Menopause: shattering the silence

Menopause: a life stage
Technically defined as the first 12 consecutive months without a menstrual period, menopause is anything but a uniform experience. Its timing and course vary with age, health and individual circumstances. It may occur naturally or be induced abruptly by medical interventions such as surgery, chemotherapy or certain hormone treatments.

A still-mysterious onset
There is still no biomarker or lab test that can reliably predict when menopause will begin. Genetics, however, appear to play a major role: the timing in a woman and her mother can be correlated by as much as 85%. Research has also mapped around 100 genetic variations that, when severe enough, trigger premature ovarian insufficiency (POI) or early menopause. The same genes regulate the timing of natural menopause, and many play a key role in repairing damaged DNA.

Early vs. late onset
In the absence of medical or surgical intervention, menopause typically occurs after the age of 45. It can also be induced by surgery, specifically ovary removal surgery, or brought on by cancer treatments, such as chemotherapy, endocrine therapy or radiotherapy. Menopause is considered "late-onset" after age 55 and "early" (or "early-onset") between ages 40 and 45. Menopause before the age of 40 is classified as "premature ovarian insufficiency" (POI), at which point it is considered pathological.

A three-phase process

Produced exclusively by the ovaries, oestrogen and progesterone are two of the body’s key reproductive hormones. During perimenopause, their levels fluctuate sharply before oestrogen falls substantially at menopause, followed by a decline in progesterone. Testosterone, meanwhile, decreases more gradually and steadily.
Perimenopause: Average age: 47 – Average duration: 4 years 
Menstrual cycles become irregular, sometimes accompanied by symptoms that affect daily life, such as night sweats, hot flushes and weight gain, before complete cessation of ovarian function. 
Menopause: Age 51 on average in France
Benchmark Definition (WHO, 1996): the permanent cessation of menstruation resulting from the loss of ovarian follicular activity, recognised to have occurred after 12 consecutive months of amenorrhea. 
Postmenopause: Past age 51 
Phase after menopause 
Average age (years) 

Diverse symptoms

87 % of surveyed women report at least one menopause-related symptom alongside the cessation of periods. 20 to 25 % experience severe symptoms that impact their quality of life*
* Data sourced from the ELISA study (Toulouse University Hospital, July–August 2020), which surveyed 5,000 women aged 50–65.  Despite criticisms over its pharmaceutical funding (Theramex), it remains the most detailed study to date of menopausal symptoms.

Symptoms can last anywhere from a few months to more than a decade. 

• 68% genitourinary issues: vaginal dryness, painful intercourse, frequent urge to urinate
• 59% hot flushes, night sweats
• 52% joint stiffness and pain, worse in the morning or after rest
• 61% disrupted sleep patterns
• 58% irritability, mood swings, brain fog, anxiety/depression, weight gain
• 48% hair growth changes, drop in libido

Silver lining
The end of periods can bring a profound sense of relief, particularly for those who have experienced painful cycles, heavy bleeding, hormonal migraines or restrictive, poorly tolerated forms of contraception. For the one in ten women living with endometriosis, menopause can offer a welcome reprieve from a highly painful, chronic inflammatory gynaecological condition.

To take hormones or not: that is the question

In 2002, the US Women’s Health Initiative (WHI) study sent shockwaves through the medical community by linking Menopause Hormone Therapy (MHT) to heightened risks of breast cancer and cardiovascular disease. The findings contributed to a sharp decline in MHT use in France, from 50 per cent in the early 2000s to just 4.4 per cent in 2025. However, this study, while valuable, had important methodological limitations, including an unrepresentative sample, North American prescribing protocols that differed from those used in France and treatment initiated later than is now considered appropriate. So where do we stand on MHT today? 

In the short term, MHT cuts ‘climacteric syndrome’ — hot flushes, night sweats, insomnia, mood swings — by an average of 75 per cent. Long-term benefits are equally striking: a 30 to 40 per cent drop in osteoporosis fractures and a 30 per cent reduction in overall mortality when initiated early.

These benefits depend on several conditions: starting treatment within ten years of menopause and before the age of 60, limiting duration to seven years and using natural progesterone — the standard approach in France — rather than synthetic progestogens. Outside these parameters, the balance of benefits and risks may change, with potential risks including heart attack, stroke, breast cancer and meningioma.

Findings from the French E3N cohort (Inserm/Gustave-Roussy), which has followed 100,000 women since 1990, point to an increased risk of ovarian and endometrial cancers with MHT. Although less common, these cancers can have poorer prognoses. Recognising the therapeutic merit of MHT, the French National Authority for Health recommends the use of MHT "when women experience severe distress", provided that "clear, tailored information is given to patients".  It recommends "the shortest possible treatment duration, re-evaluated at least annually." In France, women use MHT for an average of 5.1 years.

Since 2025: a new era of care

Like pregnancy, menopause is a natural biological phenomenon — one that can nevertheless require medical support when symptoms become severe or health risks escalate. France is now developing dedicated, multidisciplinary menopause clinics to meet that need. At the start of 2025, Toulouse University Hospital was the only public institution with a dedicated centre. Since then, Bordeaux University Hospital has opened an expert centre, while Lyon has introduced a specialised clinical pathway. In Paris, AP-HP offers specialised consultations. Since 1st April 2026, women aged 45 to 65 can also benefit from a free ‘menopause consultation’. The measure brings France closer to countries such as Belgium, the UK, Canada and Australia, where menopause has been incorporated into public healthcare.

And in the workplace?

Menopause remains taboo in the workplace. A 2023 study by Kantar, MGEN and the Fondation des Femmes found that a third of the French population finds it difficult to talk about, while 53 per cent feel anxious about raising the subject. An earlier survey found that only half of women living with a partner had ever discussed menopause with them. This is hardly surprising: society’s attitudes towards menopause are shaped by centuries of cultural norms and gender relations. For women, ageing still carries a social penalty, compounded by the persistent belief that productivity declines after 50. 

According to sociologist Cécile Charlap, menopause is still viewed as a departure from the fertile norm, rather than simply a new hormonal phase.

Fearful of being seen as past their prime at work, women often conceal their symptoms, sometimes cutting back on their working hours as a result, according to a June 2023 report by the Senate Delegation for Women’s Rights. The report also highlights the heavy toll on physically demanding jobs, particularly in healthcare and cleaning, where symptoms such as joint pain can be especially debilitating.

Gradually, however, attitudes are shifting, starting with the formal recognition of the very real physical impact of menopause. While stopping short of recommending dedicated ‘menopause leave’, the 2025 parliamentary report calls for its impact on women in the workplace to be measured, employers to receive appropriate training and menopause awareness to be integrated into occupational health services. In the workplace, corporate initiatives are gaining traction, from awareness programmes at Schneider Electric and Sanofi to flexible working arrangements and remote-work options at BNP Paribas.

« Let's show off!»

In 2025, photographer Caroline Fabre presented ‘Nous afficher !’, a documentary project with a strong political dimension that challenges the silence surrounding menopause. Struck by the changes in her own body and society’s silence around them, the artist sought out 20 women and photographed them in their homes, creating raw, intimate portraits.

True or false?