Friday, October 2, 2020

The 5 Myths Of Menopause

There's a lot of uncertainty out there about menopause, so today on the blog my guest from The Cusp is going to clarify the five myths pertaining to the "change of life" phase women experience. The Cusp is a telemedicine startup that provides an integrative care model and personalized treatment plans for menopause. 

                  THE 5  MYTHS OF MENOPAUSE

Whether you’re approaching perimenopause or in the thick of it, you’ve probably heard more than a few dire warnings about what to expect during this new life phase. Or maybe you’ve heard absolutely nothing and have no idea what’s in store. Either way, getting the straight scoop will go a long way toward easing your mind and your transition. Let’s take a look at five common myths about menopause, then bust them to smithereens.

Myth #1: Menopause is natural, so just grin and bear it.

This is a sneaky myth-couched-in-a-truth. Yes, menopause is natural. Everyone who is born with a uterus and ovaries will eventually go through menopause. Some of us will hit this milestone organically; some surgically, due to hysterectomy/oophorectomy. But either way, it’s gonna happen. 

That said, you do not have to just grin and bear it any more than you have to grin and bear...a headache. Think about it: you get a headache, naturally, and you immediately find a way to relieve it. Maybe you rehydrate. Or walk away from your computer screen for a while. Or take ibuprofen. Same with the symptoms of menopause. There are multiple ways to relieve them, from natural supplements to lifestyle changes to prescription meds, including hormone therapy (HRT). 

And honestly, you really shouldn’t grin and bear it. As your estrogen levels start to dissipate, your risk for osteoporosis, cardiovascular disease1, and Alzheimer’s disease2, go up. And some of the symptoms of menopause—weight gain, sleep loss, insulin resistance, depression—can increase your risk for Type 2 Diabetes3. So there are both immediate and long-term health benefits to treating your menopause symptoms.

This grin-and-bear-it myth probably exists because historically, people haven’t talked about menopause. Because it’s linked to sexual health, some women are uncomfortable sharing their experiences, even with other women. And we’ll say it: because only women go through menopause, it hasn’t received the attention it deserves from our male-dominated medical and scientific communities. This becomes glaringly obvious when you consider that 80% of OB/GYNs receive no menopause training during residency4. That’s right. Medical schools aren’t even talking about it! No wonder there’s a shortage of information and a plethora of misinformation out there. To that end, when you’re finished reading this article, please share it!

Myth #2: Menopause is all about hot flashes and mood swings.

These are two of the most common symptoms of menopause, along with weight gain around the belly and sleep troubles. They often kick in during perimenopause, which usually starts in a woman’s early- to mid-40s. And they can continue for years after you log your last period. But there are more than 20 symptoms associated with menopause. And your particular “cocktail” of symptoms may be quite different than your friends’ or your sisters’. It can also change as you progress through your transition. 

Changing hormones and symptoms mean that “treating” menopause tends not to be a one-and-done situation. It’s a process that should evolve with your experience. A treatment that works for hot flashes and night sweats at first, may lose its effects over time. Or you may start experiencing new symptoms like vaginal dryness or urinary incontinence or dry skin. In these cases, a doctor with menopause expertise can fold new treatments into your care plan to keep you feeling your best.

Myth #3: Hormone Therapy (HRT) is Dangerous.

We could write an entire article debunking this myth. In fact, we have. A few times. Here’s the Reader’s Digest version:

In the early ‘00s, HRT got a bad rap due to the media’s skewed reporting on the results of a massive hormone study called The Women’s Health Initiative (WHI)5. The reports claimed HRT puts women at risk for breast cancer and stroke. And because of this negative press, many women—and most doctors—decided the risks of HRT outweighed the benefits of managing symptoms of menopause. 

But a closer look at the data has revealed the risks are quite different depending on a woman’s age, the form of HRT she takes, and when she starts treatment. Women under 60 who took estrogen alone showed a lower risk of heart disease6. And follow-up7 studies8 are showing that these women have a significantly reduced risk of breast cancer (23% less) and an even lower risk of mortality due to breast cancer (44% less). Not even interventions explicitly designed to treat breast cancer have that kind of impact on mortality rates.

Now, the only women who can take estrogen-only HRT are those who no longer have a uterus. Women who still have their uterus need to take estrogen+progesterone, to protect their uterus from endometrial cancer. These women, when under 60, showed a slightly higher risk9 of heart disease (2.5 women per 1000). And women taking estrogen+progesterone for 5 years showed a slightly higher risk10 of breast cancer (3 cases per 1000). This may be related to the forms of estrogen and progesterone used during the study. In 2018, the FDA approved a bioidentical hormone therapy combination of estradiol (estrogen) and progesterone. But it’s still unknown if this form mitigates those risks. Neither estrogen-only nor estrogen+progesterone HRT is associated with an increased risk of all-cause mortality.11

The upshot of all this is that for women under 60, with no history of breast cancer or stroke, the benefits of HRT tend to outweigh the risks. To understand if HRT is right for you, it’s best to speak with a doctor who has menopause expertise and is well-versed in the art and science of HRT dosing. 

Myth #4: Your sex drive disappears forever.

“The biggest surprise to me is that I want sex even more than I did a few years ago,” says Dianne, 47. “I thought it would be just the opposite.”  

It is totally normal for a woman’s sex drive to change during the menopause transition. But 1) it’s not a given that yours will, 2) if yours does, there are ways to get it back, and 3) you may not miss it. Let’s dig into that first comforting statement.

During perimenopause, your hormone levels fluctuate wildly. So you may have months marked by less (or no) interest in sex, and months when you feel like a sex goddess. Once you reach menopause (the one-year anniversary of your last period) your hormone levels will bottom out and you may feel a more consistent lack of libido. But not to worry! Remember comforting statement #2? 

Some of the reasons why women lose interest in sex during this transition have to do with the fact that sex stops feeling good. Your dwindling hormones can bring about changes in your nether regions (vaginal dryness, vaginal prolapse) that make sex downright painful. Once women receive treatments for these issues, they often regain their desire for sex.

And then there’s comforting statement #3. “I’ve been single for a while and have a feeling that in the long run, my libido was more of a hindrance than a help (hello, bad judgment calls). So I am completely comfortable with this state of affairs,” says Kristy, 56. 

Indeed, since when is a woman’s libido a measure of her happiness? If you lose yours and your life is better for it, more power to ya!

Myth #5: You’ll lose your femininity. 

Okay first, what is “femininity” anyway? It’s not a measure of our femaleness. Our bodies and brains decide that. Femininity is a social construct used to describe “attributes, behaviors, and roles associated with women and girls.” Last we checked, those of us who identify as women are still women once we stop menstruating. So our current “attributes, behaviors, and roles” must be counted as feminine. In fact, this is the time that we tend to become the most distilled, true expressions of the women that we are. 

Femininity goes far beyond the girly, coquettish, reproductive phases of our lives. Indeed, the power of our femininity seems to take a consistently upward trajectory as we age. As far as we’re concerned, by the time we hit menopause, we achieve SuperFeminine status; strong, wise, beautiful, and confident. 

Let’s keep talking about menopause, sharing our experiences, and busting the myths until everyone knows what to expect and how to navigate it. This phase of our lives absolutely does not have to be mysterious. And no one has to go through it alone. 


1. Sherman S. Defining the menopausal transition. Am J Med. 2005;118 Suppl 12B: 3–7. doi:10.1016/j.amjmed.2005.11.002

2. Mosconi L, Rahman A, Diaz I, Wu X, Scheyer O, Hristov HW, et al. Increased Alzheimer’s risk during the menopause transition: A 3-year longitudinal brain imaging study. PLoS One. 2018;13: e0207885. doi:10.1371/journal.pone.0207885

3. Kim C. Does Menopause Increase Diabetes Risk? Strategies for Diabetes Prevention in Midlife Women. Women’s Health. 2012. pp. 155–167. doi:10.2217/whe.11.95

4. Wolff J, Wolff J. Doctors Don’t Know How to Treat Menopause Symptoms. 2018 [cited 13 Aug 2020]. Available: Doctors Don't Know How to Treat Menopause Symptoms

5. Design of the Women’s Health Initiative clinical trial and observational study. The Women's Health Initiative Study Group. Control Clin Trials. 1998;19: 61–109. doi:10.1016/s0197-2456(97)00078-0

6. Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003;349: 523–534. doi:10.1056/NEJMoa030808

7. Ragaz J, Qian H, Wong H, Wilson KS, Shakeraneh S, Spinelli JJ. Abstract P6-13-04: Estrogen-alone based hormone replacement therapy (HRT) reduces breast cancer (BrCa) incidence and mortality whereas estrogen plus progestin Provera based HRT increases both BrCa incidence and BrCa mortality: A comparative analysis of Women’s Health Initiative trials. Poster Session Abstracts. 2019. doi:10.1158/1538-7445.sabcs18-p6-13-04

8. Chlebowski RT, Anderson GL, Aragaki AK, Manson JE, Stefanick ML, Pan K, et al. Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials. JAMA. 2020;324: 369–380. doi:10.1001/jama.2020.9482

9. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SAA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004;291: 1701–1712. doi:10.1001/jama.291.14.1701

10. Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310: 1353–1368. doi:10.1001/jama.2013.278040

11. Manson JE, Aragaki AK, Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials. JAMA. 2017;318: 927–938. doi:10.1001/jama.2017.11217


  1. Great information here. (Typographically using superscripts or a different color for the footnotes would render this post superb.)

    1. Thanks for the heads up! I just copied and pasted it from the original submission.

  2. This is wonderful!!! Thank you so much for the info! Signed Flash. :)

  3. Very informative article. Thanks for sharing this guest, Marcia.

  4. Really helpful information here. I found the discussion about HRT particularly enlightening because I was also under the impression that HRT was "bad." I'm glad to hear this, as I'm considering this as my next option. Thanks so much for the sound and clear post!

  5. Nice article! I've been in perimenopause for years now and I'm just looking forward to menopause. I'm 52 years old and ready. I hope a few of my issues go away, but so far, I haven't had too many symptoms other than mood swings, depression, and migraines. And I still haven't gone gray.



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