by DR. JEN GUNTER
Dr. Jen Gunter is an OB/GYN and author of The Menopause Manifesto and The Vagina Bible.
Many women struggle to get the facts about menopause, which is problematic. That most will spend one third or more of their lives in menopause makes it even more enraging. The consequences of not knowing what to expect when you are no longer expecting a period are profound. Many women suffer with symptoms or are unaware of the medical care that they may need for health and longevity. It is also frightening and disempowering not to understand what is happening to your body. When women do bring up their concerns with their providers, they often hit a dead end. They may be told, “That’s just part of being a woman,” or they may be given incomplete information about therapies (that is if they get any quality information at all). Unfortunately, this void has brought about an industry of influencers, so-called functional medicine experts, and predatory products all exploiting these gaps in medicine.
The lack of quality information about menopause isn’t what women want, but many don’t know where to turn. This is only made worse as the final menstrual period is treated as a ticket to irrelevance, when society has taught us there is no greater shame in our society than an aging woman’s body.
This was why I wrote The Menopause Manifesto, to explain the science behind menopause so women can make empowered decisions about their health. But also, so women can understand the history of menopause, meaning why it exists and how a patriarchal culture has affected our beliefs about our own bodies.
To help you combat menopause misinformation right now, here are some of the most common myths I hear about menopause, gleaned from my 25 years of talking with women in my own practice and from interacting with countless women online.
Before we get started, let’s have a short primer on menopause terminology, so we are all talking about the same thing. The menopause transition is the time leading up to the final period, also known as premenopausal or perimenopause. Everything after a woman’s final menstrual period is post menopause. However, many people use menopause for the final menstrual period onwards, and that’s perfectly fine.
1. Symptoms start with the last period.
False. For decades many women were either gaslighted about their symptoms, meaning they were told they couldn’t be having hot flashes before their final period, or told that therapy for bothersome symptoms couldn’t start until after the final period. We now know that the menopause transition, which starts several years before the final menstrual period, is a time of hormonal chaos (like puberty). Many women have bothersome symptoms during this time, such as hot flashes, difficulty sleeping, brain fog, depression and joint pain. In fact, the menopause transition can be the time of the worst symptoms for some women. Therapy most definitely doesn’t have to wait until after the final period.
2. Everyone is plagued with hot flashes.
False. While heat seems synonymous with menopause, about 25% of women have few or no hot flashes.
When hot flashes occur, they last an average of seven years. Approximately 25% of women are known as super flashers, meaning they start having hot flashes early in their menopause transition and they may have flashes for 10 years or even longer.
This is perhaps a good time to point out that menopause isn’t universally awful. Many women who were plagued with heavy or painful periods, or medical conditions triggered by their periods, such as migraines, feel better once their periods end. In addition, many women enjoy not worrying about pregnancy.
3. You need a blood test to check where you are on your menopause journey.
False. Just as you didn’t need blood tests to check on your journey through puberty, you don’t need blood work to track your progress towards menopause. In fact, there is no test that can accurately predict where you are in the menopause transition. And one isn’t needed, because we don’t offer therapy based on hormone levels, we offer therapy based on symptoms and risks for conditions, such as osteoporosis.
There is one exception. Women younger than 40 need blood testing if they have symptoms of menopause to make sure they do not have primary ovarian insufficiency (a condition that used to be called premature menopause).
4. Menopausal hormone therapy or MHT is risky.
False. MHT, which used to be known as hormone replacement therapy or HRT, is an excellent therapy for many bothersome symptoms that women may experience across the menopause continuum. It is also preventative therapy for osteoporosis and can treat depression. Fears about MHT started with a large study called the Women’s Health Initiative (WHI), but we have more information now to guide therapy. What women should know is the risks associated with MHT, especially transdermal therapy, fall in the rare range (1-10/10,000 women per year) for those who start when they are younger than 60 or are within 10 years of their last menstrual period. The rare risks associated with MHT, such as breast cancer, must be balanced against the benefits such as treating hot flashes and depression, and reducing the risk of type 2 diabetes and colon cancer. Importantly, MHT isn’t associated with an overall increase in mortality for women under the age of 60. There are nuances here and a full discussion of MHT requires collaboration with your own provider.
It’s also important to note that MHT isn’t the only therapy game in town. There are other medications and even cognitive behavioral that can be used for many of the bothersome symptoms associated with menopause.
5. Compounded hormones are customized and safer.
False. The opposite is actually true. Compounded hormones have not been subjected to the same testing and safety standards as traditional pharmaceuticals. This can result in women getting too low of a dose of hormones or too high. In addition, compounded preparations typically don’t contain the FDA required warning labels, giving them an illusion of safety. Some of these compounded preparations also contain hormones not recommended for menopause or are given in non-standard ways. One example is topical progesterone. It is not absorbed through the skin, and so women who use this product and are also taking estrogen may be putting themselves at risk for cancer of the uterine lining (endometrial cancer), as estrogen when taken without the right dose of progesterone can cause this cancer.
Compounded hormones are often paired with blood tests, which we just discussed as not recommended. Providers who offer this hormone testing under the guise of “finding the right hormone levels” are not practicing evidence-based medicine and this practice could result in recommending inappropriate doses. The tests are also an added expense, and keep women coming back to monitor their” customization.” Blood tests and so-called customized hormones may provide an illusion of caring, but what they are doing is exposing women to untested and potential unsafe therapies.
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