October is here, but for many women, the shiver of fear caused by the idea of menopause is worse than even the most chilling haunted house. Mainstream dialogues about menopause have told us that there’s a lot to be anxious about, and we’re here today with Dr. Barbara Frank, OB-GYN to combat that. In honor of Menopause Awareness Month, relief comes in the form of real answers to a few of the questions that women have as we approach or enter this much-feared phase, like on the misunderstood but important topic of hormone replacement therapy during menopause. Are you ready to be prepared instead of scared? Let’s jump in.
Menopause: Is it a moment? Is it a phase? Is it ever over? Tell us everything!
We tend to think of menopause as a concrete, wake-up-and-it’s-happening thing, but menopause is actually very fluid and continuous. From a numbers perspective, on average, most women in the U.S. go through menopause by age 51 and an estimated 6,000 women in the U.S. alone reach menopause every day (more than 2 million per year). In terms of the sequence of events, menopause is preceded by perimenopause (which can last for years) and followed by post-menopause.
After menopause, your ovaries are no longer fertile, but you can (and should!) continue living your best life. As we age, a lot of things change, but we shouldn't be defined by a life stage. Instead, with proper self-care and a positive mindset, it can be a period of empowerment and a time to embrace new possibilities, living life to its fullest. Aging is natural, and the wisdom, experiences, and strength that come with it should define this stage—not menopause itself.
How do we know exactly when we’ve started menopause?
Says Dr. Barbara Frank, “That is a really, really tough question to answer because some people will go through it and have no symptoms. I hope that that is me one day! Some of the symptoms that women may have noticed during perimenopause may continue, like vasomotor symptoms AKA hot flashes. Other people will have complaints about symptoms like vaginal dryness or libido changes which also come from those changing hormones. They might feel like they're having more sleep disturbance, even insomnia, as well as mood changes, bone density loss, or changes to body composition. These can all be menopausal symptoms.”
Many of these symptoms can’t be prevented, but bone density loss may be addressed through appropriate exercise. Read our interview with senior fitness specialist Rachel Ridgeway to learn more.
What’s HRT (hormone replacement therapy) all about? Is it safe, and how can we use it?
Hormone replacement therapy was once something that wasn't really talked about—it just was a part of menopause. Says Dr. Frank, “Just about every doctor gave women a pill like, “Here are your estrogen pills, you’re 50 years old and it's time for menopause.” But in the 1990s, a study came out, the Women's Health Initiative, that brought questions about risks involving this medication to the forefront.”
The risk of taking HRT is based on your personal medical history, so Dr. Frank emphasizes the importance of having a detailed conversation with your provider. Don’t have a great doc right now? Explore our directory.
Specific risks that were identified in the Women's Health Initiative were venous thromboembolism (VTE) which could include dangerous blood clots in the legs, or stroke. These are scary potential risks that were appearing in higher numbers than expected, but it’s important to note that this study included women who had an average age of about 70. For women in their 50s, the risk profile is typically very different. Another variable that your provider will take into account is whether you or your family have a history of breast cancer, which may be a reason to avoid extra estrogen. If you have any blood clotting risk, HRT might not be right for you either.
What about the benefits of HRT? How can it change how women experience menopause?
Dr. Frank tells us “Alongside the risks for some people, HRT also has a ton of potential benefits. For example, lower risk of cardiovascular disease and colon cancer. For some people, it gives a bit of a boost with your day-to-day activities.
The other type of hormone replacement therapy is aimed specifically at the vagina. Your vagina goes through menopause, too, often creating vaginal dryness that can not only be irritating but can increase your risk of urinary tract infections (UTIs). For women who can’t take the oral HRT or don't really need it systemically, they may be able to choose local estrogen just for the vagina. From what we’ve heard, it can be a miracle!
(P.S. When it comes to friction, Dr. Frank has way more to say about lube in this blog!)
When is a good time to consider HRT as a way of managing menopause symptoms?
The goal of HRT, from a medical standpoint, is to use the lowest dose possible for as short a period of time as you need it. So when you're in that perimenopausal phase, and you're getting closer to menopause, that would be a good time to start. So that you're not having this abrupt shift of going from absolutely no estrogen in your body to “here's brand new estrogen!”
Dr. Frank explains her approach to handling HRT as her patients get older: “Typically every year or so I'll try to wean women off by trying a couple of days or even weeks without it and see how they do. For every woman it’s different—I have some women that come off by 55, and I have other women that want to take it into their 60s.
What are women’s options when it comes to localized estrogen?
There are so many: You can have a tablet, you can have a cream, there's a ring, there's a string (which kind of looks like a rubber band for your hair ), etc. Each has its own frequency and dose. The way that these work is by giving local estrogen, which we think has less systemic absorption, which means it's likely less risky for those who can’t do oral supplements, or even people that have a history of breast cancer.
Says Dr. Frank “Some patients of mine went into early menopause because of breast cancer medications. They are young and want to have sex, but they have issues with vaginal dryness or vaginal atrophy (when you've lost that elasticity and collagen). Local estrogens really work wonders for them, and a lot of oncologists will be ok with it, too depending on the specific patient.”
What alternatives to traditional estrogen replacement therapy are out there?
There are many alternatives but it’s important to note that many are not actually FDA-approved and tested. That means that the amount of “estrogen-like product” that you get from using them is not regulated.
Again, this is a conversation to have with your doctor to discuss the options, risks, and benefits for you personally. Complementary treatments or therapies like nutrition plans, acupuncture, pelvic floor therapy, are all options that you may want to bring up to address various aspects of your menopausal symptoms. Looking for a specialist? Don’t forget to check out our directory.
What’s the most important thing that women should know about menopause?
Dr. Frank, who works with many women approaching, and going through menopause, had this to say: “I think number one is not being afraid. We get set up for menopause to be this day that’s going to come, and all of a sudden, we're just going to crumble to pieces. It's really not like that for everybody. The best thing that you can do for your health is to be really in tune with your body. Take the time to talk to your doctor about it, talk to your mom too (because most women will go through menopause around when their moms went through menopause). The more prepared and informed you are, the less you’ll feel like this whole change just hit you like a ton of bricks.”
As always, many thanks to Dr. Frank for sharing her expertise. This Menopause Awareness Month, join us in breathing in wisdom, and breathing out fear. Like so many women who have come before us, we will get through it–thankfully with vastly more information, resources, and honest conversations than our mothers had. And from what we hear, the best is very much yet to come.