At this Baltimore boutique, women talk menopause over manicures

The Baltimore storefront aims to draw women with services that help them look and feel good about themselves, such as a “signature glow facial” and a gel manicure.

But, as the women are being pampered at the Good Box Boutique on Howard Street downtown, they may find providers easing the conversation from hot compresses to hot flashes.

Menopause was once a taboo subject, but women are talking more than ever about the period of life when they go through hormonal changes and stop having menstrual cycles.

Celebrities including Oprah Winfrey and Halle Berry have brought the issue to the forefront with their own stories of life-altering symptoms such as hot flashes, brain fog, dry skin, hair loss and weight gain. And, after years of messaging that treatments for menopause came with too high a risk, federal regulators lifted the long-standing “black box” safety warning on hormone replacement therapy in November.

But there is still skepticism from some women and their doctors. Years of messaging that hormone therapy can cause cancer and other health issues are hard to undo.

The Good Box Boutique, which bills itself a feminine wellness social club, caters to women of color, who often have more intense side effects from menopause than white women.

It offers a purposeful twist on women’s wellness, in which traditional salon services are a floor away from a gynecologic exam performed by practitioners who have partnered with the boutique. An aim is to make women feel more comfortable talking about a subject that was likely avoided in their homes and even their doctors’ offices.

Berry and Winfrey are among many well-known figures who have advocated for more open discussion of the transition to menopause, officially 12 months without a period. The subject also includes perimenopause, which begins months and years earlier as hormones estrogen and progesterone begin to drop.

Women began refusing the most established treatment, hormone replacement therapy, after a 2002 study linked it to cancer. The study, called the Women’s Health Initiative, misrepresented the risk for many women, but it has taken two decades for federal regulators to make that finding official.

Soon after the U.S. Food and Drug Administration lifted the safety warning, Delayna Watkins, a nurse who recently began partnering with the boutique, scheduled a virtual meetup for women to ask experts questions and even hear from some skeptical of hormone therapy.

Watkins founded the Women’s Wellness Lounge, a nonprofit group that focuses on reducing health disparities, which includes offering consultations about menopause care at the boutique.

“We are a one stop shop wellness center; we aim to elevate the feminine care experience,” said an online message about a soft launch in April, which was liked by 6,700 people.

The announcement came in response to a post that caught the attention of Watkins and Shannon Thomas, the boutique’s founder, who said it encapsulated frustrations women, particularly women of color, often feel when it comes to their wants and needs.

“Why is there no Period store??? A one stop shop for all your flow needs???” the post began.

“It would have pads, diva cups, tampons, and underwear!”

“ENDOMETRIOSIS RELIEF and NSAIDs.”

“Birth control options: the pill, an IUD, and the depot shot.”

“CHOCOLATE.”

Thomas and Watkins said there are reasons for the frustrations about care. For menopause, some are cultural, because Black women’s experience has often been limited to watching their mother or grandmother “fan themselves with a magazine.”

But, even if they wanted care, studies show doctors weren’t always prepared to offer appropriate services to certain women.

A review of more than 20 years of research published last year in the journal ScienceDirect suggested racial and ethnic minorities, veterans, women living with HIV and incarcerated people faced more obstacles accessing menopause care.

The review said more research is needed but pointed to lack of insurance coverage and healthcare providers “possibly driven by lack of content knowledge or implicit bias.”

Another long-running study has suggested Black and Hispanic women may have earlier and more intense menopause symptoms and doctors are often unaware of the differences.

Some women who have brought up symptoms felt their providers were dismissive, Watkins said.

When symptoms persisted, the women “were faced with going back to a provider they didn’t trust or figuring it out on their own,” she said.

Now that more women are asking about hormone replacement therapy, there’s a new barrier, a short supply of prescriptions for some hormones, which come in pills, gels and creams, and patches, according to the American Society of Health-System Pharmacists. At least one patch manufacturer specifically cited increased demand.

But more providers say they are seeing a change in their patients, who seem more aware of menopause and symptoms, which could be due to increased media attention.

Dr. Charis James, a Nottingham family physician, said she’s getting less resistance when she brings up menopause or perimenopause. She also is holding her own forums so women can feel less alone and more comfortable asking questions.

She said hormone treatments aren’t safe for, or ultimately wanted by, everyone. Others are asking for it.

“They may have heard bits and pieces of news,” James said. “I explain the benefits, what the studies may have gotten wrong the first time and how they don’t have to live like their moms and even older siblings.”

Dr. Tamika Auguste, an obstetrician-gynecologist at MedStar Washington Hospital Center, said just after the safety warning was lifted plenty of patients, and doctors, were still hesitant to talk about menopause.

The result, she said: “We see a lot of health inequities around this.”

The Maryland Commission for Women and top female lawmakers successfully pushed legislation this session in the General Assembly requiring more provider training in menopause and broader insurance coverage.

That’s good news in the boutique, where Watkins and Thomas were plotting their next event. They recently held a sexual health forum they called “Hot Girl Summer,” during which they talked about safe sex and testing for sexually transmitted diseases. The conversation included talk about perimenopause and menopause symptoms, which can show up in women as young as their 30s.

“Why shouldn’t they be able to learn about it over a manicure,” Watkins said.