One Gynecologist Gets Real About Menopause

Here's the low-down on common symptoms—plus how to deal.

Medically reviewed in June 2022

Updated on June 24, 2022

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Scientifically speaking, menopause occurs when a woman goes 12 consecutive months without a period. “But the holistic reality of menopause covers the head-to-toe physical, spiritual, and sexual changes that are much more important than the basic definition suggests,” says OBGYN Susan Hardwick-Smith, MD, of Complete Midlife Wellness Center in Houston, Texas.

Menopause can bring a slew of symptoms like hot flashes, vaginal dryness, mood swings, and more. But what does all of that really feel like? 

The idea of menopause can be daunting for many, but it’s important to remember that it’s a natural transition and women should feel comfortable talking with their gynecologists and partners about it. Learn about what many women experience, plus new ways to think about these life changes.

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Hormone therapy is safe for most women

Despite what you may have heard, major organizations, including the North American Menopause Society, the American Society for Reproductive Medicine, and the Endocrine Society agree that menopausal hormone therapy is an acceptable option for healthy women (younger than 60 and within 10 years of menopause) who experience moderate to severe menopausal symptoms. Small doses of vaginal estrogen are preferred if you just have vaginal dryness or sex is uncomfortable.

But the type that’s right for you depends: If you have a uterus, combined hormone therapy, with progestogen and estrogen, is recommended. And if you’ve had a hysterectomy and no longer have a uterus, estrogen is the only hormone needed.

While these therapies are generally safe, there are some potential dangers. Menopausal hormone therapies can increase the risk of blood clots and strokes. The risk is lower among women 59 and younger and for those using transdermal therapy (patches, gels, and sprays). Combination estrogen and progestogen therapies taken for five years or more may raise a woman’s risk for breast cancer, but as soon as the therapy is stopped, the risk is reduced.

If you’re having symptoms that can be controlled by hormone therapy, you and your gynecologist can talk through the treatment that’s right for you.

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It’s very likely you’re going to have hot flashes

The most common early symptom of menopause is temperature sensitivity, says Hardwick-Smith. Hot flashes are pesky—and often embarrassing—sudden feelings of warmth on the face, neck, or chest areas. You may also develop blotchy skin and a rapid heartrate, and it’s very likely sweating will accompany these episodes, especially at night. “I often woke up in a sweat and had to change my sheets and pajamas,” says Hardwick-Smith.

Hot flashes can be uncomfortable and can even cause some stress. You may have them daily and they can last as long as 10 years. But you can expect they’ll improve over time, especially with treatments like hormone therapy and antidepressant medications, among others. These lifestyle changes may also offer relief:

  • Keep your body temperature cool. Dress in layers, carry a fan, and sip on a cold drink if you’re out in the heat or feel a hot flash coming on. At night, lower the thermostat in your bedroom and layer or use light bedding.
  • Avoid or limit hot flash triggers like spicy foods, alcohol, smoking, and caffeinated beverages.
  • Try some slow, deep-breathing exercises to relax.
  • Maintain a healthy weight.

Some women also find that their symptoms improve when they reduce their stress levels with techniques like mindfulness or meditation. Your OBGYN can help you figure out what kind of treatment may be right for you. 

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Make a to do list because you might have some memory issues

Sleep issues are common for many women during perimenopause (the period just before menopause), menopause, and in the years following menopause. This is due in large part to menopause-related symptoms such as night sweats, depression, anxiety, and sleep apnea, which can be induced by hormone changes. 

Hardwick-Smith says these sleeping issues can contribute to memory problems. When you’re tired, it’s hard to remember things or concentrate. Normal, age-related changes in thinking and memory can become noticeable around the same time as menopause, but research hasn’t proven whether it’s related to hormonal changes or it occurs for another reason.

“I was only sleeping two to three hours a night, and I couldn’t even remember my own phone number,” says Hardwick-Smith. If you’re unaware of what’s happening, this type of memory loss could be frightening. “Experiencing memory problems might make you think you have Alzheimer’s,” she adds.

Here are some ways to keep your brain young as you age:

  • Try mentally stimulating activities like reading, word puzzles, math problems, and painting.
  • Get regular exercise and maintain a healthy weight.
  • Limit foods high in saturated fat, cholesterol, and trans-fatty acids.
  • Make sure you’re getting folic acid, and vitamins B6 and B12 in foods like whole grains, fortified cereal, and leafy greens.
  • Avoid smoking.
  • Avoid alcohol completely or limit your intake to one drink a day.
  • Make sure you’re socializing with friends and family.

Practice healthy sleep habits and aim to get seven to nine hours of sleep per night.

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You should keep exercising

Your body is going to change during menopause, but that doesn’t mean you have to forgo your weekly exercise regimen. In fact, menopausal women should develop a fitness routine that combines cardio, strength training, stretching, and posture work. Here’s an easy guide:

  • Cardio workouts to improve your heart health: elliptical machine, swimming or walking, at least 150 minutes of moderate activity or 75 minutes of vigorous activity every week
  • Strength training to help maintain muscle and ward off osteoporosis: work all major muscle groups two to three times a week, including legs, arms, core, and butt
  • Posture and core work to improve your balance and ease pain: standing on one foot, heel-to-toe walks, and Tai Chi, once or twice a week

Remember to talk to your healthcare provider (HCP) before you start any new workout plan.

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Aging is probably going to become a reality

We all know we don’t live forever, but Hardwick-Smith says that as soon as women realize they can no longer have children, the concept of dying and the shortness of life becomes very, very real.

“Losing our fertility can be really challenging and hard to accept, even if we’ve had our tubes tied or never wanted to have children,” she says. Your friends and family may also be experiencing age-related issues. “Your parents will probably need more help than they used to and some of your friends and family may be dealing with chronic health conditions.”

Sometimes, all of these life changes may feel overwhelming, but seeking support is the best medicine. Find a friend or family member who can relate to what you’re going through. You can share your stories and talk through how you handled challenges. 

You may also consider therapy to cope with the emotional and life changes that occur during menopause. To find a good therapist, talk with friends to get referrals, see your HCP, or consult a reputable organization such as Mental Health America.

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You don’t have to have painful sex

Many factors influence a person’s sex drive, but waning libido is a natural part of aging for most men and women. For women, this usually happens in menopause.

Why? For one, decreasing estrogen and testosterone hormone levels can reduce your desire to have sex. Hardwick-Smith says the absence of fertility can have that effect, too. “Part of our biological sex drive is by our very old instincts to get pregnant. So, when we're not fertile anymore, some of that can go away,” she explains. Not to mention, recurring hot flashes won’t exactly get you in the mood.

Many women may also develop genitourinary syndrome of menopause, a condition that can cause thinning and inflammation of the vaginal walls. It occurs when estrogen levels are reduced and can affect libido, thanks to symptoms like frequent or urgent urination, decreased vaginal lubrication, and discomfort during and after sex. 

In addition to medical treatments like hormone therapy, here’s how to keep the fire alive during menopause:

  • Communicate with your significant other about what feels good to you. Make sure you listen to your partner, too.
  • Invite your significant other to join you at one of your gynecology appointments so they can learn more about the changes you’re experiencing.
  • Plan a fun activity with your partner.
  • Consider talking to a sex therapist.
  • Use lube for sex or moisturizers every two or three days as needed.
  • Strengthen your pelvic floor muscles with exercises like Kegels.

Talk to your partner about your feelings so you’re both on the same page. If you periodically want a break from intercourse, that is normal.

Remember: While you can’t get pregnant after menopause, it’s still possible to contract a sexually transmitted infection (STI)—and drier, thinner vaginal walls put you at higher risk because they tear more easily. Prevent STIs by practicing safe sex.

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You can use the transition as an opportunity

While menopause brings a lot of physical and mental changes, it can also be an opportunity to focus on you. “While we shouldn’t negate the difficult changes that will happen, reframing this time in our life from a crisis to a real opportunity for awakening can actually be pretty amazing,” says Hardwick-Smith.

Think about this: Many menopausal women have kids that are older and have left home, a job that may have transitioned to a place where they have more time to themselves, and a long-term relationship.

“It’s an opportunity to figure out who you really are and what you want from your own heart, not driven by anyone else,” she adds. It can be an opportunity to get involved with charities you’ve always been passionate about or take on a fitness goal you’ve always wanted to achieve, but haven’t had time. And it’s also an opportunity to rekindle your relationship. 

If you start looking at menopause in this way, she says, “you may find peace with your new self.”

Slideshow sources open slideshow sources

The North American Menopause Society. The Experts do Agree About Hormone Therapy. Page accessed June 24, 2022.
Mayo Clinic. Hot flashes. Page accessed June 6, 2022.
Johns Hopkins Medicine. How Does Menopause Affect My Sleep? Page Accessed June 6, 2022.
MD Anderson Cancer Center. Alcohol and breast cancer risk:  What to know. Accessed June 6, 2022.
Mayo Clinic. Fitness tips for menopause: Why fitness counts. March 12, 2021. Accessed June 6, 2022.
Mayo Clinic. Vaginal atrophy. September 17, 2021. Accessed June 6, 2022.
Harvard Health Publishing. Menopause-related hot flashes and night sweats can last for years. August 14, 2020. Accessed June 22, 2022.
The North American Menopause Society. What You Should Know About Memory and Concentration at Midlife. May 2011. Accessed June 22, 2022.
Harvard Health Publishing. 12 ways to keep your brain young. May 13, 2022. Accessed June 22, 2022.
The North American Menopause Society. Fitness After 40: Building the Right Workout for a Better Body. 2022. Accessed June 22, 2022.
The North American Menopause Society. Decreased Desire. 2022. Accessed June 22, 2022.
The North American Menopause Society. Effective Treatments for Sexual Problems. 2022. Accessed June 22, 2022.
The American College of Obstetricians and Gynecologists. The Menopause Years. November 2021. Accessed June 24, 2022.
NIH: National Institute on Aging. Hot Flashes: What Can I Do? September 30, 2021. Accessed June 24, 2022.
Office on Women’s Health. Menopause and your health. February 22, 2021. Accessed June 24, 2022.

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