Will my generation be the last to go through menopause?

Just a few years ago, that would’ve seemed like a bizarre question — I’ve always assumed that I and every other human being with ovaries would eventually experience what my grandmother called “the change of life.” But now, researchers are calling into question what once seemed like basic facts of human existence. “What if menopause happened later?” they are asking. “What if it never happened at all?“

In recent years, patients have gained access to a wider variety of medications to treat menopausal symptoms like hot flashes and vaginal dryness. But newer treatments, one already in clinical trials, go deeper: The goal is not just to treat the symptoms, but to actually slow down ovarian aging so that the hormonal changes associated with midlife happen later — or maybe even never. “For the first time in medical history, we have the ability to potentially delay or eliminate menopause,” Kutluk Oktay, an ovarian biologist at Yale University, said in a release last year.

I cover reproductive health, and my inbox has been filling up for months with news of research like this. As an elder millennial barreling toward the uncertainty of perimenopause (which some research suggests can start as early as one’s 30s), I’ve received these updates with interest, sure, but also with a fair amount of trepidation.

On the one hand, the loss of estrogen that comes with menopause is associated with a host of illnesses and conditions, from cardiovascular disease to osteoporosis. Delaying the menopausal transition even five years “would result in an enormous improvement in terms of women’s health and decreased mortality,” Zev Williams, the chief of reproductive endocrinology and infertility at Columbia University Irving Medical Center, told me. “It’s a really exciting opportunity.”

On the other hand, the idea of getting rid of menopause can feel like yet another way of insisting that women remain young and fertile forever. At a time when JD Vance is talking dismissively about the “purpose of the postmenopausal female,” I’m unsettled by the prospect of treating women’s aging out of their childbearing years, in particular, as something that must be cured.

If the idea of stopping menopause is a fraught one, though, it’s also an opportunity to think about what we want from our later lives, and to consider what it would look like to balance the real medical concerns of midlife and beyond with the fact that women are flesh-and-blood human beings who, like everyone else, get old. As Ashton Applewhite, author of the book This Chair Rocks: A Manifesto Against Ageism, put it to me, “you can’t stop aging, or you’re dead.”

To understand menopause, it helps to understand a little bit about ovaries, the human reproductive organs that store and release eggs. Starting in puberty, these glands ramp up their production of estrogen, a hormone that leads to breast development and a host of other changes to the body. Throughout the reproductive years, the ovaries make estrogen and other hormones according to a monthly cycle to help prepare the body for potential pregnancy.

Starting around a person’s late 30s, however, estrogen production starts to drop off. By the mid-40s, people typically enter perimenopause, which means “around menopause.” This period is characterized by unpredictable ups and downs in estrogen, though on a general downward trend (Mary Jane Minkin, an OB-GYN who teaches at the Yale School of Medicine, likens the pattern to the stock market during the Great Recession). That hormonal decline can lead to symptoms like irregular periods, hot flashes, and night sweats.

A lot of the symptoms most commonly associated with menopause actually start in perimenopause, and they can range from annoying to devastating. Perimenopause has been getting a lot of media attention lately, along with more focus from brands who may want to sell you stuff to help you manage it. Problems like hot flashes and brain fog can cause women to miss work, resulting in $1.8 billion in lost work productivity in the US per year,........

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