Millennials know more about menopause than other generations. Why is it so hard?

Whitney Cummings thought menopause would include mall walking and knitting, comfortable shoes and the end of her sex life.

The comedian grew up believing that once a woman turns 40, it’s over.

Now at 43, with friends entering perimenopause, she sees it in a whole new way.

“I felt like my life was just starting at 40 … I finally had wisdom, making good decisions in friendships, relationships and work. You can’t tell me I’m falling apart. I’m finally cool,” she tells USA TODAY. “They’re not doing shame. You go on TikTok and ‘I’m 35. I’m in perimenopause. Here’s the deal, here’s my patch, here’s my cream.’  It’s the best.”

Millennials – now 30 to 45 - are approaching menopause and perimenopause with more information and understanding than previous generations. They know about estrogen patches, testosterone cream, and finding doctors who treat symptoms not just lab results. In many ways, these women are re-inventing the way they approach menopause.

Are millennials in menopause?

Millennials are quickly discovering that their symptoms – brain fog, frozen shoulder and itchy ears – are perimenopause, the years leading up to menopause when a woman still has her menstrual period but hormone levels fluctuate. Menopause typically begins from age 45 to 55, and perimenopause comes two to 10 years prior.

The oldest millennials – now the largest generation − are entering menopause and many more are starting perimenopause.

And the generation that was mocked for eating so much avocado toast that they no longer could afford homes is being credited with reinventing the way menopause is navigated.

“Millennials are coming into this phase with far more information and a willingness to question outdated medical guidance,” Dr. Mary Claire Haver tells USA TODAY. The obstetrician and gynecologist wrote “The New Perimenopause.” “They are advocating for themselves earlier, seeking evidence-based care, and building communities where these conversations are normalized. That combination of curiosity and confidence is changing the standard of care in real time.”

How millennials are changing the menopause script

Millennials’ moms were mostly Baby Boomers, who now are 62 to 80. Their generation barely spoke about menopause and many suffered through it without hormone therapy after the 2002 Women’s Health Initiative study linked it to a higher risk of breast cancer, heart attacks and strokes in postmenopausal women. The risks, recognized later, were mostly found in women who were older when they started hormone therapy. But hormone therapy dropped from 40% before the study to about 5%.

Many in Gen-X had never heard of perimenopause. They learned about it after they were in menopause and found out they had been misdiagnosed with depression, anxiety or often ADHD in the years prior when they likely needed estrogen.

More millennials are recognizing perimenopause in real time, reading about treatment options, looking at personalized plans, and finding solutions such as telehealth companies.

“Millennials have been called the entitled generation. And call us entitled, because we are entitled to quality health care,” says Lauren Tetenbaum, 41, who wrote the book “Millennial Menopause.” “I hope and expect that we won’t be told just to suck it up and ignore it.”

They are coming to appointments with apps tracking their periods and symptoms − and armed with lots of ideas.

“They grew up with wearables, so they are sharing their data. They want doctors to understand them, not just the age they are,” says Kathleen Jordan, chief medical officer for Midi, the largest provider of menopause care in the United States. “They want smart care, personalized care.”

The demand for menopause care keeps increasing

Even as this next generation enters menopause, the medical community isn’t entirely ready.

While the number of certified menopause providers has quadrupled in the past 10 years, according to the Menopause Society, the number of women seeking care has gone up exponentially with women starting hormone therapy earlier and staying on it longer.

Women still struggle to find doctors who specialize in perimenopause and menopause.

One in three women 35 and older still doesn’t know if she is in perimenopause, according a new survey conducted by Flo and Wakefield Research. And with more women giving birth in their late 30s, they often go from postpartum to perimenopausal.

Rebecca Garity Pinto, 43, says after giving birth to her second child at 35, she didn’t feel like herself.

The fitness coach gained weight, mostly in her mid-section, despite strength training and eating healthily.  She was tired all the time.

After her doctor told her that her “labs were normal,” she began her own research. Then she had a telehealth appointment with a menopause specialist.

“It made me feel like there was hope. It wasn’t all in my head,” says Garity Pinto, who started hormone therapy for perimenopause. “Knowing menopause is next and the options I have gives me more control and makes me feel more optimistic about it all. You don’t have to suffer through it."

Embracing menopause and finding optimism

Almost 70% of women ages 38–50 say they felt more prepared for puberty than perimenopause, according to the Flo survey.

“Doctors need to approach this the same way they do with girls who are 10 or 11 and talk about their period coming,” Tetenbaum, a therapist and certified menopause provider says. “Women can be very surprised, maybe they know the term perimenopause, but they don’t think it applies to them. Once they understand it, that they are in perimenopause they want all of the information.”

Gen-X has made it easier for millennials to not just talk about menopause, but embrace it, says Raquel Alexander, the chief marketing officer with Alloy.

“In many ways, they removed the fear,” she says. Seeing high-profiles celebrities such as Halle Berry, Drew Barrymore and Naomi Watts talk about menopause has helped.

 “Once you work on your health and make sure you get good treatment then this can be a really great time in your life," Alexander, 39, says. “Millennial women are starting to see this."

Cummings says she no longer fears menopause.

She recently partnered with Hone Health, a telehealth company focusing on longevity, to launch a "Death to Midlife" campaign to rebrand the time as something to embrace rather than fear.

“Words like midlife brainwash us. At 40 I feel like my life is just beginning. I finally am in a place (where) I know what I like, what I want, I know who I am,” she says. “Women over 40 or 45, whose kids are grown are who will change the world.”

Laura Trujillo is a national columnist focusing on health and wellness. She is the author of "Stepping Back from the Ledge: A Daughter's Search for Truth and Renewal," and can be reached at [email protected].