‘No Pausa’ walks with women on long road through menopause

“You will no longer be able to have children in any way,” they told María Eugenia Zapatero. She was 38 years old and had gone to the gynaecologist after a long time of noticing symptoms she didn’t recognise. Although motherhood was already out of her plans, she felt a knot in her stomach, as if a woman’s life ended when reproductive possibilities ceased. The reality was that María Eugenia was taking her first step on the long road to menopause – a journey that women living on this earth will experience at some point, yet few truly understand.

She was young and didn’t know why she was feeling what she felt. Why her body was changing naturally without warning: fluctuations in menstruation, intense hot flashes, insomnia at night. Added to this was the fact that she was living abroad, where medical sensitivity was different. So, she called an Argentine friend who was going through the same thing and asked what she could do: her friend suggested visiting the No Pausa website.

From her apartment in Madrid, Spain, she found a space of understanding on this website: “I’m not alone in this” was one of her feelings. From afar, she was able to navigate a place where she sensed hugs, information, community, and the possibility of professional support.

We all have different ways of encountering menopause. Some with a fear about fertility, like María Eugenia; others through a process of reflection, like Milagros Kirpach, co-founder of No Pausa and Operations Director. At just 25, she became aware of her body, hormonal biology, and fertility: menstruation would eventually end. But then what?

After finishing her university degree, she met for coffee with her then-mentor, Miriam Di Paoli, who later became a co-founder and CEO of No Pausa. In that conversation, Miriam told her about menopause, the physical and psychological changes she was experiencing, but most importantly, how long it took her to realise that it was ultimately a biological process. There was a click for both of them. One had the experience; the other had the push of curiosity.”

Combating ignorance

In 2019, they formed a civil association aimed at raising awareness about menopause. Initially, they knocked on doors (literally) to provide information, though they were often turned away. They later held their first meeting, which had fewer than 20 attendees, in a coffee shop. “We wanted to put the topic on the agenda. We started to understand what was happening and quickly realised that this individual personal experience was something collective and replicable,” Milagros confesses..

During those early attempts, they discovered that while everyone shared a biological experience, they also shared ignorance and a lack of support. “The lack of information ultimately impacts women’s quality of life,” explains Milagros. In fact, a British study showed that a million women could be forced to leave their jobs due to menopause-related symptoms and the lack of attention to these in the workplace.

Today, they aim to change this reality with their information network (as Milagros calls it). It’s a website dedicated exclusively to providing professional and scientific information about menopause from every possible angle: the types, symptoms, tips for coping during this stage, and even an observatory conducting in-depth research on the subject. They have essentially created a gateway to knowledge for everyone, with the goal of helping to dismantle stereotypes.

The first seed of misinformation lies in the misconception that menopause refers only to the day of our last period. In reality, women experience climacteric, a biological transition process that encompasses the before, during, and after menopause. “We misuse the term, reducing a day in our lives to a stage that lasts about 10 years. This reductionism perpetuates stereotypes that simplify, stigmatise and render invisible,” states Julieta Verna, a nutritionist who, along with gynaecologist María Victoria Pereiras Giuliano, is part of the No Pausa professional team.

In detail, climacteric is divided into three stages. First, there’s perimenopause, the period when the first symptoms related to declining estrogen levels appear, leading up to menopause. This typically begins in the mid-40s and is characterised by more intense hormonal fluctuations. Then comes menopause itself, marked by 12 consecutive months without menstruation.

Finally, there’s postmenopause, where hormones begin to stabilise, and symptoms decrease in frequency and intensity. This stage starts with those first 12 months without menstrual periods and can last up to five years. Throughout climacteric, more than 34 different symptoms can arise (over 90% of women report experiencing at least one), including hot flashes, night sweats, insomnia, mood swings, fatigue, vaginal dryness, joint pain, and memory lapses, among others.

According to research from No Pausa, 77.3% of women do not know that menopause refers to just one day in their lives. “I felt that I entered this stage with very little information. It’s not a disease, but it can bring very significant changes that are felt through sharp and bothersome bodily signals,” expressed Mariana Carbajal, a journalist, feminist, and author of the book Encendidas: Un viaje íntimo por la menopausia. Una guía para anticiparse y transitarla mejor, in an exclusive interview.

Ignorance can exacerbate symptoms and even lead to other consequences, according to nutritionist Verna. “Women who do not understand their symptoms may feel isolated and alone, thinking their experiences are not shared by others. This can lead to social withdrawal and decreased emotional support,” Verna details.

That’s why it’s crucial for this information to circulate at an early age. “In my environment, there’s a lot of taboo. I have no knowledge of menopause. Everything I know is very vague and general, probably because other elements take precedence at this age: pregnancy, sexually transmitted diseases, sexuality,” confesses 24-year-old Pilar de León in a conversation with this media outlet. “I think it’s highly relevant for women, but I don’t feel prepared to face that stage of life,” she adds.

Similarly, 31-year-old Natalia Zuluaga expresses a similar sentiment to Pilar but with more concern: “You only start to be warned about menopause symptoms when you’re close to it. I’m theoretically far from it, but I might have early menopause,” she reflects. “Socially, we don’t talk about it enough. There’s no explanation of the process. Often, it’s only mentioned in a joking context that stigmatises women,” she adds.

Moreover, the lack of information is not exclusive to women experiencing menopause; it also extends to healthcare professionals and systems – those who should be providing support. According to a World Health Organization study, 70% of women reach this stage without sufficient information to decide how to approach it. In many countries, the well-being of menopausal women is overlooked, and this process receives little attention in training plans for numerous healthcare workers.

One example illustrating this trend is that feminine tampons were tested with real blood only last year in the United States, decades after the product hit the market, according to a recent study published in BMJ Sexual & Reproductive Health. “The misinformation surrounding the taboo of ceasing menstruation has a high incidence on individuals and also incurs a high cost for the healthcare system,” says Verna.

After information comes treatment

While information is a starting point, it is not enough on its own. As a result, Miriam and Milagros decided to take a further step beyond creating a civil association (which remains active for informational and community purposes). In early 2023, they launched a startup that offers medical treatment to users in Argentina, Chile, and Uruguay. Thus, MenoCheck was born – a self-assessment test costing approximately 10,000 Argentine pesos (about $10) that allows individuals to identify where they are in the climacteric process and what suggestions and recommendations exist for managing symptoms.

Once diagnosed with MenoCheck, users can choose from several options. They can consult their personal gynaecologist and continue their process individually; at this point, the person has only engaged in a simple beginning. However, they can also opt for in-depth follow-up to address symptoms with the No Pausa team.

For this, a one-time subscription fee of approximately 40,000 Argentine pesos ($40) for the “MenoCheck + Consultation” plan is required. This plan includes everything offered in the previous step and adds the possibility of a thirty-minute virtual consultation with a professional (nutritionist or gynecologist). Here, prescriptions can be given to alleviate symptoms, and personalised chat support is also available.

Those who want to enhance their treatment can subscribe to the Nutritional MenoPlan for a one-time fee of approximately 80,000 Argentine pesos ($USD 80). Over two months, a professional-led action plan is developed to address symptoms. This option includes a monthly one-on-one virtual consultation with a nutritionist, weekly group sessions to clear doubts, access to closed peer groups going through the same process, and constant virtual support.

What follows these treatments is a sense of relief among women, as Milagros describes. “First, it comes from understanding what’s happening to you and how to manage it. This is a crucial moment where whatever you do will define how you live your longevity. Second, it involves shedding the stigma and negative burden associated with menopause. Moving away from an image of aging and finality towards the reality of something that has nothing to do with that,” the founder elaborates.

According to data from No Pausa, they have already registered over 500 women who have taken the next step towards professional consultation with the team. Additionally, more than 250 users have opted for the MenoPlan to track their climacteric journey, and there are now over 120,000 women in the community sharing experiences, information, and support.

Leticia Da Silva is a 45-year-old woman living in Montevideo, Uruguay. She began experiencing symptoms like menstrual fluctuations and joint pain at the age of 40. After tests, doctors diagnosed her with fibromyalgia, a condition unrelated to the climacteric, which she was actually beginning to experience. Some professionals told her it was just “part of life”. But her suffering only increased, along with her anguish over not understanding what was happening.

When hot flashes began – one of the symptoms most associated with menopause – she realised that what she was experiencing might be connected. “A friend mentioned No Pausa, and I started following them. I realised that everything I read on the site resonated with me. I began to wonder if what I truly had was perimenopause,” she explains.

However, she struggled to find a doctor or professional who understood her situation. Consequently, she decided to enroll in the Nutritional Plan. “It truly changed my quality of life. My headaches disappeared, and I stopped taking medication to alleviate them. I learned how to eat better, lower my sugar spikes and increase my protein intake. I exercise consciously, thinking about my muscle mass,” she details.

A similar experience occurred for María Eugenia, who was initially diagnosed with the end of her fertility before menopause. After completing the MenoCheck, she accessed the consultation plan that guided her through all the tests she needed to have done over the next two months, as well as some medications to manage her symptoms. In her case, she started hormonal replacement therapy and natural supplements.

“I’ve been at it for a month, and my symptoms are much better. However, I found it crucial to talk to someone who could explain that this is a process that takes time and that you need to give it at least two months to see effects,” she comments. “I still need to incorporate the nutritional aspect. So far, I’ve found a very simple and friendly system to access,” she describes, referring to No Pausa’s digital platform.

A pending issue

Although both Leticia and María Eugenia have physically improved, there remains a crucial need: psychological support. “I didn’t plan to have children at this age, but perhaps someone else did, and having support can be fundamental,” María Eugenia explains. “There’s an idea that when fertility ends, life ends. But nothing ends; rather, everything begins – the enjoyment. Understanding that is a process,” she shares.

In this vein, Leticia points out that navigating the climacteric and menopause often involves a complex mix of emotions. “I notice that everything stresses me out more; I’m more anxious. I would love to have the tools to manage these feelings,” she says. She notes that being in Uruguay makes it difficult to find healthcare professionals aligned with No Pausa’s values.

The No Pausa platform operates digitally, and for now, it will remain that way. The challenge arises when people from various Spanish-speaking regions wish to continue their journey after the MenoCheck. Although virtual consultations are possible, medical prescriptions and orders for tests aren’t valid everywhere in the world. This was a difficulty María Eugenia experienced firsthand while in Spain, wanting to begin her treatment. Currently, only women in Argentina enjoy this benefit. Women in Uruguay and Chile are referred by the team to professionals so they can undergo the necessary tests.

However, expanding also comes with its costs: Not all countries in Latin America, where they aim to be pioneers, face the same issues – both socially and in public health systems. This challenge becomes an obstacle whenever they approach a new nation with their initiative. “We need to understand the idiosyncrasies and the ongoing conversations around this topic,” Milagros says.

Rural areas: Tough gap to fill

In this context, even expanding within the same region can pose challenges. Being a digital platform, reaching areas where digital resources are scarce already presents a limitation. According to a report from the Inter-American Institute for Cooperation on Agriculture, while Argentina ranks as one of the countries with the most connected rural areas, the digital divide compared to urban zones can reach up to 70%.

Furthermore, No Pausa’s current audience primarily belongs to the ABC1 socioeconomic segment, where most have private or mixed health insurance – indicating a higher purchasing power. However, not all women can afford health services; many depend on public systems, which often lack the necessary professionals. This reflects a broader structural social issue.

No Pausa has already attempted to bridge this inequality gap. Through their civil association in 2019, 2020, and 2021, they conducted a series of workshops in Barrio 31, a popular neighborhood in Buenos Aires. Over a month, they held four meetings covering topics like menstrual biography, nutrition, sexuality, and gynecology. They successfully validated this format, directly impacting over 250 women. However, they currently have no plans to continue such initiatives in 2024, which may limit their outreach.

Men are part of the conversation too

The dissemination of information should not only transcend geographical and socioeconomic boundaries but also engage those in society who, while not experiencing menopause themselves, have close relationships (romantic, familial, or friendly) with women. Research from the National Institutes of Health confirms that while some men are aware of women’s biological transitions, educational interventions could help them provide better support. “I know the basics. We’re quite distant from the topic,” says Julio Asensio, 62.

No Pausa has yet to develop an exceptional service for men, but they have received requests from couples seeking help to navigate the climacteric period together. For now, they provide open and free information. “If a woman is suffering, there must be greater access to information. I want to be informed,” Asensio confesses.

For a long time, discussions about natural processes in women were absent from the conversation. A report from Balance Menopause, a UK initiative similar to No Pausa, indicates that 8 out of 10 women never discussed menopause at home. “For the women of my generation, starting to menstruate was already a taboo. Today, they still carry the notion that biological intimacy is not shared with men, but rather among women,” Asensio reflects on his experience.

Ultimately, this represents another chapter in the necessary social deconstruction, especially concerning women and their bodies. “There’s an idea that we came to nurture. Leaving behind menstruation, that potential for motherhood places us in a position of being discarded. There’s a collective unconscious that validates the idea that when reproductive life ends, life itself ends,” Milagros contemplates. “Many women do not experience this natural process in fullness but rather through repression,” she elaborates.

Today, No Pausa aims to grant women that freedom.

This story was initially published in RED/ACCIÓN (Argentina) and is republished within the Human Journalism Network program, supported by the ICFJ, International Center for Journalists.