Oprah Shares Scary Menopause Symptoms
Joining the ranks of A-list menopause advocates is entrepreneur Oprah Winfrey, who spoke candidly about "The Big M" in an episode of the Paramount+ series "The Checkup With Dr. David Agus."
In a discussion with Agus and her longtime friend and journalist Maria Shriver, Winfrey recalled how her mother, Vernita Lee, insisted that she didn't remember menopause.
"I couldn't get my mother to talk about [menopause]," Winfrey said. "My mother was a very shut-down person. I think she did not have symptoms that she recognized."
Why our mothers don't talk about menopause
Winfrey's experience with her mother is a common one, according to Mary Jane Minkin, M.D., a gynecologist who specializes in menopause at Yale School of Medicine.
"Our mothers just didn't talk about menopause," Minkin said. "One of my standard lines to my patients is, 'Oh, right, your mother and Queen Victoria never went through menopause,'" she said with a chuckle.
And it's not just our mothers who are tight-lipped about menopause, Minkin added. Society at large views menopause as taboo both because it relates to sex and it's a marker of age—"and we are a society that worships youth," she said.
Winfrey, lacking reliable information from her mother and healthcare professionals, had trouble identifying her own perimenopausal symptoms.
She described how she was troubled daily by seemingly inexplicable heart palpitations, mood swings and restlessness.
"I have journals filled with 'I don't know if I'll make it until the morning,'" Winfrey said on the show. "I thought I was going to die every night."
It didn't occur to Winfrey to connect her symptoms to menopause because she wasn't experiencing hot flashes.
"I think if you don't have hot flashes, which I didn't have hot flashes, then you don't understand the mood swings," Winfrey said.
According to Stephanie S. Faubion, M.D., medical director of the North American Menopause Society (NAMS) and director of the Mayo Clinic Center for Women's Health in Jacksonville, Florida, hot flashes are by far the most common symptom, but heart palpitations, sleep problems and mood disturbances are also hallmarks of perimenopause and menopause.
Despite the routineness of her symptoms, Winfrey went to five different doctors without finding answers.
"No one ever once suggested that it could be menopause," she said.
This may be due, in part, to a lack of training in menopause management, according to Faubion.
"The fact is that we're not training many providers to be educated in menopause management anymore," she said. "We did a study a couple of years ago that demonstrated that internal medicine residents, family medicine residents and OB-GYN residents get at most one to two hours of menopause education during their residencies and, by and large, do not feel comfortable managing menopause when they get out."
Eventually, it was a co-worker, not a doctor, who suggested Winfrey might be going through menopause. And it was a friend, not a doctor, who suggested that she take an estrogen supplement, a type of hormone replacement therapy (HRT) that can help ease the symptoms of menopause.
Winfrey wrote about her experience with estrogen replacement therapy in Oprah Daily in 2019. "[My estrogen] comes in cream form; I just rub it on my arm," she wrote. "All it took was one application, and the world returned to technicolor. I could feel my countenance shifting. For the first time in years, I was sleeping the whole night through."
What to know about estrogen replacement therapy for menopause treatment
According to Minkin, the cause of many menopause symptoms is the loss of estrogen.
"The exact mechanisms are still to be determined; we're working on that," she added, speaking on behalf of the medical community.
"When we are taking estrogen, our brain doesn't know the estrogen isn't coming from the ovaries," Minkin said. "The brain stops going on overdrive; our adrenaline levels drop; we make less of the stress hormones that drive us nuts."
Minkin noted that not everyone is a good candidate for hormone replacement therapy—specifically, people with a history of breast cancer or blood clots—and it's best to begin therapy within 10 years of menopause onset.
If your practitioner doesn't feel comfortable discussing menopause, Minkin recommended taking your menopause journey into your own hands.
Both Minkin and Faubion directed women to the NAMS website, which includes a Find a Menopause Practitioner tool that lets you search for certified menopause providers in your area.
Faubion noted that the providers listed are verified as NCMP, or NAMS certified menopause practitioners, meaning they have to pass a stringent test demonstrating expertise in menopause management.