Early in the twentieth century, childbirth in the United States was defined by a practice that modern observers look back on with sheer horror. Under the guise of medical advancement, women in labor were routinely subjected to “twilight sleep”—a disorienting cocktail of morphine and scopolamine that did not actually erase the agonizing pain of labor, but rather erased the brain’s ability to remember it. Denied the presence of loved ones, stripped of their agency, and quite literally strapped to sterile hospital beds to prevent them from thrashing in their drug-induced delirium, these mothers woke hours later to be handed babies they had absolutely no conscious memory of delivering. Today, we shudder at the clinical cruelty and systematic gaslighting of that era, wondering how such a deeply dehumanizing practice could ever have been accepted as the gold standard of care. Yet, a chillingly similar systemic failure is happening right now in our modern healthcare system, hidden in plain sight. Generations from now, our granddaughters will look back with the exact same sense of disbelief and outrage when they examine how our current society treats, dismisses, and completely abandons women going through menopause. Like the laboring mothers of the past, women transitioning into their midlife years today are routinely met with a profound medical vacuum, forced to navigate a major, life-altering biological event in isolation, silence, and shame.
This systemic neglect manifests in painful, everyday realities for millions of women who walk into their doctors’ offices seeking desperately needed relief, only to walk out empty-handed, confused, and utterly defeated. The average woman at forty-five or fifty is transitionally caught in a whirlwind of severe symptoms that disrupt every single aspect of her existence—from agonizing insomnia that robs her of night after night of rest, to debilitating joint pain, unpredictable heart palpitations, sudden waves of clinical depression, and terrifying brain fog that makes her feel as though her cognitive faculties are slipping away. These symptoms do not strike in a vacuum; they arrive precisely when women are at the absolute peak of their professional careers, managing complex households, raising teenagers, and caring for their own aging parents. There is an entire constellation of family members, colleagues, and communities relying on her strength, yet her own body feels like it is unravelling from the inside out. The Mayo Clinic estimates that these untreated symptoms cost the United States a staggering twenty-six billion dollars annually in astronomical medical expenses and lost workplace productivity. Despite this catastrophic human and economic toll, only a pitiful twenty-five percent of menopausal women in the United States receive any form of medical treatment, leaving the vast majority of our mothers, sisters, and friends to suffer through the dark hours of the night in silence.
Even for those with access to world-class healthcare, navigating this transition is an uphill battle against systemic ignorance, a reality that became blindingly clear to me when I first began experiencing my own symptoms. Despite spending the last twenty-five years as a dedicated global advocate for women’s health and possessing resources that most women can only dream of, I found myself shocked by how much I simply did not know, and how hard I had to fight to receive basic answers and viable treatment options. The truth is that menopause is not merely a collection of temporary, uncomfortable inconveniences like hot flashes; it is a fundamental shift in a woman’s underlying hormonal profile that carries long-term, life-threatening cardiovascular, skeletal, and neurological risks. Untreated insomnia and systemic inflammation drastically increase a woman’s vulnerability to developing Type 2 diabetes and cognitive decline, while crumbling estrogen levels accelerate bone loss and double the risk of heart disease. Witnessing this profound gap in care firsthand solidified my resolve to expand my philanthropic mission to include significant new funding specifically targeted at midlife and menopause care. This new initiative brings my total commitment to women’s health over the last two years to more than six hundred million dollars—an investment that simultaneously defends maternal and reproductive rights while aggressively fighting for women’s health at every stage of their lives.
To understand why menopause care is in such a dismal state, we must look at the deep-seated biases embedded within medical training, where women’s physical realities have historically been treated as an afterthought or an anomaly. It is a stunning, unacceptable truth that less than one-third of all American OB-GYN residency programs offer any kind of formal, standardized menopause curriculum to their doctors-in-training. The very medical specialists who are supposed to guide women through the natural transitions of their bodies are being graduating into the workforce without the basic tools, data, or education required to help half the population manage a universal biological event. This training deficit is further compounded by a legacy of fear and misinformation surrounding hormone replacement therapy—the most effective tool we currently possess to manage severe symptoms—which saw its usage plummet to less than five percent following flawed, panic-inducing studies decades ago. Because clinical research has historically treated the male body as the default human canvas, we are left navigating a massive scientific void regarding how to protect women from chronic midlife health risks. We are effectively asking women to accept a lower quality of life, telling them to grin and bear physical and emotional decay because our medical pipeline has simply not bothered to prioritize their bodies.
To correct this historic injustice, we need nothing short of a comprehensive, nationwide menopause revolution that transforms our medical, political, and social institutions from the ground up. This revolution must begin in our classrooms and lecture halls, with medical schools, residency programs, licensing boards, and accreditation bodies mandating menopause education for all healthcare providers who treat adult women. Beyond the clinic, our state and federal policymakers must step up to expand insurance and Medicaid coverage for advanced menopause therapies, while enacting robust workplace protections that mirror pregnancy accommodations—such as flexible hours and medical leave—so that women do not have to choose between their careers and their physical well-being. We also need aggressive, culturally sensitive public health campaigns to dismantle the heavy stigma of aging and address the deep, painful racial disparities in accessing treatment. Currently, postmenopausal white women are more than twice as likely to receive hormone therapy as their Black and Hispanic peers, highlighting a compounding layer of systemic bias that leaves women of color to bear the heaviest physical burdens of this medical neglect.
Despite the agonizingly slow pace of progress, there are undeniable glimmers of hope appearing on the horizon, fueled entirely by the brave solidarity of women who are finally refusing to suffer in silence. Thanks to their loud, collective demands for better, medical organizations are updating clinical guidelines to safely reintroduce hormone therapies, progressive companies are offering dedicated menopause benefits, and forward-thinking legislators are introducing bills to protect midlife workers. To truly accelerate this momentum, we must direct substantial global research funding toward women’s biochemistry, correcting the absurd reality where only five cents of every medical research dollar is spent on women’s health. We must actively reshape the cultural narrative so that our society ceases to view menopause as a joke, a weakness, or a shameful secret, and instead recognizes it as a natural, powerful phase of life that deserves dignity, support, and scientific investment. Decades ago, courageous women stood up and put an end to the horrific practice of twilight sleep, reclaiming the beauty, safety, and agency of childbirth for all those who followed. Today, we are standing on the shoulders of those reformers as we ignite a matching revolution for midlife care, ensuring that our daughters and granddaughters will inherit a world where their bodies are fully understood, deeply respected, and thoroughly cared for.
