There are lots of misconceptions out there. We asked experts about the biggest offenders.
Inescapable hot flashes. Hormonal chaos. Sexless partnerships. Such stereotypes of menopause are deeply ingrained, and few are fully accurate.
Menopause can produce symptoms in many parts of the body, and sometimes in unexpected ways, said Rebecca Thurston, an assistant dean for women’s health research and a professor of psychiatry at the University of Pittsburgh.
We asked gynecologists, endocrinologists, urologists and other experts about the biggest menopause misconceptions they had encountered. Here’s what they want patients to know.
Myth 1: It’s just hot flashes
Hot flashes are a menopausal hallmark: up to 80% of women have them. But numerous lesser-known symptoms are also linked to menopause, including insomnia, mood changes, brain fog, vaginal dryness, joint pain and more.
That’s largely because menopause is driven by changing levels of estrogen, which affects all tissues. During perimenopause, the years leading up to one’s final menstrual period, estrogen fluctuates wildly. After menopause, it settles at a low level.
Unfortunately, many people don’t know the full range of symptoms this process can cause, said Dr JoAnn Manson, an endocrinologist and professor at Harvard Medical School. That means they may not realise a symptom is menopause-related, which can mean missing out on helpful treatments.
Myth 2: ‘Everything’ is a menopause symptom
“Until recently, a lot of women’s symptoms were dismissed or misunderstood as something not related to our hormones,” said Dr Anna Barbieri, an obstetrician-gynecologist (OB-GYN) and integrative medicine physician in New York.
But some doctors worry that there has been too much of a shift in the opposite direction.
“Now the pendulum is swinging more toward, ‘Everything is menopause and perimenopause,’ and that’s an oversimplification also,” Barbieri said.
She noted, for example, that joint pain in middle age could be linked to declining estrogen, but also to arthritis.
Dr Pelin Batur, a professor of obstetrics, gynecology and reproductive biology at the Cleveland Clinic, said she had seen many cases in which patients and their providers attributed symptoms like fatigue to menopause, and didn’t do basic testing that would have revealed anaemia, thyroid problems or vitamin deficiencies as the real cause.
Myth 3: Hormone therapy is dangerous
Until 2002, medical providers routinely prescribed hormone therapy for menopausal symptoms. Then a highly publicised study found a small increase in breast cancer and blood clots among women taking estrogen and progestin.
Hormone use plummeted, and many women still fear it.
In reality, experts said, the benefits – including relief from hot flashes and vaginal dryness, and reduced risk of osteoporosis – outweigh the low risks for most women in their 40s and 50s who are experiencing disruptive symptoms. Some older women may also safely benefit, said Dr Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University.
While there are people, like breast cancer survivors, for whom systemic hormone therapy is generally not recommended, these limits are pretty narrow, experts said.
And hormone therapy comes in many forms, so if one type doesn’t work for a particular person, another might.
For example, estrogen pills typically aren’t advised for people at high risk of blood clots, because they can increase the liver’s production of clotting proteins. But estrogen skin patches don’t do that. And low-dose vaginal estrogen for urinary and genital symptoms is safe for everyone, said Dr. Rachel Rubin, a urologist specialising in sexual medicine.
Myth 4: Hormones are the only treatment option
Hormone therapy is “neither a miracle nor a poison”, said Dr Jill Liss, an associate clinical professor of OB-GYN at the University of Colorado School of Medicine. “It can be life-changing for some, unnecessary or even risky for others.”
And for those whom it doesn’t help, experts emphasised there are alternatives.
Providers have long treated hot flashes with the anti-seizure drug gabapentin, the antidepressant paroxetine, cognitive behavioural therapy and breathing exercises. In 2023, the Food and Drug Administration approved fezolinetant, which targets neurons that regulate temperature. And hyaluronic acid products can treat vaginal dryness.
Myth 5: ‘Natural’ treatments are safer
Many women, fearing hormones, opt for herbs and supplements. But “just because something may be marketed as natural, that does not necessarily mean that it’s safe,” Manson said. “Arsenic is also natural.”
Almost none of the supplements promoted by many influencers are supported by solid evidence, said Dr Nanette Santoro, the chair of the Department of Obstetrics and Gynecology at the University of Colorado. And their production is only lightly regulated, which can lead to contamination.
After many women abandoned FDA-approved hormones, some chose another ostensibly natural treatment: “bioidenticals”, or hormones that match those the human body produces. Loosely regulated compounding pharmacies that make them have claimed they are safer than conjugated estrogen, derived from horses. But research doesn’t back that up, experts said.
“Do you know the major reason the compounded hormones are safer than regular FDA-approved hormones?” joked Dr Mary Jane Minkin, a clinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine. “There’s no package insert telling you all the side effects.”
Myth 6: You just need to tough it out
Many patients are determined to ride out menopause without help. But researchers say that could lead to serious medical problems.
Women who have frequent or severe hot flashes are likelier than those who do not to develop cardiovascular disease, and those with more hot flashes during sleep tend to have poorer memory. Research is underway to determine why, said Thurston, who has studied the topic. Hot flashes can lead to poor sleep, which is linked to cardiovascular disease, diabetes and cognitive decline, but less-understood factors may be involved as well.
Vaginal dryness also increases the risk of urinary tract infections. Even asymptomatic people typically experience metabolic changes and lower bone density in menopause.
Women can get tests and treatments that may reduce their risk, several experts said. And in general, menopause is a crucial time to pay attention to your health, including eating well, exercising and monitoring your blood pressure and cholesterol.
Myth 7: Symptoms don’t last long
Many women expect hot flashes to be short-lived, experts said, but they last more than seven years on average – sometimes much more.
Other symptoms can persist even longer. For instance, urinary tract infections in older women are commonly connected to menopause, but many women don’t realise that, said Dr Elizabeth Evans, a urogynecologist and professor at the University of Texas Health Science Center at San Antonio.
“You’ll have somebody who comes around who’s 70 and says: ‘I’m past all that. Why are we talking about menopause?’” Evans said.
Symptoms can also start earlier than people expect. While age 45 or later is typical for a final menstrual period, it isn’t abnormal to experience perimenopausal symptoms in your mid-to-late 30s, said Dr Stephanie Faubion, the director of the Mayo Clinic Center for Women’s Health and medical director of the Menopause Society.
“Women get gaslit a lot in this space, because if you have a 37-year-old going in complaining of mood issues, sleep issues, whatever, they’re told it’s not possible,” she said.
Myth 8: Your sex life will never be great again
Pain during sex is common in menopause, and “people tend to have lower spontaneous desire”, said Dr Diana Bitner, the chief medical officer and co-founder of true. Women’s Health, a concierge clinic. That can create a self-perpetuating cycle in which “the less sex that happens, the less sex that is asked for”.
But this cycle is breakable. Experts said open discussions with patients were essential.
Moisturisers, lubricants and vaginal estrogen can help with dryness and pain. And testosterone, while not approved by the FDA for menopausal symptoms, is prescribed off-label for libido.
Myth 9: Perimenopausal women can’t get pregnant
It’s a common scenario in Batur’s practice, she said: a patient who hadn’t had a period for months, and who believed they were in menopause based on unreliable lab tests, shows up pregnant.
Even if your periods are infrequent, you can get pregnant during perimenopause. In fact, a 2015 study found that, behind teenagers, women in their 40s were the second most likely group to have an unplanned pregnancy.
“All it takes is one egg and one sperm,” Batur said.
Pregnancy remains a possibility until you have finished perimenopause and gone a full year without a period (in the absence of another condition that affects your periods).
Myth 10: Going through menopause is always awful
Cultural representations of menopause are grim. Beyond the unpleasant symptoms, it is often characterised, Thurston said, “as this time of decay and loss”.
But while the symptoms are real, they aren’t the whole story. Many women feel more authentic and self-confident, Thurston added. “They care less about what other people think, and that’s very freeing.”
There are other benefits, too. After all, who in possession of a uterus has not, while lying in the fetal position around a heating pad, longed for the misery to end?
This article originally appeared in The New York Times.
Written by: Maggie Astor
Illustration by: Yifan Wu
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