Don't Believe Everything You Hear About Menopause

You can 100% have a happy and healthy sex life—you may just need some lube. That’s because as your ovaries shut down, estrogen drops, too, says Lauren F. Streicher, M.D., medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago. With less estrogen, there’s less blood flow to vaginal tissue, which means more dryness. Enter lubrication. “You need to use one that’s pH balanced, preservative-free, and has ‘low osmolality’ or you’ll increase vaginal irritation,” says Dr. Streicher. (Replens Silky Smooth is a good choice.) You can also try low-dose vaginal estrogen therapy and/or oral hormone therapy.

“Low-risk menopausal women under age 60—or those who are within 10 years of the onset of menopause—safely can go on hormone therapy to treat hot flashes, insomnia, and more without fear of an increased risk of breast cancer,” says Sherry Ross, M.D., an ob-gyn and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period. In fact, the hormone level used to treat menopause symptoms is lower than the Pill, says Dr. Streicher. Still, hormone therapy isn’t for everyone, including those who’ve had breast or uterine cancer; unexplained uterine bleeding; liver disease; blood clots; and/ or cardiovascular disease.

Yes, the average age of menopause is 51, but that age is in no way a hard and fast deadline. “The timing of menopause is very dependent on genetics,” says Dr. Streicher. “If you tell me that your mom, your sister, and your grandmother went through menopause in their mid-40s, there’s a good chance you will too.” If you’re a smoker and/or have a chronic illness or an autoimmune disease, such as multiple sclerosis or lupus, your chances of early onset menopause goes up. P.S. It’s also a myth that the earlier you start menstruating, the earlier you're going to go through menopause.

Many women pack on a few extra pounds during menopause, thanks in part to hormone shifts that slow metabolism. Eating 200 to 300 fewer calories daily can help maintain your pre-menopausal weight. Hormone therapy has also proven to be an effective strategy for limiting belly fat, according to a 2018 study in the Journal of Clinical Endocrinology & Metabolism. At the same time, a lack of physical activity and disruptive sleep patterns also shoulder some of the aging-and-weight-creep blame. “Exercising regularly, eating a well-balanced diet, and getting plenty of rest is all important for controlling weight gain,” says Dr. Ross.

Your gynecologist may be the perfect physician to usher you through this phase, but there’s no guarantee. “Most doctors don’t have a lot of training in menopause,” says Dr. Streicher. “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.” (Another clue you’re working with a non-expert: Your physician suggests “date night” as a solution to your middle-age libido or dryness issues.) To find a doctor who is also a menopause expert, go to menopause.org; you’ll find North American Menopause Society-certified practitioners near you.

While hot flashes, in general, are not a forever symptom, they’re also not a (hot) flash in the pan. “For Caucasian women, hot flashes can occur for 7 to 10 years. For African American women it's even longer and for Asian women a little shorter,” says Dr. Streicher. With that noted, the most intense hot flashes often occur in the first two to three years of menopause. Avoiding alcohol, tobacco, caffeine, and spicy foods has been known to ease hot flashes. Hormone therapy and the low-dose antidepressant Brisdelle, better known as Paxil, may minimize hot flashes, too.

If you like edamame, tofu, and miso—enjoy! They can be a healthy addition to most everyone’s diet. “But know that soy is neither dangerous nor a cure-all,” says Dr. Streicher. “Some people think eating a lot of soy can ease menopausal symptoms, but there’s no proof beyond a placebo effect. And others believe the estrogen in soy is dangerous. I've never been convinced of that either.” Isoflavones, a compound in soy, act like estrogen. And because certain breast cancers require it to grow, people worry that soy may increase one’s breast cancer risk. This, however, has not been proven.

When estrogen is depleted, bone loss can follow. However, the greater your bone density when you begin menopause, the lower your chance of osteoporosis. Translation: If you enter menopause consuming calcium-rich foods and beverages and have a history of regular weight-bearing exercises you’re at a great starting point. Also, women who partake in hormone therapy can increase bone mass and improve bone structure, according to a study in the Journal of Clinical Endocrinology & Metabolism. Concerned? Talk to your doctor about adding bone-boosting exercises to your routine and find out if calcium and vitamin D supplements might help.

Don’t blame the big M for this one. Forgetting names, misplacing your keys, double checking if you locked the door goes hand-in-hand with aging—for women and men. “Since the average age of menopause is 51 years old, brain fog and not remembering day-to-day details becomes more noticeable, but it’s not necessarily because of menopause,” says Dr. Ross. “There are a number of other causes for cognitive decline, including depression, anxiety, medication side effects, poor nutrition, stress, and thyroid dysfunction.” If you (or your loved ones) are concerned, speak to a healthcare professional.

Behavioral and lifestyle changes have been known to go a long way in controlling mild symptoms associated with menopause. For example, a 2019 study in Climacteric found that practicing mindfulness may be especially helpful for menopausal women struggling with irritability, anxiety, and depression. Another 2019 study notes that women whose diets were fruit- and veggie-heavy experienced fewer menopausal symptoms. “Yoga, meditation, acupuncture, and herbal remedies such as passion-flower extract, black cohosh, and red clover are all healthy hormone alternatives for mild symptoms,” says Dr. Ross. “And so is ditching harmful habits, like smoking, inactivity, and excessive alcohol and caffeine consumption.”