Whether you’re curious about managing symptoms, exploring treatment options, or understanding how menopause affects your overall health, getting answers from your healthcare provider before menopause starts can help you feel more informed and empowered.
Here are 10 questions, and some background on what to expect during this time, to guide your conversation about menopause.
1. How Will I Know When I’m Starting Menopause?
Sometimes symptoms can be very subtle, but the menopause transition (which includes perimenopause) may start with changes to the menstrual cycle, says Traci Kurtzer, MD, medical director at Trauma Informed Solutions for Healthcare and a board-certified ob-gyn in Chicago.
“Those changes could be things like a decrease in the days between periods, or some might notice worsening premenstrual symptoms or premenstrual dysphoric disorder (PMDD),” says Dr. Kurtzer.
Symptoms of PMDD start during the week before menstruation and end within a few days after your period starts. They commonly include:
- Depressed mood
- Hopelessness
- Increased anxiety
- Mood swings
- Increased irritability
“If a person has had a hysterectomy, is taking something that suppresses periods like birth control pills, or has a hormonal IUD [intrauterine device], we don’t have the period to go by to tell us when you’re postmenopausal,” says Adams.
If you aren’t experiencing a period, you and your doctor will rely on symptoms of perimenopause and menopause to try to understand what’s happening, as most people experience similar symptoms.
“Around 80 percent of people get hot flashes, up to 70 percent get mood disturbance, 60 percent get sleep disturbance, and 50 percent get joint pain or vaginal dryness, so we look for those symptoms,” she says.
Typically, labs aren’t used to determine what’s happening because in perimenopause, hormone levels are so irregular. “[Labs] don’t tell us anything your symptoms aren’t already telling us,” says Adams.
2. Will I Have Hot Flashes? And What Helps?
About four out of five women experience hot flashes at some point during menopause, so there’s a good chance you will have them.
“There are both hormonal and nonhormonal ways to manage hot flashes,” says Adams.
Estrogen will help reduce them in about three weeks and may also help with other common menopause symptoms, she says.
However, estrogen therapy isn’t for everyone. People with breast cancer or endometrial cancer, people with liver or gallbladder disease, people with unexplained vaginal bleeding, people who are pregnant, people who’ve had a heart attack or a stroke, and people who’ve had a blood clot in their legs, lungs, or brain shouldn’t take estrogen, says Adams.
“Nonhormonal options are drugs like fezolinetant (Veozah), a once-a-day pill that blocks the neurons in the brain that trigger hot flashes. Another drug that works well is gabapentin, which we typically prescribe to take at night because it can be helpful for sleep,” she says.
Antidepressants can be used to treat hot flashes, but they often come with some unwanted sexual side effects like decreased orgasm, says Adams.
3. Can Any Nondrug Lifestyle Changes Help With Hot Flashes?
There is some evidence that natural remedies for hot flashes, like lifestyle or behavioral changes, can help, says Adams. These interventions include:
- Four to six sessions of cognitive behavioral therapy have been shown to effectively reduce the number and severity of hot flashes.
- Weight loss studies have shown women with obesity are more likely to report more frequent and severe hot flashes than women who are at a healthy weight. Weight loss is also linked with a decrease in hot flashes and night sweats.
- Quit smoking and avoid alcohol use as these can make menopausal symptoms, like hot flashes, worse.
4. How Will Menopause Affect My Sleep?
Although more women report having hot flashes than sleep disturbances, women tend to report being more bothered by the inability to get a good night’s sleep, says Adams.
“Treating night sweats can help with sleep, so estrogen can help, and progesterone also helps, since its side effect is drowsiness. The best treatment for sleep disturbance after managing night sweats is cognitive behavioral therapy for insomnia,” says Adams.
Adams advises that other conditions, such as sleep apnea and restless legs syndrome (both more common in menopausal women), can also cause sleep problems, so you’ll want to rule those out.
5. Are There Solutions for Loss of Libido?
Low libido is complicated, and many factors can affect your sex drive, says Adams.
“It can be related to medical issues, medications people are on, pain with sex, decreased arousal or orgasm, partners’ sexual issues, relationship issues, drugs or alcohol, stress, or fatigue,” she says.
Treatment for low libido involves getting to the source of the problem, which typically isn’t due to menopause alone. Drugs to treat low libido, like flibanserin (Addyi) or testosterone, generally have low efficacy and don’t work as well as behavioral approaches, says Adams.
6. What Can I Do About Pain During Sex?
According to a study, between 13 and 84 percent of menopausal women experience pain during sex, or dyspareunia, but doctors rarely evaluate or treat the symptom.
This is often because most women in the U.S. no longer visit a gynecologist after menopause, women rarely discuss dyspareunia with their primary care physicians, and painful sex often takes the backseat to other serious health problems. But it’s still a common effect of menopause that can negatively affect a woman’s life.
There are three steps to managing painful penetration in menopause, says Adams.
- Over-the-counter vaginal moisturizers: These can be used three times weekly to make the vagina more plump and moist.
- Lubricant with sexual activity: Adams maintains this is important. “Water-based lube should be used with latex condoms or silicone vibrators, but otherwise, coconut oil is my favorite lubricant. It’s cheap, smells great, and promotes a healthy vaginal microbiome,” says Adams.
- Prescription topical estrogen products: These can be a cream, tablet, suppository, or ring, can thicken the vaginal tissue, and may help you manage painful penetration.
Kurtzer suggests seeking out an expert in menopause and sexual dysfunction.
“If one is not getting support from their primary care physician or gynecologist to discuss their concerns, they can go to the International Society for the Study of Women’s Sexual Health or The Menopause Society websites to locate specialists who will be more likely and able to help,” she says.
7. Will I Need to Change My Diet to Keep From Gaining Weight?
It’s unfair but true: When women go through menopause and don’t adjust their diet and exercise routine, weight gain can occur, says Adams.
“This is because metabolic changes that happen in menopause tend to slow our metabolism, marble our muscle with fat, and cause weight to settle around the midsection,” she says.
Adams suggests adopting a whole-food, plant-based diet to maintain a healthy weight.
Half your plate should be fruits and veggies, a quarter whole grains, and a quarter beans, peas, and legumes. A few days a week, it’s also a good idea to minimize your intake of animal products such as meat, eggs, and dairy and focus on whole, plant-based foods where possible.
8. Can Hormone Therapy Help With Menopause Symptoms Beyond Hot Flashes?
“Estrogen therapy provides other benefits by treating other menopausal symptoms like poor sleep, low mood, and vaginal pain with penetration. Plus estrogen improves bone strength, making osteoporosis less likely,” says Adams.
“Pursuing menopausal hormone therapy is a personal decision based on a discussion we each should have with our doctor. They have an in-depth knowledge of our health history and offer advice based on our needs,” says Kurtzer.
That being said, Kurtzer advises that women going through the menopause transition shouldn’t fear or demonize hormone therapy, as has happened over the past 20 years. “For many, many women, hormone therapy has been a lifesaver that helped them through a difficult transition period,” says Kurtzer.
9. Should I Take Supplements During or After Menopause?
You generally don’t need to take a lot of supplements during menopause, says Adams. While individuals should talk to their doctor before taking any supplements, she recommends the following:
- Vitamin D Take 1,000 to 2,000 IU per day, because we absorb less from the sun as we age.
- Calcium Intake should be 1,200 milligrams (mg) per day, but no more than 500 mg from supplements, because amounts above that tend to deposit in the heart.
“Otherwise it’s best to ‘eat the rainbow’ and get your fiber, minerals, and anti-inflammatory compounds through your diet,” she says.
10. Will I Still Need to Get Regular Pap Tests During and After Menopause?
Guidelines for preventive screening tests, like a Pap smear for early detection of cervical cancer, don’t necessarily change as soon as someone goes through menopause, but they can change somewhat over time, says Kurtzer.
Updated American Cancer Society guidelines now state “individuals with an average risk of developing cervical cancer may stop being screened after having negative primary HPV [human papillomavirus] tests or negative co-testing using HPV tests and cytology testing (Pap tests) at age 60 and 65.”
Additionally, this new guidance allows for self-collected vaginal specimens that take place privately in a clinic or at home, without a healthcare provider present, to serve as HPV testing as part of screening for cervical cancer.
As long as the home tests are negative, you should repeat these self-collected tests every three years, though clinician-collected specimens are preferred and should happen every five years. If you opt to self-test and are nearing 60 or 65, you should consult with your doctor about the results and if any additional screening is necessary.
Periodic examinations are still important for checking on other body parts, like the breast, vulva, vagina, uterus, and ovaries, that can develop conditions, says Kurtzer.
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