As a gynecologist, I’ve had many recent conversations about perimenopause and menopause. From questions about hormones to managing disruptive symptoms, it’s clear that many myths and misunderstandings still surround this natural phase of life. In this blog, I want to address a wide range of the most common—and important—topics my patients have been bringing up. Whether you're unsure about menopause hormone therapy (MHT), worried about your risk of certain health conditions, or simply looking for tips on how to manage the physical and emotional changes, this post is for you.
By breaking down the science and dispelling misconceptions, my goal is to give you the knowledge and confidence to make informed decisions about your health.
Menopause: A Natural Phase, Not a Problem to Solve
Menopause marks a significant milestone in a woman’s life, but it's often misunderstood. Let’s break it down: menopause is the end of ovulation, which is the phase of the menstrual cycle when a mature egg is released from the ovary. Every egg a woman will ever have is made during fetal development, and once the body stops releasing mature eggs—due to the follicles no longer functioning in the same way—menstruation ends. The day that marks 12 months after your final period? That’s menopause.
What About Perimenopause?
Perimenopause is the lead-up to menopause, typically lasting 3-4 years. During this time, the supply of immature eggs dwindles, leading to irregular ovulation. The hormonal system, finely tuned for reproduction, gets disrupted. This is why many women experience some of the most disruptive symptoms, like hot flashes, mood swings, and sleep disturbances, during perimenopause.
Menopause Isn't a Disease
Menopause is not a defect, disorder, or a condition to be "fixed." Women are designed to go through menopause just as they go through puberty. Both bring changes, some of which can cause discomfort or disruption, but it’s entirely natural. The goal isn’t to "replace" your hormones. You don’t have an estrogen deficiency. Your body is doing exactly what it’s supposed to do. Just as puberty has its bumps, menopause does too, but that doesn’t mean something is inherently wrong with you.
Why We Don't "Balance" Hormones
If you’ve ever been told your hormones need to be "balanced," know that the term is misleading. Throughout your reproductive years, hormones naturally fluctuate—monthly cycles of estrogen, progesterone, and testosterone enable egg production and prepare the uterus for pregnancy. After menopause, those hormonal swings are no longer necessary. While some may choose to manage their symptoms with Menopausal Hormone Therapy (MHT), it’s not about restoring some ideal “balance.” Science doesn’t support the idea of an ideal level of hormones in menopausal women. The goal is symptom management, not achieving a specific hormone level.
Blood and urine tests for hormones? Not useful. Your hormone levels can change dramatically throughout the day, making a single measurement unreliable. More importantly, different women can experience wildly different symptoms, even with similar hormone levels. This is why doctors focus on how you feel, not the numbers on a test.
The Serious Health Risks of Menopause
Menopause does come with some increased risks for conditions like osteoporosis, heart disease, diabetes, and dementia. But it’s not just about a drop in estrogen or progesterone. There are many physiological changes happening during menopause that we’re still learning about. While MHT is the gold standard for preventing osteoporosis, there are other medications and lifestyle changes that can help protect your bones, heart, and overall health. Your doctor can guide you through the best options for you.
Supporting Emotional Health During Menopause
Menopause isn’t just a physical shift; it can also bring emotional changes. Hormonal fluctuations can impact mood, stress levels, and even relationships. Some women report increased anxiety, irritability, or even a sense of loss. It’s important to recognize these feelings are valid, and it’s okay to seek help. Talking to your healthcare provider, a counselor, or even joining a support group can provide emotional relief and connection during this time.
Lifestyle Interventions: Your Powerful Ally
Menopause is a great time to double down on healthy habits. Exercise, particularly resistance training, is essential during and after menopause to support muscle mass and bone health. Regular physical activity also boosts mood, helps manage weight, and reduces the risk of serious conditions like heart disease and diabetes.
Incorporating a nutrient-rich diet—especially one focused on calcium, vitamin D, and omega-3s—can further support your bone and heart health. These simple lifestyle changes can make a big difference in how you feel day-to-day.
Hormonal Therapy Isn’t One-Size-Fits-All
MHT is a broad term that includes various doses, types, and methods of hormone delivery. Whether it's through pills, patches, or creams, there’s a form that may suit you. Don’t dismiss the possibility of MHT just because you had side effects from birth control in the past; these are entirely different formulations, and MHT is tailored to support women in menopause, not prevent pregnancy.
For years, concerns about MHT—particularly around heart disease and breast cancer—have caused hesitation. However, more recent studies have clarified that for healthy women within 10 years of menopause, MHT can be a safe and effective way to manage symptoms.
Always discuss your personal risk factors with your doctor to make an informed decision.
What Is Genitourinary Syndrome of Menopause (GSM)?
Most women will experience some level of GSM, a chronic, progressive condition affecting the vulva, vagina, and lower urinary tract. Symptoms like vaginal dryness, itching, and discomfort during sex are common, as well as urinary issues like urgency and frequency. Early intervention is key to managing GSM. Talk to your doctor even if you don’t have symptoms yet, as addressing this condition early can greatly improve your long-term quality of life.
Don’t Forget Sexual Health
Menopause can also bring changes in sexual health, such as a decrease in libido or discomfort during intercourse. These issues are more common than you might think, and they shouldn’t be a source of shame. Local vaginal estrogen, lubricants, or even pelvic floor therapy can help. Don’t hesitate to talk to your doctor about any changes in your sexual health. There are effective treatments that can help you maintain a satisfying sex life post-menopause.
Start the Conversation Early
Menopause-related symptoms can sneak up on you in your 40s. You might not even realize some of the changes you’re experiencing—like sleep issues, mood swings, or decreased libido—are connected to menopause. That’s why it’s crucial to start talking to your doctor early, so menopause becomes a part of the conversation. Knowing what’s happening in your body is the first step toward managing symptoms effectively and maintaining your quality of life.
Embrace the Freedom of Post-Menopausal Life
For many women, post-menopausal life brings a newfound sense of freedom—no more periods, no more hormonal fluctuations. With the right management of symptoms, you may find yourself with more energy and emotional stability than during your reproductive years. Menopause marks the beginning of a new chapter, and with the right support, you can embrace it with confidence and excitement for what’s ahead.
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Menopause is a new chapter, not a problem to solve. Understanding your body, working with your doctor, and exploring your options will help you navigate this phase with confidence, while also maintaining a healthy, active lifestyle.
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