lana Glazer is done with shame. The comedian is
known for her work in no-holds-barred projects like
Broad City and Rough Night. Yet despite her boldness when discussing topics like gender equality, her journey with chronic pelvic pain, anxiety, and depression is something she’s just now feeling empowered to speak about.
"It's a long ongoing, lifelong process," she explains. "I am only now beginning to talk publicly about the chronic pain that I experienced in my pelvic floor. It is empowering me to understand my own story." Glazer began dealing with pelvic floor dysfunction at age four. However, it would be years before she told her mother about her pain.
"My household was open-minded and supportive, but we didn't have much body vocabulary," the Long Island-born actress reveals. When Glazer was growing up during the '90s, discussing sex and bodily functions was taboo. "I didn't talk about my vagina," says Glazer. "I didn't grow up being encouraged to look at and understand it, and I didn't know how to express it. The first time I told my mom about my pelvic pain was at age seven."
What Happened to the 2022 Bill Calling for More Menopause Research?
by Aramide Tinubu | photographs by Bertram Knight
I
The representatives wanted to begin to remedy the gaping hole in women’s healthcare with a bill that directed the National Institutes of Health (NIH) to evaluate existing menopause-related research and develop a strategic plan to close those gaps and flesh out the knowledge. It was a rare moment of bipartisan governance during the second session of a divided Congress.
After introducing the bill, Axne publicly acknowledged that “millions of working-aged women” across the United States were coping with menopause-related symptoms and the disruption to “their lives, careers, mental health” and beyond. Yet, a lack of information persisted on what menopause is and how to treat it.
Ever since 1991, when the NIH launched the Women’s Health Initiative (WHI) study, modest progress has been made to scientifically and comprehensively understand how menopause impacts issues of morbidity and mortality during a woman’s menopausal journey starting in midlife through her postmenopausal years. “There’s a lot of history about why menopause research and midlife women’s research has languished,” says Sharon Malone, an OB-GYN with 30 years of experience who is also the Chief Medical Adviser of Alloy Health, a telehealth company that connects menopause-trained doctors with women seeking treatment. “I have a sense of what it was like before the WHI study and what it’s like now, and how detrimental that has been for women over these past 21 years,” she says.
The detriment as Dr. Malone and many other experts explain it has to do with one section of the study’s findings about the safe use of menopausal hormone therapy (MHT). MHT has been used to treat a host of menopause-related symptoms, including hot flashes, achy joints, vaginal dryness, painful sex and urinary tract infections. Alarming data from the study linked MHT to elevated risks of cancer and cardiovascular disease, but when the mainstream press shared the findings out of context, the dangers of MHT use were exaggerated and scared the public. What had once been commonly prescribed to ease the symptoms of menopause was abandoned overnight. Additionally, the findings “had a chilling effect on any subsequent studies,” says Dr. Malone, noting that most research came to a halt. “That’s why the thrust of our op-ed was to say this is something that’s got to be done by NIH,” she emphasizes because drug companies, who frequently fund such research, would not touch it. “Drug companies have no desire to redo this study.”
The landmark study, composed of a series of randomized clinical trials, specifically looked at the benefits of hormone therapy, the impact of dietary interventions and use of calcium and vitamin D on 160,000 postmenopausal women. Costing $625 million, it was the first time in history that a study of its scale and size focused solely on women. The study followed some women over the course of a 20-year period and issued reports on the data during that period. Although one of the reports declared there was an increase in cancer in women taking hormonal treatment, what was left out of public conversations was that the link to cancer was observed in women over the age of sixty and who were taking the treatment for more than five years.
The day after Axne and McKinley’s bill was introduced, the bill was sent for further inspection to the subcommittee on health where little to nothing happened — until three months later, when two additional Democratic representatives, Kathy E. Manning from North Carolina and Josh Gottheimer from New Jersey, signed on as co-sponsors. By then, both Axne and McKinley had been voted out of office in the 2022 mid-term election that gave a slim majority to Republicans. Without its advocates, the Menopause Research Act died on the vine. Meanwhile, little to no communication about the status of the bill emerged from Congress, and women, once again, were no closer to understanding what happens to their bodies during perimenopause and menopause. “It’s just unconscionable that we are still asking the same questions in 2023 that we asked in 1993,” Dr. Malone emphasizes. Soon enough, however, another woman would step in to champion the effort.
by SHIRLEY VELASQUEZ | PHOTO: Steve Parsons/PA Images via Getty Images
They’ve Waited 30 Years For
How a New Menopause Research BiLL
|
“
“
It’s just unconscionable that we are still asking the same questions in 2023
that we asked in 1993.
— Dr. Sharon Malone,
OB-GYN and menopause advocate
by Aramide Tinubu | photographs by Bertram Knight
“
“
It is not good enough to say that we will
find consumer products that give us a bandaid to our problem; it's not good enough to let our employers say, ‘Sure, we'll provide cooling rooms for you, or we'll be more easygoing about dress codes, we'll even ensure that we talk about it in the workplace.’ None of those things are bad or problematic on their face. But they
are not the sole solution.
—Jennifer Weiss-Wolf,
reproductive rights lawyer,
activist and author
n the long history of marginalizing women’s health in the United States, menopause arguably remains one of the biggest mysteries for far too
many women. For Jennifer Weiss-Wolf, the reproductive rights lawyer, activist and feminist author, however, a silver lining appeared in the form
of a ping from a Google alert while sitting at her desk at the Brennan Center for Justice at New York University. It mentioned an op-ed she had co-written with Sharon Malone, a renowned obstetrician and gynecologist and a menopause advocate, four months earlier in The Washington Post titled, “America Lost Its Way on Menopause Research. It’s Time to Get Back on Track.”
The essay urged the U.S. government to close vast gaps in information about menopause research and treatments, such as hormone therapy, which, they argued, “resulted in a cascade of harm to millions who have undergone menopause in the United States.” Inspired by the op-ed, two representatives, Cindy Axne, a Democrat from Iowa, and David McKinley, a Republican from West Virginia, jointly introduced the Menopause Research Act of 2022.
During the winter in early 2023, Weiss-Wolf and Dr. Malone received a call. It came from the office of Congresswoman Yvette Clarke, a Democrat from New York, who was inviting the dynamic pair to participate in a group she was assembling to pick up where the previous bill had left off. This time, she wanted menopause advocates in the room with her in order to include their expertise in the drafting of a new bill to be presented in October 2023 in time for World Menopause Day on October 18th. “There are a number of ways in which the healthcare establishment has failed to comprehensively address women’s health from cradle to grave for lack of a better term,” says Congresswoman Clarke. “I thought it was really important that we look at the full woman, from her highly reproductive years through menopause.”
One of the other women contacted by Clarke’s office was Donna Klassen, a licensed social worker and co-founder of Let’s Talk Menopause, a nonprofit that demystifies menopause through its online educational resources and virtual events. This time around, Klassen points out, the fate of the bill will be different because of the multidisciplinary cohort the Congresswoman has assembled. “We’re building a groundswell of support,” explains Klassen. “There’s 55 million women in the United States going through menopause; 75 percent of those don’t get treatment for their symptoms. They suffer in silence.” And the treatments that are available, such as hormone therapy, have been undermined because of the cohort flaws in the WHI study, which looked at the effects of MHT use in women over 60. When it comes to women in midlife, Klassen emphasized, the research is just not there. “Women have been understudied, underfunded,” says the therapist. “The effects of hormone therapy are very confusing to people.”
Malone clarifies the confusion this way: “We took all the bad stuff that happened to the women who were, on average, 63 and applied it to everyone. There are differential effects; it matters whether you started [MHT] at 45, or whether you started at 75.” That’s the subtlety of the message that never got communicated: that it matters when you start. Furthermore, women who are 50 to 60 gained benefits, such as stronger bones and improved heart health than taking MHT later in life. “That’s not an inconsequential finding from the Women’s Health Initiative, but it kind of got ignored,” Dr. Malone adds.
So does hormonal therapy increase the risk of breast cancer? “No, it doesn’t,” says Dr. Malone for women who are taking the treatment within the right time frame: when she’s under the age of 60, symptomatic, or treated within the first 10 years of her last period. “The timing matters,” she says, noting that the treatment has been around for 80 years with few adverse effects on women treated in the proper time frame.
55
With little attention or interest from the press, Clarke’s group has been dutifully working on new legislation and building support. Though the sources interviewed for this article say that the language in the new bill does not depart radically from the former bill, the specificity of the new text seemingly expands the scope of what it is directing the NIH to do once the act is passed. “Dr. Malone and I participated in conversations with [Clarke’s] office so that it is written in a way that is a little more full-throated in terms of the research that it is calling for, the funding for that research and the need to be public about communicating the findings,” says Weiss-Wolf, the lawyer-activist who is now the executive director of the Birnbaum Women’s Leadership Network at NYU.
For example, where the previous bill generally required the director “to conduct an evaluation of menopause-related research (including gaps in research and knowledge regarding the causes, symptoms, and treatments for menopause),” the new bill asks that the NIH director zoom in on research concerning menopause, perimenopause, and the overall health of mid-life women. Once the NIH has conducted an evaluation, studied the research results, given a status of ongoing menopause and perimenopause research and research on women’s health at mid-life, the bill requires the NIH director to produce a report and a strategic plan that is “designed and implemented by a multidisciplinary group composed of gynecologists, oncologists, endocrinologists, cardiovascular researchers, and neuroscientists,” according to the upcoming bill.
In Weiss-Wolf’s view, much of what went wrong with the WHI study was the way the story was told in the media. “It created a chilling effect in the country because people heard it in such a dramatic way. We want to undo that damage by using the media to tell the story in a meaningful way,” she says. That is why when the new bill is introduced, it will call for a new research study and for the results “to be publicized and treated as the blueprint for how to move forward,” she says.
MILLION
ARE GOING THROUGH MENPOAUSE
75%
OF THOSE DON'T GET TREATMENT FOR THEIR SYMPTOMS
Could Give Women THE ANSWERS
How a new menopause research bill could give women
the answers they’ve waited 30 years for
What Happened
TO the Menopause Research Act?
A study that yielded confusion
A bill in search of advocates
An inflection point
A new era in women’s health
return to FLOW HOMEPAGE
return to FLOW HOMEPAGE
55 million women in the United States going through menopause; 75 percent of those don't get treatment for their symptoms
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55 million
women in the United States are going through menopause
Stat #1
55 million women in the United States going through menopause;
85%
of women experience menopause symptoms
Stat #2
75 percent of those don't get treatment for their symptoms
$100 million
allocated per year to carry out the work in 2024 and 2025, should the bill pass
$100 million
another $100 million for 2025
If passed, the bill would allocate
Stat #3
If passed, the bill would allocate $100 million to carry out the work for 2024 and another $100 million for 2025.
The stylist and TV personality has gone through a mid-life personal and professional transformation.
“
“
There are a number of ways in which the healthcare establishment has failed to comprehensively address women’s health from cradle to grave for lack of a better term. I thought it was really important that we look at the full woman, from her highly reproductive years through menopause.
—Congresswoman Yvette Clarke
Perhaps, the most consequential difference between the Axne-McKinley bill and the new one is that the former targets the misinformation around hormonal treatment and requires a multidisciplinary study of the effects of hormonal treatment for menopause. If passed, the bill would allocate $100 million to carry out the work for 2024 and another $100 million for 2025.
Despite the bill’s relevance to all women, regardless of political affiliation, supporters worry the bill may face an uphill battle or even stall in a divided and dysfunctional Congress. For now the strategy is to put the bill through the usual process of being introduced in the House of Representatives and then being assigned to a committee. “That is the best way to garner support — slow, steady, and amenable to other potential congressional support, just in case there needs to be edits or small changes,” says one anonymous source familiar with the proposed legislation.
The ultimate goal, says Weiss-Wolf, is for this bill to help women and the medical establishment get to the root of the problem that begins for women at perimenopause: a lack of science and the ensuing societal confusion. “It is not good enough to say that we will find consumer products that give us a bandaid to our problem; it’s not good enough to let our employers say, ‘Sure, we’ll provide cooling rooms for you, or we’ll be more easygoing about dress codes, we’ll even ensure that we talk about it in the workplace.’ None of those things are bad or problematic on their face. But they are not the sole solution.” Instead, she wants to see a whole government approach that finds out everything it can know about menopause “and that we are then shaping our medical establishment and every other private sector properly, not just as gap fillers.”
Clarke, for her part, is hopeful. “There are many more women in the Congress now than there have ever been. And I think as time goes on, and more and more legislators are women, you will find more pieces of legislation specific to the concerns and lived experiences of women being introduced. Hopefully, we’ll get the golden ticket, and it’ll become law. We’ll keep you posted.”
