Unmasking Midlife Why the FDA Hearings Signals a New Era in Menopause and Women’s Health

“There is no greater agony than bearing an untold story inside you.”— Maya Angelou

One of the menopause

I rarely get political, but when it comes to women’s lives, I feel like it’s time to speak out—especially about the midlife journey and the menopause transition.

That’s why I’m writing this blog series: to talk about what’s been missing in our cultural understanding of this life stage, and to unpack how recent changes—like the FDA’s open hearing and currently contemplating the removal of the black box warnings of hormone replacement therapy—impact not just women, but men, families, workplaces, and communities.

So let’s unmask so midlife and openly talk about menopause.

Menopause, Perimenopause, and Postmenopause: Understanding the Hormonal Journey

Up until about three or four years ago—yes, as recently as 2022 or 2023—mainstream media and even many providers simply used the term "menopause" to describe what is actually a decades-long biological and neurological transition.

But a newer term has been gaining traction: perimenopause. This word is now being used to describe the approximate 10-year lead-up to menopause, a time marked by significant hormonal shifts and nervous system changes.

Perimenopause is not just a prelude; it’s a critical and often misunderstood chapter in a woman’s health journey.

And after menopause? There’s postmenopause — the longest phase of them all. This is when women are no longer cycling but are still living in hormonally altered bodies that require just as much attention and support (that we have not been educated to care for properly).

Menopause Is a Midjourney, Not an Ending

There’s now greater recognition of the full journey:

• Perimenopause: The ~10-year phase leading up to menopause, where estrogen and progesterone shift unpredictably, and symptoms like brain fog, anxiety, insomnia, and cycle changes begin.

• Menopause: The one-year anniversary of your last period.

• Postmenopause: The decades that follow, when symptoms may persist or evolve, and chronic health risks like osteoporosis, cardiovascular disease, and cognitive decline increase.

Understanding these stages is key. And yet, too often, women are given antidepressants instead of answers to how to care for their bodies in a new way because it is neurologically and physiologically changing. (Please note: I support the proper use of SSRI's and antianxiety medications IF they are the proper diagnosis and treatment)

The widespread prescribing of SSRIs or anti-anxiety medications, misdiagnosis and lack of proper education and care of the neurobiological shifts —in other words, without discussion of hormones—is a symptom of a much larger issue: the historic lack of training and research in women’s health. Again, I am not advocating against these medications, rather I am advocating for the proper listening, diagnostic case conceptualization and education of women's health.

The FDA Hearings on the Black Box Warning on HRT: What It Really Means

The FDA’s hearings and the medical doctors stimulating conversation about the real consequences of the lack of women's health care opens the door to something deeper: dialogue, education, and real options for women's long term health. It means we can research, educate and talk honestly about hormonal transitions that affect half of the human population for half their lives.

For the record, I am not promoting hormone therapy as a one-size-fits-all solution. HRT is not for everyone, and this blog will never suggest otherwise. But healthy options should be for everyone and women are not appropriately counseled in their options for health, aging and risks with the current atmosphere for one half to one-third of their lifespan.

I am advocating for is open, honest, and nuanced dialogue about the intersection of hormones, trauma, mental health, and women's whole-body wellbeing.

As we will explore in this series this coincides with women and trauma, specifically something we call an ACE score. ACE stands for Adverse Childhood Experiences and is linked with long term health and illness consequences.

And this is what is missing Mental health providers need to be part of this conversation. Mental Health practitioners are also minimally trained in the biological realities of menopause, and trauma. Just this week on an intake call when I asked about a person's possibility of menopause related symptoms, she exclaims "You are the FIRST mental health person to ask me about that."

Clients suffer in the gap - women, men, families, couple's, friends and so forth.

And this leads them vulnerable to the rising tide of predatory cures offered through wellness fads, and youth-obsessed messaging that profit off of women's confusion and pain. This is becoming a 16-18 billion dollar industry.

The Menopause and HRT Controversy Context:

In the 2002 Women's Health Initiative (WHI) study led to widespread fear around hormone therapy and breast cancer. The original WHI findings linked combined estrogen-progestin therapy with increased risks of breast cancer and cardiovascular disease, but later analyses revealed significant flaws, including the age of the participants (many well past menopause) and lack of nuance around different types of hormones and methods of delivery.

Psychosocially this has lead to widespread fear of hormones and was already a topic of stigma cloaked in shame. Subsequently there was a lack of focus the menopause transition in women's lives.

Today, we understand that for healthy women under 60 or within 10 years of menopause, low-dose HRT may provide more benefit than risk, especially in managing moderate to severe symptoms and protecting long-term health. I encourage you to listen to the FDA panel which is posted in the introductory blog.

Menopause Symptoms by Severity: Why Support Matters

Recent data show that when the menopause transition is ignored or mismanaged, women face profound emotional, relational, and occupational consequences:

Symptom Severity	% of Women Affected	Impacts
Mild	~20–30%	Mood dips, hot flashes, sleep disruption
Moderate	~35–45%	Anxiety, insomnia, brain fog, daily distress
Severe	~20–25%	Suicidal ideation, panic attacks, relationship strain, job loss

Women with high ACE scores, surgical menopause, or histories of trauma are even more vulnerable to these outcomes—and are often misdiagnosed with anxiety, depression, or personality disorders, when in fact their bodies are calling for support.

We can stop pretending one solution fits all. Not every woman needs or wants hormone therapy. But now, we can explore it when appropriate—especially for those with severe symptoms or early onset menopause. We can also begin to look into more social, physical and mental well-being approaches. And in Mental Health we can further screen for women in the "vulnerability window."

I am hoping the take-away from this blog is the importance of a paradigm shift. It’s no longer taboo to discuss menopause as a biological, psychological, and sociocultural journey. We’re entering a time where women’s experiences are being researched, resourced, and—finally—respected.

As we continue through this series, we’ll explore how trauma history, nervous system dysregulation, and hormonal shifts converge in powerful ways during midlife. So this series is my contribution to that unfolding conversation.

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Disclaimer

This blog is for educational and informational purposes only and does not constitute medical advice. The content is not intended to diagnose, treat, or replace professional medical or mental health care. Always consult with a qualified physician, licensed therapist, or healthcare provider regarding your specific health needs.

While Julie Cardoza, MS, LMFT, RYT is a licensed mental health professional in the state of California, this content is not a substitute for psychotherapy or medical evaluation. References to hormone therapy, menopause treatments, or trauma-related care are offered for awareness and discussion purposes only.

Heartscapes, LLC provides wellness education and coaching services focused on midlife transition and integrative care. Clinical therapy is provided separately through Julie Cardoza’s LMFT license under applicable California law.