since then?

1. Menopause became mainstream.
The conversation moved into mainstream media, workplaces, medical conferences, and women's health. Women increasingly began asking not only “How do I survive menopause?” but “How can I remain healthy and thrive during this stage?”

2. Hormone therapy is being reconsidered.
The interpretation of the old Women's Health Initiative data form 2001 has become much more nuanced. Researchers and regulators now emphasize that the benefit–risk balance depends on age, timing, dose, formulation, route of administration, and individual risk factors. In 2025, the FDA held an expert panel specifically to reassess these issues. 

3. 2023 brought a major new type of treatment.
The FDA approved fezolinetant (Veozah), the first neurokinin-based nonhormonal treatment specifically approved for menopausal hot flashes. It treats hot flashes without estrogen by acting on the brain's temperature-regulation pathway. 

By 2025, another similar drug, elinzanetant (Lynkuet) has received FDA approval, giving women another option for vasomotor symptoms. 

4. 2025–2026 has brought an important change in the HRT conversation.
In November 2025, the FDA announced steps to remove broad boxed warnings from menopausal hormone therapy labeling, arguing that the older warnings did not adequately reflect differences in individual risk and timing of treatment. The FDA continued emphasizing individualized benefit–risk assessment. 

5. Menopause is now viewed as more than hot flashes.
The medical community increasingly recognizes the importance of sleep, , cognition, mood, sexual health, vaginal and urinary symptoms, bone health, cardiovascular health, and quality of life. The FDA's current patient guidance, for example, recognizes approved therapies for hot flashes, night sweats, vaginal symptoms, painful sex, and bone loss. 

Menopause: A Brain Transition 

We now understand that menopause is not simply an ovarian or hormonal transition—it is also a brain transition. Estrogen plays an important role in brain function, influencing memory, mood, sleep, temperature regulation, and cognitive health. The decline in estrogen during menopause can therefore have significant neurological effects, opening a new area of research and personalized care. This has become an important part of the new menopause conversation.

Estrogen receptors are widely present in the brain, including areas involved in memory, mood, sleep, and temperature regulation. 

During perimenopause and menopause, the drop and fluctuation of estrogen can affect brain function, contributing to brain fog, sleep disruption, mood changes, and difficulty concentrating. 

Research is increasingly examining whether earlier estrogen exposure during the menopausal transition (perimenopause) may have neurological and cardiovascular implications. 

Estrogen also interacts with neurotransmitters, blood vessels, and brain energy metabolism, which may help explain some of the cognitive and emotional changes women experience during menopause.

“Doctor, I can’t sleep, and I’m so anxious and moody. I don’t feel like myself anymore”

Sleep disturbances and mood changes are among the most underestimated effects of menopause. Fluctuating hormones, declining estrogen and progesterone can disrupt the brain’s sleep and mood-regulating systems. Insomnia can then amplify irritability, anxiety, low mood, and cognitive difficulties—creating a cycle in which poor sleep and emotional well-being reinforce each other. Recognizing and treating sleep problems is therefore an important part of comprehensive menopause care.

Menopause and Sex Drive

A decrease in sexual desire (libido) is common during perimenopause and menopause, but it is not something women simply have to accept. The changes can be multifactorial: declining estrogen and androgens, sleep problems, mood changes, stress, and vaginal dryness or pain can all affect sexual desire and sexual satisfaction.

Changes in sexual desire are an important—and often overlooked—part of menopause. Today, sexual health is increasingly recognized as an essential part of menopause care, with treatments tailored to the individual woman rather than accepting loss of desire or discomfort as inevitable.

Menopause and Bone Health

Menopause affects how we sleep, how we feel, how we function—and of course how we age. The bones are no exception.

Bone health is one of the most important long-term considerations of menopause. Estrogen helps maintain bone remodeling and strength, so the decline in estrogen during menopause can accelerate bone loss, particularly during the years around the final menstrual period.

Today, we are increasingly focused not only on treating symptoms, but also on protecting long-term health—including maintaining strong bones, preserving mobility, and reducing the risk of osteoporosis and fractures.

Menopause: Weight Gain & Metabolic Changes

It’s a question Dr. Fradin-Read hears from women again and again: “Doctor, I’m doing everything the same, but I’m gaining weight. What happened?”

Weight gain during menopause is not simply a matter of eating too much or exercising too little. The menopausal transition is associated with changes in hormones, body composition, muscle mass, fat distribution, and metabolic health.

Menopause can change the way a woman’s body stores and uses energy. As estrogen declines, there is often a shift toward more abdominal and visceral fat, while muscle mass may gradually decrease. These changes can influence insulin sensitivity, cholesterol, and overall metabolism.

The important message is that menopausal weight gain is not simply a failure of willpower. Understanding the biological changes allows us to take a more personalized approach—focusing not only on the number on the scale, but also on preserving muscle, reducing visceral fat, and protecting long-term metabolic and cardiovascular health. 

The Aesthetic Corner: Skin and Menopause

Menopause doesn’t only change how we feel—it can also change how we look and experience our skin. For many women, the changes become visible in the mirror as well.

 As estrogen declines, the skin may become thinner, drier, less elastic, and more prone to changes in texture and firmness. Collagen production also decreases, contributing to loss of elasticity and the appearance of wrinkles.

But the aesthetic conversation around menopause is evolving too. It is no longer simply about “looking younger.” It is about understanding the biology of aging skin and helping women maintain skin health, quality, strength, and confidence through this new stage of life.

Menopause changes the skin—but it doesn't mean we have to stop caring for it.

A Bit of Science: What if your ovaries had a “second life” after menopause?”

For decades, we have thought of the ovary as an organ whose job essentially ends with menopause. But new research is challenging this concept.

Scientists are discovering that the postmenopausal ovary may remain biologically active, with important interactions between ovarian tissue and the immune system. Aging ovaries appear to undergo significant molecular remodeling and may participate in inflammatory and immune signaling.

Could the ovary have a role beyond reproduction? Could it continue to influence how women age and how their immune system functions?

We don't have all the answers yet—but this emerging science is changing the way we think about the ovary. Menopause may not be the end of the ovarian story. It may be the beginning of a very different one.

The Future of Menopause: Peptides?

Could peptides become part of the next chapter in menopause care?

As our understanding of menopause evolves, researchers are looking beyond estrogen and traditional hormone therapy. Peptides—small chains of amino acids that can act as biological messengers—are attracting growing interest for their potential effects on metabolism, muscle, bone, inflammation, tissue repair, and skin health.

The science is rapidly evolving, and several peptides are showing promising potential in areas particularly relevant to women after menopause. GLP-1–based therapies are emerging as an important tool for metabolic health and weight management, while GHK peptides are being investigated for their potential role in supporting skin quality and addressing age-related changes. As research continues, peptides may become an increasingly interesting part of the broader conversation around metabolic health, healthy aging, and skin health after menopause.

The future may not be about finding one magic hormone or one magic peptide. It may be about understanding the complex biological changes of menopause and developing more precise ways to support women through them.