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From Stigma to Strength: How Women and Science Are Redefining Menopause

This is part one of a three-part series addressing menopause, perimenopause, and hormone replacement therapy.

For generations, women have navigated menopause quietly, often in confusion or shame. But today’s Gen-X women are rewriting that story, armed with better science, stronger voices and a growing community of support.

“It was a difficult time to be a woman and it was a difficult time to be a physician,” says Dr. Jennifer Bettenhausen, Vail Health family medicine physician, recalling the years after the 2002 Women’s Health Initiative study on hormone therapy cast widespread fear and confusion. “We suddenly felt like we may be doing harm.”

That study’s flawed conclusions effectively slammed the door on hormone therapy, leaving women to struggle through hot flashes, night sweats, insomnia, weight gain and emotional turbulence with little medical guidance. Many didn’t even realize the symptoms they faced were tied to menopause and perimenopause.

Now, after two decades of research and renewed attention, that silence is finally breaking.
 

A New Era of Awareness

“In the last three to five years, we have this amazing opportunity to re-energize the conversation,” says Christine Pierangeli, a master nutritionist who also leads a menopause support group at Vail Health. “Knowledge is incredibly powerful in managing our expectations.”

Doctors like Bettenhausen and OB/GYN Dr. Kiara Bowen are part of Team Menopause, a Vail Health group of providers dedicated to advancing education and care for women in midlife. With updated research affirming the benefits and safety of hormone replacement therapy for many patients, they’re encouraging women, and their physicians, to take a new look at menopause.

“The science, the research and the evidence around menopause, specifically around hormone therapy and its health benefits for women, is changing every day,” Bowen says.

Both providers now bring menopause into conversation early, even with women in their 20s and 30s. Understanding hormonal changes before they happen gives women a head start on managing them, and, as Bowen emphasizes, not every treatment involves hormones. “When I treat a (menopausal) woman, I really try to tease out which of their symptoms are the most distressing so we can target those, and determine how (best) to treat them,” she says. “Not everyone is a candidate for hormone therapy.”
 

Information is Power

With more information available than ever, women are entering their doctors’ offices informed and empowered. 

Peer conversations are part of that empowerment. “I feel like the power for women is just to be in a room sharing and understanding and normalizing what we are all going through,” Pierangeli says. “The a-ha moments and the tears in those groups help women realize they are not alone.”

That connection helps shed the stigma, and sometimes, the shame, that has shadowed menopause for generations.
 

The Midlife Reset

Menopause can feel like a loss of youth or femininity, but Bowen suggests reframing it as an opportunity. “I think the post-menopausal part of life can be an exciting, enriching and empowering time,” she says.

Estrogen affects nearly every system in a woman’s body, reproductive, muscular, metabolic, even mental health, so hormonal shifts can ripple widely. Bowen encourages a biopsychosocial approach, treating not only the biology but also the mental and social dimensions of the transition.

“You really can’t treat any ailment with medicine alone,” she says. “Lifestyle, exercise and diet can contribute to or help with symptoms.”

Bettenhausen agrees. “We can skate through our 20s, 30s and even into our 40s, eating what we want and drinking too much wine, but as you get into your mid- to late-40s and hormones start to drop, we really can’t. It forces women to say, ‘What do I need to do so I can feel better?’”

Pierangeli recommends eliminating processed foods, added sugars and alcohol, which can trigger hot flashes and night sweats, and focusing on an anti-inflammatory diet rich in vegetables, lean meats and cold-water fish, like salmon.
 

Menopause in the Mountains

For many Colorado women, staying active is second nature, and that can make all the difference. “Staying active, staying fit and staying strong really helps women during the perimenopausal transition,” Bowen says.

In Eagle County, it’s not unusual to see women in their 40s, 50s and 60s skiing, biking or trail running. Dr. Cheryl Kohn, a Vail Health OB/GYN, started competing in triathlons in her late 40s. 

“I thought the best thing for me to do was exercise and eat well,” she says. “Those two things came up in the literature again and again. I thought: That’s great, because that’s what this community does.”

Strength training is also especially critical. “As women get older, fractures and fragility really affect their longevity.” Bowen explains. “Having a fall and a hip or an arm fracture really decreases their quality of life, so I spend a lot of my time urging our women to continue with their activities. A lot of people want to focus on cardio, but I love talking about strength training and weightlifting. The heavier the better.”

Research shows women benefit most from lifting heavier weights at lower repetitions, around five to seven reps per set.

Exercise also supports stress management; it’s crucial in midlife, when women often juggle careers, teenagers, empty nests and aging parents. “It’s a challenging time of life,” says Bettenhausen. “Going through menopause at the same time becomes very difficult.”
 

Tips for Thriving Through the Transition:

• Stay active — move daily and lift heavy weights.
• Eat an anti-inflammatory diet; skip sugar and alcohol.
• Practice mindfulness, yoga or breathwork.
• Find your community and talk openly.
• Seek care from a board-certified provider.

 

When to Seek Support

Even active women sometimes need extra help. “Active women are going to be less tolerant of the negative symptoms of menopause, like fatigue and weight gain, because it impacts their lifestyle more,” Bettenhausen says. For some, hormone therapy can help manage persistent symptoms and restore quality of life.

“I love to talk about the benefits of hormone therapy,” Bowen says, “but it’s also really important to understand the risks and make sure you’re being appropriately counseled.” Women should seek care from a board-certified medical provider, not a spa or unlicensed wellness clinic.
 

A Second Spring

Menopause can be a turning point — not an ending, but a beginning. Bowen encourages women to use this time for reflection: “Really looking at: ‘What am I going to do? What brings me joy? What are my coping strategies?’”

Some cultures call this phase the “second spring.” Pierangeli agrees: “It’s an opportunity to really look inward and think about who we are.”