INTERVIEW - "Women have long been told that they would eat an old, dried-up biscuit," says gynecologist Susanne Spoerri

Ms. Spoerri, middle-aged women are becoming more visible, thanks in part to books like Miranda July's "On All Fours" or films like "Babygirl" with Nicole Kidman. Menopause is celebrated as a phase of self-empowerment, the best time in a woman's life. How do you perceive this breakthrough?

In fact, the years in which women lose their ability to have children can be very liberating. You've achieved a lot professionally, perhaps reaching the peak of your career. The children are past the worst, and you have more time for yourself and your partner. At this age, a woman usually knows much better what she wants. I see this in my patients.

So everything is wonderful?

No. A woman must first work for this liberation by going through a phase of uncertainty.

For a long time, menopause was perceived as threatening. Women were told their lives were over at fifty. Now, the taboo surrounding it has been completely removed. How does this manifest itself in your practice?

There's more openness, but I still see many women who don't simply accept menopause. It remains a nightmare. For too long, women have been told that menopause will turn them into a dried-up old cookie.

Is that what women say?

It's noticeable. For the past two or three years, my patients have been asking for hormones as soon as they reach a certain age. This starts with women in their forties, who feel the first signs that something is happening to their bodies. They become alarmed as soon as the interval between periods becomes more irregular. Demand for hormone replacement therapy has skyrocketed.

What happened?

The book "Woman on Fire" by American gynecologist Sheila de Liz has had a huge influence. Practically every second woman reads it today, and friends give it to each other as gifts. It's incredible. I've been and continue to be asked about it all the time, so I finally read it myself to find out what inspires women so much.

De Liz speaks of the "fabulous menopause" one can experience if one is open to hormones. She practically praises their rejuvenating effects.

Much of it sounds Hollywood-like. De Liz attributes miraculous effects to hormone use, making any woman who forgoes it feel foolish. "You're doing something wrong," she's told. I don't want to demonize the book; much of it is medically correct. I'm just annoyed by how the only alternative to hormone use is presented, as if it's the only way to grow old fulfilled.

Were women in the past more likely to accept that their bodies were aging and changing, or were they simply more hesitant about taking chemicals?

The majority of middle-aged women refused to take hormones, even women who would have benefited from them because their menopausal symptoms were so severe, and they suffered from sleep disturbances, mood swings, or joint pain. For a long time, the advice was: Stay away from hormones! Today we know that hormone treatment only slightly increases the risk of breast cancer.

Did women back then tend to say: Menopause is a natural process in a woman's life, it's part of it?

That's the argument many made. They wanted to endure this phase. Women still exist. But the pendulum is swinging the other way.

What is a common sign that worries women?

The absolute buzzword is "brain fog." It makes you forgetful, distracted. I hear that all the time. But not all "brain fog" is hormonal. A typical example is the woman with multiple stressors who notices her mental performance declining. It's important to ask about her living conditions.

Do you want to find out whether a woman is simply struggling with getting older or is under multiple pressures from her job and family?

I see many women in this multitasking mode, who have children and work. Their lives are so hectic. It's understandable that you're exhausted. Or that you experience this "brain fog." The brain isn't designed to allow you to think about several things at once. That's fine at 25. At around 40, things change. It's a short-circuit to think you just need to take hormones and you can carry on as before.

Do women also complain about a reduced desire for sex?

That's part of it. Libido is a delicate plant. Many women with libido loss have neither time for themselves nor for their relationship. After a full day of pumping, sexuality can't be checked off in bed in the evening. And even then, referring to the past, when one had more energy, is of little use.

Testosterone, the male hormone, has become a sought-after hormone alongside estrogen and progesterone for women in menopause. It's said to increase libido. What's the truth behind this?

While everyone's talking about testosterone these days, there are also many myths surrounding it. For Sheila de Liz, libido equals testosterone. When testosterone is firing, she writes, a woman's desire is so intense that she'd like to have an affair. But for women who are otherwise dissatisfied with their lives, testosterone will have little effect on libido.

Do you prescribe it?

Rare. Women's testosterone levels are low, falling steadily from the age of 20. A prescription must be well-founded, as the effects of maintaining testosterone levels above normal have not yet been researched. But as soon as a media article about it appears, my phone rings the next day, and women practically storm my practice.

Women who take testosterone report feeling less fatigued, sleeping better, being more focused and assertive, and no longer trying to please everyone. Is this just their imagination?

It is known that 30 percent of this can be explained by the placebo effect. But testosterone does indeed have the effect you describe; it actually enhances the so-called male attributes. This is why testosterone has repeatedly been used as a proven doping agent for women.

Do you risk becoming masculinized?

The dosage for women is much lower than for men. Testosterone levels must be monitored and checked regularly. If they are too high, irreversible side effects can occur. These include a deepening of the voice and male-pattern hair loss, which is characterized by the formation of a receding hairline.

Can one condemn a woman who wants to feel alive again? Wants to desire and be desired, and wants to feel the power of a healthy sexuality?

Of course not. People with a vibrant and satisfying sex life, whether they're 40, 50, 60, 70, or 80, are healthier. This is scientifically proven. The question is whether taking hormones is all it takes to feel alive again. I wish women would become more self-confident. Women sometimes apologize for being with the same man they like for 20 or 30 years.

You apologize?

In the sense: It's still the same guy, but we're doing well. That's wonderful! We don't stand still; we develop together. It bothers me when I see women conforming to male ideals. What does a 50-year-old do? He buys a Porsche and has a girlfriend 20 years younger.

Isn't that a cliché?

It's exaggerated, admittedly. And every woman around 50 deserves it. But it would be a shame if women declared this behavior the new normal.

So the downside of removing the taboo is that women are under pressure: Menopause has to be fabulous, and hormones seem to be the solution. From a feminist perspective, do you consider this a step backward?

When I started practicing in the 1990s, my bosses were exclusively male. They invariably recommended hormones because they supposedly helped women age better. They criticized me if I didn't prescribe hormones to a woman because she didn't have symptoms or didn't want them. Today, there's a renewed pressure to do everything to preserve beauty, the smoothness of the skin, the athletic body. Women remain objects. At the moment, however, this seems to be coming less from men; rather, women are putting pressure on themselves. I find that worrying.

For young women, the opposite is true. They're much more skeptical about hormones these days and are increasingly foregoing the contraceptive pill. Have you noticed this too?

The numbers also show this. My patients explain this with the fear that they might suffer from mood swings and become depressed. Social media has a huge influence. If a young woman posts on Instagram or TikTok that she has become depressed while taking the pill, distrust of this form of contraception spreads explosively.

Rightly so?

It's one of the rare side effects. The rejection seems to be more related to the fact that young women today are more depressed. Sometimes they also say they don't want to interfere with their natural processes, and that taking hormones is bad for their health. But the pill has been on the market for over 50 years. It has been continually developed based on experience and risks.

Young women are avoiding hormones, while older women are losing all their fear of them. Isn't that ironic?

It reflects social change, and that's what makes my work so interesting, beyond the medical aspect. It's striking how feminist and self-confident the young women are compared to women in their 50s and 60s. They say what they want, including regarding their sexuality, and express their desires openly.

What do you wish for women in midlife?

Middle age can be enriching. I always recommend that women become a little more anarchic. They can finally do what they want again. Many women are only able to shed the coats they've worn all their lives at 50. They can free themselves from the expectations placed on them by their parents or their environment. They have their careers, are well established in life, and earn their own living. They no longer have to please everyone. Many women have such a self-confident, wonderful charisma without conforming to the usual beauty standards of fake breasts and a size 8 dress. For me, that is true emancipation.

Susanne Spoerri is a gynecologist with her own practice in Zurich.