Perimenopause. Menopause. Postmenopause. Three words that describe a transition every woman who lives long enough will go through — and yet, for decades, most women have entered it blind. No warning, no education, and doctors who often know little more than their patients do.
That’s finally starting to change, thanks to some very loud, very public voices.
The Three Phases, Briefly
- Perimenopause is the run-up to menopause, when estrogen and progesterone start fluctuating unpredictably. It can begin as early as the mid to late 30s or 40s and last anywhere from a few years to a decade or more.
- Menopause is a single point in time — reached after 12 consecutive months without a period.
- Postmenopause is everything after that, often a third or more of a woman’s life.
None of these phases are a disease. But all three come with real physiological changes that deserve real medical attention — attention many women still aren’t getting.
The Voices Breaking the Silence
Halle Berry has become one of the most visible faces of this shift. Her own turning point came after she was misdiagnosed — her doctor initially attributed her symptoms to herpes when she was actually in perimenopause. She has since testified before state legislatures and appeared on Capitol Hill advocating for menopause research funding, and she’s been candid that even one of the top doctors in California, her own doctor, didn’t fully understand what she was going through. Berry has reframed the conversation around aging itself, arguing that arriving at this stage of life should be seen as a privilege rather than something to fear. Her company, Respin, was born directly out of that frustration — a belief that women deserve better information than she got.
Oprah Winfrey brought the conversation into millions of living rooms with her ABC special, The Menopause Revolution. She’s talked openly about how bad her own experience was, describing roughly two years of insomnia, an inability to concentrate, and heart palpitations that no doctor ever connected to menopause. It got severe enough that she stepped back from hosting her book club because she could no longer focus enough to finish reading — and she’s said starting estrogen is what brought her concentration back. Her takeaway: silence is what makes menopause harder than it needs to be.
Dr. Rachel Rubin, a urologist and sexual medicine specialist who has appeared on both The Diary of a CEO and The Mel Robbins Podcast, has become one of the clearest clinical voices in this space. She frames menopause not as a niche “women’s issue” but as a whole-body hormone event that spans every stage of life — puberty, childbirth, perimenopause, and menopause alike, she argues, deserve the same level of attention and care. She’s also pushed back hard on the myth that testosterone is a “male hormone,” pointing out that losing it at menopause can drive fatigue, low mood, and low libido the same way it would in a man. Dr. Rubin recently played a role in one of the biggest regulatory shifts in this field in decades: the FDA’s move to remove its black-box warning from menopausal hormone therapy.
Advocacy Doesn’t Start at 50
One of the most important threads running through all of this is that women’s health advocacy can’t just switch on at menopause. It has to start at puberty and run all the way through the rest of life.
The same pattern shows up again and again: symptoms dismissed, pain normalized, women just barely getting by and dealing with so much discomfort and unanswered questions silently, then told to “wait and see.
Whether it’s a teenager with debilitating periods, a new mother whose postpartum symptoms are brushed off, or a 55-year-old told her brain fog is “just stress: or “getting old,” the through-line is the same — women are frequently undertreated because the medical system hasn’t been built around their bodies, it was built for men’s.
Advocating for better care at every single life stage, not just midlife, is what actually closes that gap.
HRT: Rewriting a Story Built on Fear
For over twenty years, hormone therapy carried the FDA’s most serious warning label — a “black box” cautioning about breast cancer, stroke, and heart disease. That warning traces back to the 2002 Women’s Health Initiative study, which released preliminary findings before they’d been fully peer-reviewed. The results were widely reported in ways that overstated the actual risk, and it triggered a wave of fear that kept an entire generation of women away from a treatment that, for many, could have meaningfully improved their lives.
In late 2025 and into 2026, that finally began to change. Following an FDA advisory panel review, the agency initiated removal of the boxed warning, with officials acknowledging the original data had been misinterpreted and the risks overstated for most women, particularly those who start hormone replacement therapy near the onset of menopause. FDA Commissioner Marty Makary put it bluntly, describing the old warning as designed to scare women away from a treatment with real benefits. That doesn’t mean HRT is right for everyone — it isn’t — but it does mean the conversation can finally start from evidence instead of fear.
The Mental Health Overlap Nobody Warns You About
Mood changes are often one of the earliest and most disorienting symptoms of the menopause transition — and one of the least talked about. As estrogen fluctuates, so does serotonin, the neurotransmitter tied to mood regulation; progesterone, which has a calming effect on the brain, also declines. Research has found the odds of new depressive symptoms increase notably during perimenopause, and some clinicians now describe it as a distinct “window of vulnerability” for mood and anxiety disorders — alongside adolescence and the postpartum period.
Importantly, this isn’t just about hormones in isolation. Sleep disruption, hot flashes, and the ordinary stresses of midlife — caregiving, career pressure, aging parents — all compound the effect. Women with a prior history of depression or anxiety are at higher risk, but plenty of women report their first-ever anxiety or depressive episode during this transition, with no warning and no obvious cause. That’s exactly why untangling “is this menopause or is this depression” matters — the answer often shapes whether hormone therapy, therapy, or both (with other holistic modalities too if desired) make sense as part of the plan.
The Bigger Point
Menopause isn’t a footnote in women’s health — it’s a third of many women’s lives.
The women speaking up now, from Halle Berry to Oprah Winfrey to physicians like Dr. Rachel Rubin, aren’t just sharing personal stories. They’re pushing an entire medical system to catch up to something it has quietly ignored for decades.
The real work now is making sure that same energy — asking questions, demanding real answers, refusing to accept “that’s just aging” — gets applied at every stage of a woman’s life, starting well before midlife and continuing long after it.
You Don’t Have to White-Knuckle This Alone
If you’ve read this far, maybe something in here landed a little close to home. Maybe it’s the mood swings that feel bigger than the situation warrants. Maybe it’s the anxiety that showed up out of nowhere, or the days where you just don’t feel like yourself and can’t quite explain why. That’s real, and it deserves more than “it’s probably just stress” or “that’s just part of getting older.”
At S.A.G.E. Holistic Health & Wellness Center, we hear versions of this a lot — not always framed as menopause, but as women coming in feeling foggy, irritable, disconnected from their partners, or grieving a version of themselves they feel like they’re losing touch with. Hormones don’t ask permission before they rearrange your inner world, and there’s nothing wrong with needing support to make sense of what’s happening in your head while your body is going through something monumental.
That’s the space we try to hold. Sometimes that looks like traditional talk therapy — working through the anxiety, the identity shifts, the tension it can put on a marriage or a family when nobody quite understands what’s going on. Sometimes it looks more physical, like Reiki or breathwork to help calm a nervous system that feels like it’s constantly on edge. And sometimes it’s simply having someone in your corner who can sit with you in the “I don’t feel like myself” of it all, without rushing you toward a fix.
We also know this transition doesn’t happen in isolation from the rest of your care. If you’re working with a doctor on hormone therapy or other treatment, we’re glad to be part of that team — the mental and emotional side of the same story your body is telling.
If any of this feels familiar, we’re here. S.A.G.E. offers a free 15-minute consultation, sees clients in person in Tustin/Orange County or virtually anywhere in California, and works with sliding-scale fees and most major insurance — because cost shouldn’t be what stands between you and feeling like yourself again.
S.A.G.E. Holistic Health & Wellness Center · 2050 N. Tustin Ave, Santa Ana, CA 92705 · (714) 391-3853 · sagewellnessctr.org
