One Gynecologist Gets Real About Menopause

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

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“Scientifically, menopause is when a woman stops producing eggs, stops having periods and is no longer fertile. 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 Women’s Care Center in Houston, Texas.

You probably know that menopause, or 12 consecutive months without a period, 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 big M” is a very natural transition and women should feel comfortable talking with their gynecologists and partners about it. Here, Dr. Hardwick-Smith gets real about what women go through, plus new ways to think about these life changes.

Medically reviewed in December 2019.

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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 safe for almost all healthy women (younger than 60 and within 10 years of menopause), who are experiencing menopausal symptoms like hot flashes and vaginal dryness.

But the type that’s right for you depends: If you have a uterus, combined hormone therapy, with progestin 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, we do have to mention the risks, too. Similar to the risks associated with contraceptive methods like birth control pills, patches and rings, estrogen therapies and combination estrogen and progestin therapies can increase the risk of blood clots and strokes. Combination estrogen and progestin therapies taken for five years or more may up 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 options and treatment time 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. 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.”

Hot flashes can be uncomfortable and can even cause some stress, but you can expect they’ll improve over time, especially with treatments like hormone therapy and antidepressant medications, among others. But these lifestyle changes may help give you some relief:

  • Make sure you keep your body temperature cool, and sip on a cold drink if you’re out in the heat or feel a hot flash coming on.
  • Avoid 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 gynecologist can help you figure out what’s right for you. 

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

Hardwick-Smith says that sleeping issues (hello, night sweats!) 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 researchers are not sure this is completely related to the hormonal changes you’re experiencing.

“I was only sleeping two to three hours a night, and I couldn’t even remember my own phone number,” says Hardwick-Smith. And 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.”

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 B vitamins, folic acid, B6 and B12 in foods like whole grains, fortified cereal and leafy greens.
  • Avoid smoking.
  • Limit alcohol to 2 drinks a day.
  • Make sure you’re socializing with friends and family.

Practice healthy sleep habits and aim to get 7 to 9 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, 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 including legs, arms, core and butt, two to three times a week.
  • 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 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’ve lost their fertility, the concept of dying and 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.” And the friends and family around you could 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.”

All of these life changes may be challenging, but seeking support is the best medicine. Find a friend or counselor who can relate to what you’re going through. You can share your stories and talk through how you handled each situation.

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You don’t have to have painful sex

There are a variety of factors that influence a person’s sex drive, but a decrease in sex drive is a natural part of aging for some men and women. And for women, this usually happens in menopause.

Why? For one, decreasing estrogen and testosterone hormone levels can decrease libido, or your desire to have sex. And, 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.” Not to mention, reoccurring hot flashes and vaginal dryness that occur naturally during menopause won’t exactly get you in the mood.

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

  • Make eye contact with your partner.
  • 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!
  • Strengthen your pelvic floor muscles with exercises like Kegels.

Keep in mind: You may want to take some time away from sex during this time, too. Don’t worry—it’s completely normal. You should talk to your partner about your feelings so you’re both on the same page.

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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 relationship that they’ve been in for a really long time.

“It’s an opportunity to figure out who you really are what you want from your own heart, not driven by anyone else.” It can be an opportunity to get involved with charities you’ve always been passionate about or a fitness goal you’ve always wanted to achieve, but haven’t had time. And it’s also an opportunity to rekindle your relationship. “You may find peace with your new self,” says Hardwick-Smith.

If you start looking at menopause in this way, you may just find it’s a more peaceful time.

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