Dare I Say It: Everything I Wish I'd Known About Menopause

The Grandmother Hypothesis is an evolutionary theory that suggests women evolved to live beyond their reproductive years because they provide valuable care and support to their descendants. Watts references this hypothesis when discussing the broader societal role of menopausal and postmenopausal women, arguing that women’s worth extends far beyond their ability to bear children. 

The theory posits that grandmothers historically played a key role in ensuring the survival of younger generations by passing down knowledge, providing childcare, and maintaining family structures. Watts appreciates this perspective but also challenges the assumption that all postmenopausal women must serve as caretakers, stating, “Every woman will have to figure out what this transition means for her” (208). By introducing this concept, Watts reframes menopause as a phase of continued significance rather than decline, reinforcing her argument that midlife can be a period of empowerment and reinvention.

Hormones play a central role in menopause, as fluctuations in estrogen, progesterone, and testosterone contribute to many of the symptoms women experience during this transition. Watts explains that hormones function as chemical messengers, regulating various bodily processes from reproductive health to cognitive function and metabolism. Estrogen, the most well-known hormone affected by menopause, declines significantly, leading to symptoms such as hot flashes, vaginal dryness, and increased risk of osteoporosis. Progesterone, which helps regulate the menstrual cycle and balance estrogen, also decreases, contributing to mood swings and sleep disturbances. Testosterone, though often associated with men, is also important for women, affecting libido, muscle mass, and overall energy levels. Watts discusses how testosterone therapy can be beneficial for some menopausal women despite its relative lack of mainstream attention. 

By providing clear explanations of these hormonal shifts, Watts demystifies menopause and encourages women to explore treatment options, such as HRT, that may help regulate these changes. She emphasizes that understanding hormonal health is key to making informed medical decisions and managing menopause effectively.

Hormone Replacement Therapy (HRT) refers to the medical use of hormones—most commonly estrogen, progesterone, and sometimes testosterone—to relieve menopause symptoms. Watts devotes significant attention to HRT, particularly in correcting the misinformation that has surrounded it for decades. She explains how early studies created widespread fear about HRT’s link to breast cancer, leading many women to avoid it unnecessarily. 

Through expert interviews, including insights from Dr. Mary Claire Haver and Dr. Jen Gunter, Watts clarifies that for many women, HRT can provide significant relief from hot flashes, vaginal dryness, brain fog, and even long-term health risks like osteoporosis. She recounts her initial skepticism toward HRT and her journey toward better understanding its benefits, arguing that women should have access to accurate information when making treatment decisions. Watts encourages readers to consult menopause-literate doctors and to consider HRT as one of many possible tools in their menopause management plan rather than an inherently dangerous option.

Hot flashes are one of the most common and disruptive symptoms of menopause, characterized by sudden, intense feelings of heat that can be accompanied by sweating, flushing, and rapid heartbeat. Watts describes how hot flashes can strike unpredictably, affecting sleep, daily activities, and overall comfort. She explains that hot flashes occur due to hormonal fluctuations, particularly declining estrogen levels, which interfere with the body’s ability to regulate temperature. 

In Dare I Say It, Watts presents multiple strategies for managing hot flashes, including lifestyle adjustments, cooling techniques, and medical treatments such as HRT and non-hormonal medications like Veozah. She also challenges the notion that women must simply tolerate hot flashes without intervention, emphasizing that while menopause is natural, suffering through its symptoms should not be. By addressing hot flashes openly, Watts helps normalize the conversation around menopause and encourages women to seek relief rather than endure discomfort in silence.

Menopause marks the end of a woman’s reproductive years, officially diagnosed after 12 consecutive months without a menstrual period. In Dare I Say It, Watts describes menopause not just as a biological milestone but also as a major life transition that affects physical health, mental well-being, and self-identity. She highlights the wide-ranging symptoms that can accompany menopause, from hot flashes and brain fog to mood swings and changes in libido. 

While menopause has long been framed as a sign of aging and decline, Watts actively works to redefine it as a stage of empowerment and opportunity. She critiques the medical field’s historical neglect of menopause-related research and treatment, advocating for better healthcare, education, and open conversations. By sharing both her own experiences and those of other women, she demystifies menopause and encourages readers to approach it with knowledge and self-compassion rather than fear or shame.

Perimenopause refers to the transitional phase leading up to menopause, during which hormone levels fluctuate and symptoms such as irregular periods, night sweats, and mood swings begin to appear. Watts discusses how perimenopause can last for years, often beginning in a woman’s late thirties or early forties, and how many women, including herself, enter this stage without realizing what is happening to their bodies. She reflects on her confusion when she first started experiencing symptoms at 36 while undergoing fertility treatments, highlighting the general lack of awareness and education surrounding perimenopause. 

Through expert insights, Watts clarifies that because perimenopause is not officially diagnosed through a single test, many women struggle to get clear answers from their doctors. She urges women to track their symptoms, seek knowledgeable medical professionals, and advocate for themselves in healthcare settings. By shedding light on perimenopause, Watts provides readers with the tools to recognize and navigate this critical phase of life more effectively.

Sexual dysfunction during menopause encompasses a range of challenges, including decreased libido, vaginal dryness, and pain during intercourse. Watts addresses this issue candidly, arguing that menopause-related sexual changes should not be met with shame or resignation. She highlights the societal double standard in sexual health, pointing out how erectile dysfunction is widely discussed and treated while women’s sexual struggles are often ignored or dismissed. 

She presents multiple solutions for maintaining a fulfilling sex life during and after menopause, including hormone therapy, lubricants, vaginal estrogen, and open communication with partners. Watts also acknowledges the emotional aspect of sexual dysfunction, noting that body image changes and anxiety can further impact desire and intimacy. By normalizing discussions around menopausal sexual health, she empowers women to seek medical advice and embrace pleasure as an important component of well-being rather than something to be sacrificed with age.

Watts introduces the concepts of “true” and “false” anxiety through the work of Dr. Ellen Vora, a psychiatrist specializing in holistic mental health. “True anxiety” refers to an emotional response to legitimate concerns, such as financial stress or relationship issues, whereas “false anxiety” is caused by physiological imbalances, such as blood sugar fluctuations or poor sleep, that create unnecessary distress. Watts discusses how hormonal changes during menopause can exacerbate anxiety symptoms, making it difficult to distinguish between true emotional concerns and biologically-driven anxiety spikes. She advocates for a comprehensive approach to mental health that includes addressing physical triggers—such as ensuring proper nutrition, rest, and hormone balance—alongside traditional therapy and mindfulness techniques. By explaining this distinction, Watts provides readers with a framework to better understand and manage anxiety during menopause, reinforcing the idea that emotional well-being is deeply connected to physical health.