“Millenopause” is reframing middle age

Millennials invented wellness culture. But as they approach menopause, why is the system failing them?

Last year I wrote in TIME Magazine about an impending gold rush. Marketers, it seemed, had discovered that at some point women experience menopause–and suddenly, there was an abundance of solutions, some compelling (workplace benefits), others dubious (“hormone balancing tea”). 

A year later the attention has only intensified. So has the debate on societal attitudes towards healthy aging, and what adequate menopausal care and support even looks like. 

In March, President Biden called out menopause funding in his proposal to invest $12 billion in women's health. Two months later, A-list actress Halle Berry lobbied Congress, testifying about her own harrowing menopause journey in support of a $275 million bill that would fund better research and education. Meanwhile, at Maven, we have seen 300% year-over-year growth in our menopause benefit, making it our fastest growing product in company history. 

In the United States the typical age of menopause falls somewhere between 45 and 58, though for some it happens even earlier and for others it happens later. Until recently, the menopause demographic was solidly anchored by Generation X, the independent-minded “latchkey” kids who gave us The Breakfast Club and alt rock radio. 

But in 2024, a different generation, the one who envisioned Office Space and propelled Britney Spears’ debut on MTV’s Total Request Live, started to experience hot flashes. And while their needs mirror those who came before them, their expectations are markedly different.

The data: millennials at work 

By 2025, my fellow millennials and I will make up 75% of the global workforce. As a generation, we remember an era before e-mail but are also digitally savvy. We remember when finding movie times required the extra effort of flipping through a newspaper, but we also created the ability to click and stream content.

As consummate self-advocates, millennials also invented wellness culture. We coined the term “self-care,” threw away the office cubicles and championed workplace benefits like gym memberships, stress management programs, and family leave policies. Now that some of us are experiencing the trials and tribulations of menopause, millennials are astounded by the lack of help, a problem we appear to perceive more acutely than Gen X.

This week Maven released data from a survey of over 1,000 women who identify as either millennials or Gen Xers with menopause symptoms. A few observations:

• 44% of millennials compared to 34% of Gen X have avoided discussing their symptoms due to fear of being judged or stigmatized. 

• 60% of millennials compared to 35% of Gen Xers have not discussed their symptoms with a healthcare provider. 

• 62% of millennials fear discussing their menopause symptoms most with their employer—more than with their friends, family, or doctor.

Also:

• 33% of millennials experiencing menopause symptoms say their symptoms have impacted their ability to perform at work. 

• 76% of millennials say that having or getting a menopause benefit would impact their desire to stay with their current employer. 

These data indicate that despite our well-earned reputations for self-advocacy, when it comes to menopause, millennials are struggling to find their footing. 

Societal shifts 

When society lets women and families down, Reshma Saujani is my favorite explainer of what we can do about it. 

Many people know her as the founder and CEO of Girls Who Code, a nonprofit that seeks to increase the number of girls in STEM. More recently I was in the room when she launched Moms First, a national movement to advance labor policies that support mothers. And not too long ago, you might have spied her asking the former president about his plans for childcare in this country. 

And yet, for all of her outstanding advocacy, even Reshma was bewildered by the onset of menopause.

“I was not prepared. At all. And many of my friends were not, either, so I didn’t have an all-knowing council to turn to like I did when I was going through puberty or pregnancy,” she told me. 

“I have found midlife to be a very challenging and soul-searching time as I try to balance being a mom, wife, CEO and individual. There’s no playbook for navigating this period, and no real community or resources that resonate,” she said.

Reshma suspects that millennials who report not quite knowing what to do with their menopause symptoms might suffer not always from a lack of knowledge, but too much. 

“Millennials are incredibly savvy,” she said. “I wonder if this phenomenon is not really about comfort but more about the fact that millennials don’t want to broadcast to the world they’re entering perimenopause and menopause because they know we’ve made it a hellscape for women at work, at home, and in society.”

A new care model

Reshma’s perspective resonates with most of my peers. Yet I was still surprised that Millennials are more reluctant to engage their doctors. To better understand this I called my colleague Dr. Jessica Shepherd, founder of the lifestyle platform Modern Menopause and author of the forthcoming book Generation M. 

As a minimally invasive surgeon and academic ob-gyn, Dr. Shepherd’s practice of medicine coincided with the back-and-forth medical advice around hormone replacement therapy (HRT). In 2002 a large study called the Women’s Health Initiative showed that HRT was associated with elevated health risks, leading a whole generation of doctors to shy away from treating menopause symptoms. Years later, secondary analyses showed that for many people the benefits of HRT outweigh the risks. But the chilling effect of the original study lingered.

“When I was trained, you couldn’t offer anyone hormone replacement therapy until they became menopausal. Imagine during the perimenopause phase, when they're like, ‘oh my God, I am dying.’ I remember I'd have to be like, ‘well, you're not really menopausal because you had a period,’” Dr. Shepherd said. 

As she became closer to midlife herself, the public was wising up to what research had long suspected (HRT can be life-changing for many women). But she found she still wasn’t satisfied with the toolbox at her disposal. 

“I just remember sitting at my desk thinking, there's got to be something different in what and how we are approaching this midlife thing. Because in academic medicine, I could only say, well, I know hormones are great for you. Do you want to start them or not? And that's all I had the time for,” she told me. 

Then she had an epiphany. What would it look like to treat menopausal patients at an office made for them?

Today Dr. Shepherd sees patients through her own sleek practice in Dallas, where she can prescribe them the very holistic practitioners she once wanted to refer them to but most doctors have no billing code for: nutritionists, acupuncturists, yoga instructors.  Of course, she can also prescribe them HRT, but now, she tells me, treatment begins with a conversation about their lives. 

Rather than scribbling down a dietitian’s name, she can ask what they like to eat; how they feel about food; how food factors into their routines. “I allow them to see their journey outside of these four walls and my white coat,” she said. 

In doing so, Dr. Shepherd earns their trust—which inoculates them from the natural misinformation menopause sometimes incites. Dr. Shepherd says she doesn’t dissuade patients away from whatever their algorithms might be selling them. “Some of them want to try a fuzzy little drink or a gummy. And I'm like, try it, if I know it’s not going to hurt them. But if it doesn't work, I'm always like, my door is open, come back, and let's talk about the other options on the list that we went through,” she said. And then, maybe, the next time they come in she can talk to them about how to avoid osteoporosis. 

Living well, in midlife and beyond

At a Maven product workshop not so long ago, one of my colleagues shared that she met a member who complained she had struggled with bouts of rage at work. When the member recounted the outbursts, our provider pointed out that they seemed completely reasonable—perhaps she wasn’t dealing with menopause, but with the midlife realization that she needed to stand up for herself more. HRT can help with many things, but it can’t help with that.

On a large scale, we know this to be true too: what our members want help with on the platform is not just the small cornucopia of classic vasomotor symptoms, like hot flashes or night sweats. In fact, when aggregated and measured, by far the most common symptoms are more quotidian: weight gain, insomnia, joint discomfort, sexual problems. 

The data also tells us that the overwhelming majority of these members articulate a desire for lifestyle remedies over prescription support. Like a virtual version of Dr. Shepherd’s practice, Maven members can work one-on-one with any number of provider types to exercise and execute a care plan that works for them. In this way, our key learning is this: more than menopause, what they really want help with is aging. And couldn’t we all use that?

In practice, Dr. Shepherd sees this as her most essential function. “I always term it as preparing for a marathon. This is not a sprint or a Saturday race in your neighborhood. This is the rest of our lives. I'm really trying to get people to understand the full scope of it, and the small steps that we can all take so that these life transitions aren’t such a drop off,” she said.

Reshma, as always, puts it perfectly. She tells me that in a society that lately seems even more obsessed with youth than usual, this is perhaps the greatest gift we can give women in menopause. 

“Instead of trying to needlessly biohack our mortality, we should fix the culture that is saying women shouldn't age in the first place. The problem has always been the structure — the unrealistic expectations thrown at us from every angle, and the lack of structural support that would allow women to thrive at any age in their workplaces, their communities, and in our culture,” she said. 

What my team is reading, considering, and building against: 

• If you’re intrigued by Dr. Jessica Shepherd’s approach to menopause care, her new book Generation M is available for preorder now here! 

• On the topic of menopause misinformation: we all know it’s out there. But how to spot it? This piece by Dr. Jen Gunter, a verifiable menopause expert, is a great guide.

• Though I couldn’t make it to the North American Menopause Society meeting this year, I heard great things from my team. One key takeaway: the drum beat of HRT only gets louder. New findings presented at NAMS suggest that estrogen-based hormone therapy isn’t just safe for the heart—it may improve cardiovascular health over time.  

• One of the great delights in a world where we can talk about aging more is seeing what that incites in artists. These recent profiles of Gillian Anderson and Maya Rudolph where they both reflect on the kinds of work they’re looking forward to doing in midlife are just two examples. 

• New research from Denmark validates that the fertility of men and women are both highly sensitive to their environments, though in different ways: the study linked exposure to air pollution with a higher infertility risk in men, while traffic noise affected women. It makes sense that sperm would be more sensitive to toxic exposure and eggs to endocrine disruption. Not all spaces are created equal for family building, and we have much to learn on how to help people maximize their chances.