First things first. Menopause is not a disease. Far from it, the change of life is actually a natural transition and the beginning of a new season in a woman’s life. Sure, there are issues to contend with – like with any journey, but some of the changes that occur during “the change” can be welcome. For instance, no more wondering in the back of your mind if it’s safe to sit on that gorgeous white sofa. And how about the fact that pregnancy is off the table – no more pills, no more devices, no more calendar watching, and no abstinence required. Just you and your libido 24/7.
But, post-menopause is about more than life without menstruation. It also marks a time in life when we tend to begin reaping the benefits of our experiences and oftentimes that comes with wisdom and a realignment of our perspectives. Certainly, it’s the perfect time to double down on self-care and to focus on loving ourselves.
The History of Menopause
Menopause has a sordid history, to say the least and, believe me, we’re all quite fortunate to have been born into the modern age. While menopause in our current world can have its challenges, thankfully, it’s no longer treated by means of bloodletting, ovariectomies and clitorectomies. Not to mention that back in the day, women were routinely committed to asylums as preventative measures for hysteria, which was associated with menopause. Admittedly, we’ve come a long way from the time when a woman’s value was dependent on her ability to procreate. Still, remnants of archaic thinking persisted in America into the late 1960s as documented in Dr. David Reuben's popular book, Everything You Always Wanted To Know About Sex. In it he states, that while menopausal women are “not a man”, they are no longer functional women.
It’s an unfortunate fact that misinformation, rooted in a whopper of a misunderstanding about what menopause is and is not, has persisted through the ages and evolved into a modern day stigma. Otherwise, conversation and information about a natural process that affects roughly half of the world's population would be commonplace and plentiful. But we all know that’s not the case. Many women in 2021, still suffer in silence with menopause-related symptoms and many others are under the care of doctors who lack expertise in menopause and issues of sexual wellness involving women over 50.
As I mentioned, menopause is not a disease. That’s not to say that things don’t happen as the body progresses through the transition. Some women experience symptoms, ranging from mild to debilitating, including hot flashes, insomnia, weight gain, depression, vaginal dryness, decreased libido - and more. Others sail through the entire process with a minimum of disruption.
Perimenopause and menopause are opposite ends of the same continuum. The natural process starts when a gradual decrease in the body’s estrogen production begins. This phase, perimenopause, can last from several months to ten years or more and typically starts when women are in their 40s.
Menopause marks the end of the reproductive years and occurs at the end of perimenopause, following 12 months of no periods. At the end of the 12 months, post-menopause begins. Symptoms sometimes continue and other times they diminish or end altogether. And some women feel a renewed sense of energy, freedom and self-awareness when they reach post-menopause.
Menopause Myth Busters
Menopause means no more sex, certainly not good sex
Many women find the opposite to be true. There is a certain freedom about being post-menopausal. No more periods and no concerns about pregnancy can be liberating and a turn on. And some women experience a feeling of renewal that translates into their sex lives. Others of us will experience a low to nonexistent sex drive or pain during intercourse. But that does not have to be the end of the story. There are safe and effective strategies to increase sexual desire and pleasure and pain can absolutely be treated and resolved. This is a good time to consider working with a specialist who treats menopausal women.
Hormone therapy is dangerous
HRT is not for everyone, most notably women with a history of breast or uterine cancers, unexplained uterine bleeding, liver disease, blood clots, and/or cardiovascular disease. That's one of the reasons why educating yourself and talking with your doctor is of the utmost importance when contemplating hormone replacement. On the other hand, many women can safely benefit from this type of treatment to help with hot flashes, lack of energy, decreased libido and vaginal dryness. HRT can also reduce the risk for osteoporosis and heart disease.
Hormone Replacement Therapy suffered from negative publicity in the 70s when it was linked to an increased risk of endometrial cancer. But it would be studies in the 1990s that caused the use of HRT to plummet. Since then, studies have shown that HRT is safe and effective for many women and, in fact, can significantly reduce suffering from moderate to severe symptoms.
“Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms.”
-- North American Menopause Society (2021)
Menopause will happen in my 50s
Not always. The average age is 51, but it can happen earlier or later. Smokers tend to start the process earlier – up to two years in some cases. Chronic conditions like autoimmune disease can also mean an earlier onset of menopause.
Also, it’s a straight-up myth that early periods means early menopause. In actuality, there is no correlation between when you started your period and when you'll start perimenopause. In this case, the far more reliable predictor is knowing the age of your mother when she went through the change.
There's no getting around weight gain during menopause
Let's be real. Many of us gain some weight during perimenopause. Part of the reason is a hormonal change that slows metabolism. There are also some symptoms of menopause that can affect our waistlines like low energy and insomnia. But weight gain is not inevitable. Prioritizing self-care that includes movement and sensible nutrition can definitely mitigate weight gain. This is also the time, if you haven’t already, to reassess the way you look at and feel about your own body. Time for kindness, patience and renewed focus.
My doctor will know just what to do to help me through menopause
Nope. This is not a safe assumption to make, because not all doctors are trained in menopause. That's according to Dr. Lauren F. Streicher, M.D. (medical director of the Northwestern Medical Center For Sexual Medicine and Menopause in Chicago). She advises, “I’d say that if you’re in your 40s and your doctor hasn’t brought up menopause and menopausal symptoms to you, you may want to switch.”
Hot flashes are a flash in the pan
Actually hot flashes can last for years - up to 10 years if you're Caucasian and longer if you're African American. Some women experience intense hot flashes and for some women they’re barely noticeable. Hormone therapy and a low-dose antidepressant have been known to help when symptoms are moderate to severe. Also, avoiding alcohol, tobacco, caffeine and spicy foods can help ease the intensity of hot flashes.
HRT is my only treatment option
Like with most things, there are natural ways to treat menopause symptoms. Behavioral and lifestyle changes can be especially helpful when you’re dealing with symptoms like irritability, anxiety and/or depression. Mindfulness, meditation and movement – all have been shown to help. Diets rich in fruits and vegetables have also been linked to fewer symptoms. Some women find relief with acupuncture and herbal remedies. When it comes to perimenopause and menopause, focusing on overall health is the first line of defense.
Menopause = Memory Loss
Memory loss is more likely to be related to age than to menopause. Age-related causes for cognitive decline include poor nutrition, stress and thyroid dysfunction. Depression, anxiety and medication side effects can also be at play. If someone you know, is suffering from noticeable memory loss, seek help instead of assuming that it’s menopause.
Soy is nature’s HRT/Soy causes breast cancer
There is no proof that soy is beneficial when it comes to menopause symptoms – beyond it’s role in a plant-based diet. On the other hand, it isn’t dangerous. Although the isoflavones in soy act like estrogen, there is no proof that it increases the risk of breast cancer.
I don't need contraceptives in post-menopause
Not so fast, lady. Of course, there's no need to bother with prophylactics in order to avoid pregnancy, when you're past menopause. But, if you're single, you need to protect yourself from STDs. Correct, that whole thing doesn't go away, just because you're a woman of a certain age. Remember, sexually transmitted diseases include HIV, so you really can't be too careful.
We're not done talking about menopause. Stay tuned for our next blog on the subject when we'll discuss some specifics about treatment and resources.
The Sex Ed Blog, Perimenopause & Menopause, Dr. Joshua Gonzalez
Creekside Center for Women Blog, News in Gynecology: The Three Stages of Menopause
The North American Menopause Society, Expert Answers to Frequently Asked Questions About Menopause
Healthywomen.com, Menopause Symptoms Are Far From Universal, Sarah Marloff, January 12, 2021
The Conversation, World Menopause Day: how cultural representations of ‘the change’ are empowering women, Katy Shaw, Professor of Contemporary Writings, Northumbria University, Newcastle, October 14, 2020
Women In Balance Institute, Menopause Around the World, Kaitlyn Pote, NCNM Naturopathic Medicine Program
Edited by Elise Schroeder, September 17, 2014
Health Central, Don’t Believe Everything You Hear About Menopause, Holly Pevzner, Health Writer Medical Reviewer: Andrea Eisenberg, M.D.
Women’s Care, 5 Menopause Myths Debunked, Women’s Care Staff
The New York Times, Why Is Perimenopause Still Such a Mystery?, Jessica Grose, April 30, 2021
Doctor’s Review, Mad With Menopause, Jackie Rosenhek, February 2014
US National Library of Medicine – National Institute of Health, The Controversial History of Hormone Replacement Therapy, Angelo Cagnacci & Martina Venier, September 2019
ABC News, Hormone Therapy Safe in Early Menopause, Sydney Lupkin, October 9, 2012
MegsMenopause Blog, Perimenopause: The Facts, Team MM, October 28, 2020