Menopause: German lawmakers push to break a taboo

Menopause "remains a taboo. It is simply not talked about, culturally, socially, or politically, even though it affects half of the population directly and the other half indirectly," says We Are 9 Million, a group of German doctors, pharmacists, academics and activists named after the number of women in Germany going through what is euphemistically known as "the change."

On its website, the group lays out what women, doctors, and researchers have been saying for years. The overall lack of funding and attention paid to women's health — from medical studies having mostly male subjects to women's heart attack symptoms not being taught in medical schools — has also had a huge impact on how little is known about menopause, which affects women at some point between the ages of 45 and 55.

Symptoms can include not only well-known hot flashes and insomnia but also depression, cardiovascular disease and neurological issues like migraines and difficulty concentrating. At least one-third of women have extreme versions of these symptoms, causing major disruptions to work and family life.

We Are 9 Million points out that menopause is still treated as "the stepchild of gynecology," receiving minimal attention in a gynecologist's studies and none at all for a general practitioner. With doctors only allowed to charge health insurance companies €16 ($17.30) for menopause consultations, there is no financial incentive for this to change.

Women's issues shrouded in silence

Yet that is precisely what a new proposal from Germany's center-right CDU/CSU bloc is trying to do. The plan calls for menopause to play a bigger role in medical studies and companies' health management practices.

"We need to bring this topic out of the taboo zone," Emmi Zeulner, a trained nurse and now CSU lawmaker who brought the proposal to the Bundestag, told DW. "Menopause happens in the 'prime time' of life. Women are settled in their jobs, in their family life. They have many responsibilities."

She explained that this makes menopause not just something that women need to grit their teeth through but an important subject for younger women, men and boys, and the economy as well.

The proposal was greeted by some in Germany's governing coalition of the center-left SPD, Greens, and the neoliberal Free Democrats (FPD). Green party member Saskia Weishaupt said she "welcomed" the initiative.

Like endometriosis, infertility and menstruation, menopause is so rarely foregrounded in medical and social settings that "often women don't even know their symptoms are menopause," Weishaupt said.

Conservatives court female voters

SPD lawmaker Heike Engelhardt was not so convinced. Accusing the CDU/CSU of electioneering ahead of next year's federal vote, she questioned why "after 16 years in federal office" under former Chancellor Angela Merkel, the bloc did nothing about it then. She criticized the proposal's vagueness and pointed out that earlier this year, the conservative bloc voted against a government budget that allocated millions of euros to funding women's health research.

The center-right has indeed been struggling to sway female voters. The CDU's candidate for chancellor, Friedrich Merz, recently made headlines for saying he would not try to impose a gender balance in his cabinet. Opinion polls show Merz is unpopular with voters in general, but especially with women.

In 2017, nearly 30% of CDU/CSU voters were women. By 2021, with Merkel out of the picture, that number fell to 25%.

Seeking a cross-party plan

Despite the dearth of women in the halls of power, Zeulner said she hopes for a "cross-party plan. Unfortunately, the SPD is being reluctant." Other challenges to her proposal include a lack of gynecologists, particularly in rural areas.

Asked how much the plan would cost, Zeulner said, "It is possible that the plan actually saves money," as earlier medical interventions are associated with reduced costs down the road. "Women won't have to wait five, six, seven weeks or longer for an appointment. And they also will be back at work sooner."

Responding to Engelhardt's criticism, she added, "I would never say that we didn't focus on women's health, we were just focused on many other topics. Topics that were and are also important (during the Merkel years). We supported research and funding for lipedema and fertility. Of course there is always more you can do," which is why they are talking about menopause now.

"The governing coalition has been in power for three years, not three weeks," she said. "And even the 15 million euros they earmarked for women's health research earlier this year has already been reduced."

There is reason for hope, however, Zeulner noted, citing the US and UK as international examples where female politicians are engaged in cross-party initiatives to shatter the silence around menopause.

Edited by Rina Goldenberg

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