“I was kind of floored that I didn’t immediately connect my perimenopausal symptoms to perimenopause—and I write about health for a living!” says Jancee Dunn, the bestselling novelist, journalist, and former MTV VJ, who just released her latest book Hot and Bothered: What No One Tells You About Menopause and How to Feel Like Yourself Again. After covering health and science for 20 years, Dunn was stunned by the lack of information available when she started going through perimenopause, a term that many women still aren’t familiar with (although around six thousand women will enter it today). Considering doctors in most medical schools receive only one hour of instruction on menopause on average, this information gap, unfortunately, adds up.
Throughout her research for the book, Dunn interviewed a range of specialists, including ob-gyns, neuroscientists, dermatologists, psychologists, and more, in an effort to help readers understand how to find relief from symptoms, including hot flashes, painful sex, and changes in mood. Ultimately, it’s a step toward removing the mystery around something that “happens to half of the population of the earth,” she stresses. And interestingly, Dunn’s research is emerging at a time when our younger generations are more delighted than ever to cosplay as their elders. Eileen Fisher clothes are trending on TikTok, Julia Fox is waxing on about the beauty of silver hair, and there’s a certain chicness and sophistication associated with getting older today. Still, Dunn emphasises that at any age, it’s no one’s responsibility to take on the persona of a mythic owl. “One thing I did avoid in the book is the word ‘wisdom’ because I feel like there’s so much pressure on women to become wise when they get older,” says Dunn. “Well, maybe you’re not wise!” she laughs.
Instead, the conversation around menopause will ideally soon match the “openness about talking about periods and your bodies and mental health struggles,” brought on by Gen Z, says Dunn. “I’m hoping for the generation going through menopause now that we could just bust it wide open—get rid of the stigma and the shame around it,” she says. So, for a crash course, here is Dunn’s guide to 7 things no one tells you about menopause.
1. The difference between perimenopause and menopause
The perimenopause process typically starts in your mid-’40s and lasts from four (on average) to eight years. “It’s the years leading up to menopause when your periods gets erratic, when your body starts changing a little bit,” says Dunn. By the time it arrives, life is distracting on multiple levels. “It usually is happening in the middle of your career; you’re raising children, you’re caring for a parent, so you’re not really thinking about it,” she explains. Symptoms (below) can create “a kind of hormonal road that can be as rocky as puberty,” says Dunn, adding that it can worsen PMS symptoms. Then, there’s menopause, which has an average entry age of 51. “When you have gone 12 months without your period, then you are in menopause,” Dunn explains. “You never leave menopause; you’re post-menopausal for many decades, and peri is the time leading up to it—for me, perimenopause was worse than when my period finally went away.”
2. There are an extensive range of symptoms
“Everyone knows about hot flashes, but there are so many different ones: Brittle nails, dizziness, irregular heartbeat,” says Dunn of perimenopausal and menopausal symptoms, which can be as obscure as “formication,” the sensation of “having bugs crawling all over your skin—so there’s that,” she says. “It can just be confusing.” The reason Dunn mentions that there are “allegedly” 34 symptoms is that several experts she spoke with agree that there are likely many more. “If you don’t know what they are, you cannot connect them to what’s happening to you,” she says of the importance of understanding the range. “If you have an irregular period, you might not think that has anything to do with perimenopause; you might be thinking that you’re under stress or your birth control isn’t working—it could be any number of things, and that’s what happened to me.” Dunn experienced her first symptoms while taking care of her toddler at 45. “It’s exceedingly helpful to know what the symptoms are so you can get ahead of it instead of being caught, like I was, almost too late,” she says. Perimenopausal depression is also one of three hormonally linked mood conditions in women (including PMS and postpartum). “Women should be routinely screened for depression in perimenopause, which is seen as a window of vulnerability,” Dunn says. “It can be hard to separate anxiety and depression from general life stress.”
3. Normalising the conversation with your partner and friends is essential
“I cannot make enough of a case for transparency and normalising this conversation,” says Dunn. “I didn’t even know my mother’s family history with menopause because we never had a conversation about it until I wrote this book; she just suffered in silence.” In order for the discussion around menstruation to truly open up, it needs to be seen as another bodily function. “I had to make myself be very upfront about menopause,” Dunn remembers. “I talked about it to my friends, my husband, my 13-year-old, even at work,” she says. “I realized so many times that I wasn’t telling my husband what was going on,” she says, emphasising the importance of keeping partners in the loop. “Sex started to hurt, and I felt embarrassed that I was getting older. Who cares? I’m getting older; why didn’t I tell him what was happening? Instead, I started to avoid him.” She’s found this to be incredibly common after speaking with multiple counsellors of people in partnered relationships. “One just starts to avoid the other, and they think, ‘Oh, this is it; it’s never going to get better,’ and I wish I had been more open because it’s the only way that we’re going to drag the subject out of the shadows.”
4. Your beauty routine will need an overhaul
“All of your go-to products will stop working–let’s talk about that,” says Dunn, who wasn’t prepared for how thoroughly her needs would change. “I had to completely overhaul my entire routine, and my skin started getting really sensitive, which happens very often—your skin gets touchy and reactive.” Dermatologists recommended products for eczema, which she switched to for the body, and she started adding retinol for the first time to her skin care. “As my skin got noticeably drier, I used every kind of oil I possibly could; I have body oil, eyebrow oil, cuticle oil, lip oil, facial oil, if there is an oil, I put it on,” Dunn says, noting that additional luster has its own appeal now. She also layers products, looks for peptides, and for hot flashes, “misting really is your friend, although it can’t be just water, it has to be with glycerine, too, so you don’t get even drier.” As we speak, Dunn grabs her bedside bottle of Heritage Store Rosewater & Glycerine Hydrating Facial Mist and begins spritzing. She namechecks Pause Well-Aging products for being “really amazing”; Cerave Skin Renewing Night Cream (“The big tub really did the job,” she says); Aquaphor Advanced Therapy Ointment Body Spray, which is “really nice and doesn’t have tackiness”; and straight-up extra virgin coconut oil. For hair, she’s “tried it all” and calls Lolavie Perfecting Leave-In “absolutely the best for your newly frizzy, menopausal hair—it works so well.”
5. Flash periods are real
Like that scene in And Just Like That where Charlotte has a “flash period” in a pair of white pants, menstrual bleeding can become erratic. When Dunn saw the episode. “I called up Dr. Mary Jane Minkin at Yale, and I said, ‘Is that a medical term, flash period?’ And she said no, but that’s a very common experience.” When it happened to Dunn, she was on a Vogue assignment in the Bahamas. While swimming in open water, “I got my period for the first time in, I don’t know how many months, and there was a school of barracuda trailing us!” she recalls. “I asked our swim coach, ‘What are those fish behind us? They look quite large!’ And she said, ‘Oh no, no, no, they’re barracuda, and they’ll stay away unless you’re wearing flashy jewelry or you’re bleeding.’” Dunn made it back on board to tell the tale.
6. Seeing a specialist is extremely helpful
Dunn emphasises the importance of seeing a menopause specialist. “Most primary care doctors are trained for an hour, maybe, in menopause, they don’t know very much,” says Dunn. “Don’t tack it onto your ob-gyn visit—it’s a complex subject that needs more than 10 minutes as you’re about to leave, so make a separate appointment.” The good news is that certified menopause practitioners are incredibly easy to find on the NAMS (North American Menopause Society) website. “They’re very rigorous; they have to be recertified every three years, and you can do virtual visits,” says Dunn. “So many of these practitioners are brilliant researchers, department chairs at Ivy League schools—you can get appointments with people who have 500 research papers, and that is who will be in charge of your menopause case.” Since there’s no single person to fix every issue, it’s a helpful tool in pooling doctors. “If you have painful sex, if you have hot flashes, if you’re not sleeping, if your bones are becoming brittle, that’s a lot of different experts,” says Dunn of their knowledge of the latest treatments and medications. “It’s just heavenly to have someone like that who can develop a detailed treatment plan.”
7. Many symptoms are temporary
Symptoms can be managed, especially if you talk to someone about them. “Some women sail through menopause without any symptoms; it’s not always this doom slog,” says Dunn. For those experiencing the weight of them, though, there’s hope. Among the many brain researchers that Dunn spoke with, Pauline Maki at the University of Chicago, who has studied menopause and cognition for years, mentioned that her brain fog was not likely to last. “Brain fog and memory problems are a normal experience through menopause, and then, it goes away,” says Dunn. “And that is tremendously good news because how often does something come back into your life after it’s gone with your body or brain? So that I love.” Today, Dunn is experiencing a different level of symptoms already. “My hot flashes have almost gone away. My brain is back. I know how to manage my skin and hair. You can get through it with the right tools,” she says. Also, “It’s fantastic not to have your period anymore.” So there’s that.
This article first appeared on Vogue.com.