Navigating Menopause: A Q&A with an OB/GYN and Certified Menopause Expert 

Menopause, the natural end of menstruation, typically occurs later in a woman's life, bringing with it hormonal shifts and the end of her reproductive cycle. Menopausal symptoms, such as hot flashes and mood swings, can feel unbearable, but connecting with your doctor and learning coping strategies can help many women. 

Understanding the physical, emotional, and mental changes of menopause is crucial, not only for those experiencing it but also for loved ones who can offer support and understanding, according to Dr. Rachel Wykes, an obstetrics and gynecology specialist with Women’s Health Services at Lee Physician Group. Dr. Wykes is credentialed as a Menopause Society Certified Practitioner.

In this Q&A, Dr. Wykes shares her expertise on recognizing symptoms, treatment options, and how women can take control of their menopausal journey.

Understanding menopause: before, during, and after

Q: What’s the key to navigating perimenopause, menopause, and postmenopause?

The most important thing about navigating any phase of menopause is to recognize it, beginning with the early signs of perimenopause.

Perimenopause, the transition period into menopause, can start years before menopause. It can begin for some women in their early 30s, though it typically occurs in the mid-40s, lasting through the final diagnosis of “menopause” when a woman is 12 months without a period.  Common perimenopausal changes include irregular periods, mood changes, hot flashes, and night sweats as the hallmarks - but there are dozens more symptoms related to the fluctuations in estrogen and progesterone.

Perimenopause lasts through menopause, which is the day a woman officially goes 12 months without having a period. This time marks the permanent end of menstruation and fertility. This natural process, associated with reduced ovarian function, results in lower concentrations of ovarian hormones, principally estrogen. The time span after the final menstrual period (menopause) is postmenopause. 

Q: What causes menopause?

Dr. Wykes: The lack of estrogen caused by a natural decline in estrogen produced by the ovaries is the hallmark of menopause. Women’s bodies have adapted to using estrogen in almost every organ system, so when estrogen production declines during menopause, symptoms can manifest in ways other than just hot flashes and night sweats. 

I often see women who present with joint pain, back pain, hair and skin changes, autoimmune flare-ups, and mental health changes, including depression and anxiety, that seem to them to appear ‘out of nowhere.’ 

Many women feel the body they knew and loved has somewhat betrayed them. The transition can be brutal, but it does eventually level out. Some of these symptoms are temporary for most women (hot flushes), but some are the ‘new normal’, including the body’s tendency to store fat and lose muscle – this is a big concern for me and my patients. It is so important for women to embrace these inevitable changes to work WITH their body and relearn how to serve it to live a long, healthy life.

Q: How long do menopausal symptoms last?

Dr. Wykes: For the average woman, hot flushes and transitional symptoms typically last about seven years. However, I have seen patients in their 70s who are still experiencing persistent hot flashes and night sweats, and a good percentage of women who have none. Women in postmenopause who have symptoms should be evaluated by their doctor. I find many symptoms are a little sneakier and need to be explored in the safety of a relationship with a doctor you trust. 

I want all women to understand their unique experience, risks and benefits of hormone therapy, and how their body is changing. Many changes are less talked about, like vaginal dryness, urinary tract infections (UTIs), brain fog, and sleep disruptions. These need to be discussed, and treatment options are available and worth pursuing for a healthy and long quality of life.

Q: What's the current thinking on hormone replacement therapy?

Dr. Wykes: Nowadays, we prefer to call hormone replacement therapy, or HRT, menopausal hormone therapy, or MHT. This field has evolved greatly since the early 2000s, when it was linked with a combination of poor data, bad publicity, and not a lot of great options. 

Today, MHT replaces female hormones, primarily estrogen and progestogens, that are lost during the menopause transition. As a first-line treatment for troublesome hot flashes, hormone therapy has received FDA approval and has proven to be the most effective treatment modality. The benefits of hormone therapy for managing symptoms like hot flashes, night sweats, and sleep disturbances during early menopause demonstrably outweigh the associated risks.

Today's modern hormone therapy includes FDA-approved bioidentical (hormones that have the same chemical and molecular structure as the body’s natural hormones) options in various formulations, such as a pill, a cream, a patch, a spray, a vaginal ring, or a vaginal suppository. There are many different formulations for women, based on their symptoms and their needs. Treatment can be personalized for each woman.

Q: Who should avoid MHT?

Dr. Wykes: The list of contraindications (conditions or factors that make a particular treatment or procedure inadvisable or potentially harmful) has narrowed in recent years. For vaginal estrogen especially, the only firm contraindication is unexplained vaginal bleeding after menopause. This of course always needs to be evaluated, and once we rule out endometrial pathology the patient is again a candidate for vaginal estrogen. 

I hear many women express concerns about their personal history of high blood pressure or family history of blood cancer – but none of these are contraindications. 

For systemic estrogen, the modern approach also has very few contraindications.  Nothing about your family history would make systemic estrogen unsafe.  Even if you missed your ‘window’ to start in the early 50’s, we still have options that are safe.  We do consider a patient’s personal history of breast cancer, though even some breast cancer patients may be eligible, depending on specific circumstances. Some patients with breast cancer can still take hormone therapy. It depends on each patient’s specific case.

Women with history of blood clots, stroke, or hypertension can still generally use vaginal estrogen or transdermal estrogen-containing product, like a patch or spray, applied directly to the skin for absorption into the bloodstream.  

That said, MHT isn’t right for every woman. For some, the risks outweigh the benefits. That’s why it’s important for women to empower themselves by working closely with their obstetrician-gynecologist, especially one who specializes in this field, to learn about menopause, its symptoms, and its treatments. 

WATCH: Meet Dr. Rachel Wykes

Q: Can MHT increase breast cancer risk or cause osteoporosis?

Dr. Wykes: In my practice, I educate my patients about the available data and empower them with it so we can make decisions together based on peer-reviewed, evidence-based science and patient preference. In fact, the Food and Drug Administration (FDA) has approved estrogen therapy for the prevention of osteoporosis. It helps with bone and muscle building and prevents fractures. 

In the research, women who were on estrogen (and no synthetic progestin) actually had lower breast cancer rates than placebo. This data surprises many women who have heard the oft-made claim that ‘HRT causes breast cancer.’ The messaging was poorly delivered, and every woman deserves to understand the data and science and how it applies to their health.

Q: How long should someone stay on hormone therapy?

Dr. Wykes: Each year, we review this issue with each patient. Emerging research shows that the earlier a woman starts estrogen therapy and the longer she stays on exerts a protective benefit to the heart as well as other organ systems.

Q: Any other aspects of menopause that women should know about?

Dr. Wykes: I would recommend understanding how to eat and move properly for your menopausal body, tracking symptoms daily, journaling if that works for you, and above all, working closely with your doctor.  Your daily habits matter more than that one doctor’s appointment, but you want to have a plan to maintain lean muscle mass and core bodily functions like sleep, so important! 

I’d also emphasize the importance of discussing sexual health. Vaginal dryness, painful intercourse, lack of libido, and other menopausal symptoms are common. These topics may feel taboo, but they are vital parts of comprehensive menopausal care and treatment options.   

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