Menopause myths: Separating fact from fiction

Many women approach menopause with anxiety about the future. You've probably heard your grandmother, mother, or aunts lament about menopause, aka "the change," as a stressful time full of hot flashes, weight gain, and plummeting sex drive.

Life changes due to menopause and perimenopause (its prequel) are real and can easily disrupt your sleep, relationships, and overall health when you're in your prime of life. Unfortunately, myths and misperceptions abound regarding what's normal, what's not, and how to safely relieve classic symptoms like night sweats and mood changes.

The good news? Menopause is having a moment. That means heightened awareness, more resources dedicated to improving women's health, and open discussions to ensure you get the information you need.

Today, there are more options than ever to treat disruptive menopause symptoms. In our roles as women's health specialists, we've seen time and again that with the right self-care and planning with your doctor, you can lead a healthy, energetic life through your 60s, 70s, and beyond.

The Centers for Disease Control and Prevention reports that the average life expectancy of a woman in the US is 80.2 years. This means you may be post-menopausal for approximately half your lifetime.

It's time society takes women's health care in menopause more seriously to reduce stigma surrounding this time of life – and make more women aware of their treatment options. Let's talk through common menopause misperceptions and what you can do to feel healthy and vibrant as you age.

Myth: Menopause just means you are getting old

Here's the truth: Perimenopause and menopause are natural cycles of aging, but these in no way mean you are becoming frail or fragile.

Perimenopause is the eight to 10 years leading up to menopause. For most women, this starts in your 40s but can begin as early as the late 20s or 30s in some. In perimenopause:

• Estrogen production begins to fluctuate. This hormone helps regulate the menstrual cycle. Estrogen also affects your bones, breasts, heart, pelvic muscles, and more to help regulate genes and influence normal body functions. Low estrogen levels can cause alterations in the body, such as weakening bones, thinning skin, wrinkles, and mood changes. Fluctuation from high to low levels can produce night sweats and hot flashes.
• Ovary function slows to a stop. The ovarian follicles – small, fluid-filled sacs in the ovaries, each containing one egg – lose function and stop releasing eggs into the ovaries. That means no more periods!

Menopause refers to the cessation of menstrual periods for at least 12 months. This most commonly occurs between the ages of 45 and 55.

Myth: Hormone therapy sounds good, but I've heard it's not safe

Here's the truth: Hormone therapy – when taken under the care of a board-certified women's health provider – is one of the safest, most effective treatments for a wide range of menopause symptoms, including:

• Hot flashes
• Mood changes
• Vaginal dryness
• Bone loss (osteoporosis)
• Urinary incontinence
• Weight gain and slowed metabolism
• Night sweats
• Chills
• Insomnia
• Thinning hair and dry skin
• Changes in libido

Hormone therapy has been found to increase lifespan, reduce the risk of colon cancer and diabetes, relieve symptoms of vaginal dryness and hot flashes, and reduce the risk of osteoporosis.

Estrogen also promotes the growth of good bacteria in the vagina. Without estrogen, the pH of the vagina increases, which can cause inflammation and bacterial overgrowth that raises the risk of UTIs and bacterial vaginosis.

Be wary of med spas and standalone, self-proclaimed hormone clinics. These providers may not have access to safe, personalized medications approved by the U.S. Food and Drug Administration.

While hormone therapy is not a fountain of youth, it can significantly reduce the symptoms of menopause. Typically, hormone therapy will consist of either estrogen alone or a mix of the female hormones estrogen and progesterone, and in some cases, testosterone. There are generally two ways to take hormone therapy:

• Systemic: This type circulates hormones throughout the body and can be taken as pills, skin patches, gels, and sprays.
• Vaginal: This type is applied directly to vaginal tissues to relieve vaginal dryness, itching, and discomfort during sex. It can also help with urinary urgency and reduce the risk of urinary tract infections. It can be taken as a cream, tablet, ring, or suppository in the vagina.

We typically recommend systemic hormone therapy for women who are perimenopausal or within 10 years of the onset of menopause. That's because certain risk factors associated with hormone therapy, such as an elevated chance of stroke, are higher in women over age 60. However, vaginal hormone therapy is safe to use at any age and has many benefits.

Menopause and hormonal therapy are not one size fits all. Hormone therapy is a safe, effective option for most women. Depending on women's preexisting conditions, family history, and the type of treatment being used, hormone therapy can be associated with a slightly higher risk of:

• Blood clots, with oral estrogen.
• Breast cancer, depending upon breast density, family history, alcohol use, smoking history, and whether the patient lives a sedentary lifestyle. In some cases, a specific estrogen can decrease breast cancer risk.
• Stroke, also highly dependent on personal health history and lifestyle.

Based on your own individual health and family history, your health care provider can help you find the formulation and type of hormone therapy that is best for you based on the risks and benefits.

Myth: Hot flashes and moodiness are just things women have to live with

Here's the truth: Umm … no. While uncomfortable symptoms are common, you don't have to "just live with" crummy sleep, low libido, or emotional changes. Most symptoms can easily be treated and managed with help from your health care provider. Here are some of the most common symptoms women worry about, along with proven, effective ways to deal with them.

Hot flashes and night sweats

Hot flashes are one of the most recognized symptoms of menopause and perimenopause. During a hot flash you'll experience a sudden feeling of warmth and sweating on your face, chest, and neck as well as other parts of your body. About 75% of women experience hot flashes during perimenopause.

When hot flashes happen at night, they're called night sweats. Excessive sweating – drenching your nightclothes and blankets – can disrupt sleep, which can spiral into daytime irritability and fatigue.

Low estrogen is thought to cause hot flashes by affecting your hypothalamus, the part of your brain that regulates temperature. They can occur spontaneously and may last from a few seconds to several minutes.

Lifestyle changes such as avoiding alcohol and maintaining a healthy weight can help relieve symptoms. Hormone therapy (estrogen, progesterone, and/or testosterone) is a safe and highly effective treatment available in pill, gel, patch, or spray form. In fact, we recommend it for just about every woman we see.

An FDA-approved non-hormonal treatment currently prescribed for hot flashes is the selective serotonin reuptake inhibitor (SSRI) medication paroxetine. Commonly prescribed for depression, paroxetine lowers the central body temperature and decreases blood flow to the skin.

Vaginal dryness and low libido

Reduced moisture in the vaginal area can happen as estrogen levels decline. This can lead to discomfort, itching, irritation, and pain during intercourse. For some women, this contributes to low libido (sex drive), which can result in relationship challenges and low self-esteem.

Sexual desire is a big part of many women's identities and can affect relationships and partnerships. Declining levels of estrogen associated with menopause can cause loss of libido. While hormone replacement therapy can restore some desire, we often see patients who expect that hormone therapy will magically restore their libido, like an on/off switch.

The truth is, it is more complicated than that. In our practice, libido falls under a biopsychosocial model. That means that it's affected by a mixture of biological, mental, and social factors. Estrogen deficiency is just one part. Many women also experience emotional challenges, such as coping with aging and body changes. In addition, they may be busy maintaining a family or dealing with other injuries and illnesses. And it's likely your partner's body and mood are also changing. So, don't blame yourself if the sparks aren't flying like they used to during this time of change.

If after treatment and lifestyle changes your libido doesn't return, we can refer you to our colleagues in psychiatry and psychology to explore other options, such as cognitive behavioral (talk) therapy.

Urinary urgency or incontinence

Here's the truth: Urinary urgency is the sudden and urgent need to urinate, which can sometimes result in leakage (urge urinary incontinence). It is often caused by changes in the pelvic floor muscles and tissues during menopause.

Urinary incontinence and urgency can be treated in many ways, including:

• A pessary: This device is inserted into the vagina to support the bladder and alleviate symptoms of urinary incontinence.
• Medication: Medications such as anticholinergics or beta-3 agonists can help reduce bladder spasms and control urinary urgency.
• Pelvic floor physical therapy: This involves exercises and techniques to strengthen the muscles that support the bladder and improve bladder control.
• Bulking agents: Collagen or water-based gel injections can narrow the urethra and reduce leakage.
• Surgery: Procedures are available to help support the bladder and/or urethra.

Mood changes and sleep disruption

Insomnia, or difficulty falling asleep or staying asleep, is a baseline contributor to SO MANY mood and health conditions at all stages of life. Chronic, inadequate sleep contributes to your lifetime risk of heart problems, obesity, and diabetes, just to name a few.

Hormonal changes during menopause and respiratory conditions such as chronic obstructive sleep apnea (OSA) – in which you stop breathing during sleep and may snore heavily – along with frustrating night sweats, can contribute to insomnia.

At the same time, your entire body chemistry is changing. Remember when you had PMS before your periods, or when you were cranky or emotional during pregnancy? Perimenopause and menopause cause very similar mood changes – it's no wonder your mood can shift from angry to crying to happy in mere moments during this time!

To address insomnia, treatments like cognitive behavioral therapy (CBT) can help change thought patterns and behaviors surrounding sleep, while sleep apnea treatments such as continuous positive airway pressure (CPAP) provide relief for respiratory conditions. Hormone therapy offers another avenue to alleviate symptoms of menopause and hormonal fluctuations, helping to restore sleep patterns and overall well-being.

Some symptoms require immediate medical care. Call your health care provider if you experience vaginal bleeding after a long gap between periods or if you have thoughts of hurting yourself or someone else. These are not normal symptoms of perimenopause or menopause and could be signs of a health emergency.

Myth: Menopause is going to make me lose muscle and gain weight

Here's the truth: It's true that as we age, we all experience sarcopenia, or loss of muscle mass. But that doesn't mean your 50s and beyond will leave you soft or weak!

You don't have to be a gym rat to glean the benefits of exercise during menopause. You can do yoga or Pilates or put on a YouTube stretching video. You can use ankle weights while you take a walk around the block or break out the resistance bands for a 15-minute training. One study showed that physical exercise can help prevent dementia, reduce pain, and lower your risk of cardiovascular disease.

Nutrition plays a crucial role, too. A balanced diet rich in lean proteins, fruits, vegetables, and whole grains can support muscle health and overall vitality. Adequate hydration is also important, especially as we age, to maintain muscle function and joint mobility. Combined with regular exercise, a nutritious diet can help combat sarcopenia and support a healthy, active lifestyle.

Exercise and nutrition are particularly important in your 40s, as you're going into menopause and perimenopause. Laying the groundwork can help you retain muscle mass, mobility, and agility as you move into your older years.

Menopause doesn't have to be a time of fear

With the right treatment and care, you can live a vibrant, active lifestyle. It's important to recognize that treatment for menopause and perimenopause symptoms isn't one-size-fits-all. Every woman is unique, requiring personalized care and support. By breaking down common myths and encouraging candid conversations with providers, we can transform the narrative around menopause from anxiety to empowerment, ensuring that women continue to thrive through all stages of life.