When menopause does not run its course, or when a course is not a course

A senior health official in Pakistan had carried something unsaid for years. She said it out loud on a livestream, after building trust for almost a decade in her peers, and in TGLF, a non-profit that supports peer learning for action at scale. That livestream was Teach to Reach 16, held on 6 August 2026 by The Geneva Learning Foundation (TGLF). This closes the series of four articles and steps outside malaria and climate deliberately: it follows an inaugural cohort of 1,100 health workers who shared experience about menopause, a subject global health data largely stops recording at 49.

Dr Faiza Rabbani had six TGLF programmes behind her and had never said it out loud.

She works at national level in Pakistan’s health system and has been learning with The Geneva Learning Foundation (TGLF) since 2021.

On 6 August 2026, invited onto a livestream to say what she had learned, she picked the shortest course on her list and described it as something else entirely.

“Actually, this was a course which was not a course. It was a deep down pain inside me for which I have never spoken to anyone before.”

Then she said it.

“And through this platform, I was able to talk to myself and the consequences of early surgical menopause, which I faced at the age of 36, by losing my reproductive life, and the consequences I faced after my surgery, not only physically but mentally and socially.”

A senior professional had carried this for years, through a career spent inside a health system, without telling anyone.

What released it was not counselling.

It was a primer that asked what she knew, in a cohort where more than a thousand colleagues were answering the same question.

“It became the usage channel to talk to people about myself and my experiences and my expectations from the health system, the support I needed at the time and even today.”

Why nobody had asked

Beyond the hot flash: a primer for health workers about menopause launched on 22 June 2026 with TGLF partner Menoglobal.

Its inaugural cohort passed 1,100 participants, mostly from Asia and Africa, mostly working in districts and communities.

Two thirds work at the front line.

Most are under 40, which means many were writing about a menopause they have not lived, watching it instead in mothers, grandmothers, aunts, patients, and colleagues.

Reda Sadki put the arithmetic on screen.

Around 70% of health workers globally are women.

“So this is a question that should be at the heart of people who work for health.”

Anete Ahokas, who works at regional level in Ireland, named the obstacle from the professional side.

She had enjoyed the course, she said, because “you learn new things from other people from their perspective.” Then she widened it.

“You realise that it is not just menopause, but it is also the people that see this being old. So it can be kind of like ageism and sexism linked to menopause.”

And then the sentence that explains the silence Rabbani had been keeping.

“And even some medical people are kind of embarrassed to talk about it.”

What Menoglobal calls the “data cliff”

Dr Rabbani had a name for the structural problem, and she took it from the advocacy content developed by TGLF partner Menoglobal.

“What we learned was the data cliff. This is a universal phenomenon wherever we are working. We do have a lot of data available on the women of reproductive health from age 15 till 49, and we do have a lot of research and studies and data available for the non-communicable diseases, but this is the only course which has bridged the gap between the non-communicable diseases and the susceptibility, or the increased risk, when women become more prone to these non-communicable diseases on account of the loss of their hormones.”

Before 49, a woman is a reproductive health population and the data is abundant.

After 49, she becomes a non-communicable disease population.

The transition connecting the two is rarely recorded, so the connection is rarely made.

The cohort’s first week suggested the cliff is cultural before it is statistical.

Asked for the first word that came to mind, participants offered transition and change most often.

Then harder answers arrived.

A medical social worker in Africa wrote that “the first thought that comes to my mind is silence. Also disgust,” and explained it.

“A woman is more important when she is fertile and when she can bear kids for the society. Once that stage is over, she is expected to go through it quietly.”

A public health worker in West Africa gave the word stigma.

His language calls it “girma,” he wrote, and although “it is the responsibility of elders and parents to disclose and share possible remedies,” what happens instead is silence.

Others reached the other way.

A nephrologist at a public hospital in Italy wrote that her first image is “spring, with green fields and colorful flowers,” while noting that women where she lives often call menopause “una jattura,” a misfortune.

A woman on a community health board in Costa Rica chose a phrase from traditional Chinese medicine, the second Spring, and said why.

“It gives me hope and peace, since I am going through this transition.”

What a midwife started noticing

Louise Nkusu Lusangu is a nurse and midwife working at a health facility in South Africa.

She described a change in what she looks for.

“It made me better understand menopause and the health needs of women, especially those between the ages of 40 and 50. I learned that menopause is a natural state of life, but many women experience symptoms such as hot flashes, night sweats, sleep problems, mood changes, and other physical and emotional challenges.”

Then she added the line that should worry anyone responsible for pre-service curricula.

“I wish that I did learn about it earlier”.

Instruction or reflection?

Rabbani ended with an instruction rather than a reflection, and she addressed it to everyone listening.

“I would request everyone in the room to look around, the woman around you, the woman in her late 40s or early 50s, who is experiencing these changes, and we keep on ignoring them and ask them to embrace these changes as physical change.”

Then she named the clinical failure exactly.

“We put them on supplements, we ask them to go for these things, but we never connect that their increasing blood pressure, their weight gain, their psychological disturbances, their mood changes need a little bit of compassion along with the medical case.”

That is the data cliff restated as a consultation.

A rising blood pressure and a mood change arrive as separate complaints, are treated as separate complaints, and the transition connecting them goes unrecorded because there is no field for it.

What comes next

TGLF is now opening Our shared challenge of ageing, extending the same approach into healthy ageing.

The argument for its timing was made during the session.

Even where most of the population is currently under 30, the demographic curve will move, and the health workers who will meet those needs are in training now.

Anuja Daniel, who runs a College of Nursing in Bihar, India, and joined Teach to Reach that afternoon, described her own reason for being there in one line.

“I would like to learn so that whatever information I receive from here, I can teach to my students and my community.”

The menopause cohort has already shown what such a course can retrieve.

More than 1,100 health workers, most of them women, most under 40, most at the front line, produced testimony about a transition that global health data largely stops recording at 49.

“It is knowledge that has been waiting for a language,” the account of their first week concluded.

Rabbani found one.

She used it to ask colleagues from all over the world to look up from their notes at the woman sitting in front of them.