Setting Better Expectations
I've spent much of my professional life caring for women—listening to their stories, examining their bodies, teaching trainees, and trying to make sense of patterns that don't always fit neatly into textbooks.
And yet, some of the most revealing conversations I've had about menopause haven't happened in exam rooms. They've happened with friends over coffee. With colleagues in quiet moments after meetings. With women who lean in and lower their voices before asking, "Can I ask you something?" The question is usually some version of: "Is this normal?"
Why Expectations Matter So Much
One of the challenges with menopause is that many women arrive at it with very little framework. We know it's coming, vaguely. We associate it with hot flashes or the end of periods. But beyond that, expectations are often shaped by silence or by extreme stories.
Medically, menopause is defined as the point when menstruation permanently stops, typically between the ages of 45 and 55. But what most people experience, and what causes the most confusion, is the transition leading up to it, known as perimenopause. That transition can begin years earlier and unfold gradually, unevenly, and differently for every woman.
Globally, hundreds of millions of women are navigating this stage of life at any given moment. By 2025, more than a billion women worldwide will be postmenopausal. This is not a niche experience—and yet it often feels like one.
What I See Again and Again
From both clinical work and personal conversations, a few themes come up repeatedly:
- Symptoms don't follow a script.
- Changes are often subtle at first—sleep, mood, energy, focus.
- Many women don't immediately connect these shifts to hormonal changes.
- The uncertainty itself becomes exhausting.
Large international studies reflect this variability. Women across countries report fatigue, disrupted sleep, mood changes, irritability, and anxiety as some of the most common experiences during the menopausal transition. And yet, the way these symptoms show up and how much they interfere with daily life varies widely.
A Reframe That Helps
One of the most helpful mindset shifts I've found is letting go of the idea that menopause should look a certain way. There is no single "normal." There is only common and uncommon, expected and worth evaluating further. Setting better expectations doesn't mean minimizing symptoms. It means reducing unnecessary alarm, self-doubt, and comparison. It creates space to ask better questions and to seek support when it's needed—without assuming something is fundamentally wrong.
This is the first in a series of articles meant to offer that framework: not quick fixes, not absolutes, but grounded information that respects both data and lived experience. It is about using the best evidence we have, so women can spend less time wondering and more time living, working, and leading with confidence.