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Think You Understand Menopause? Think Again!

The four things you need to know to make your way through this life-changing journey. 

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Jordan Sondler
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Until recently, menopause — the time defined as 12 months after your last period — was shrouded in mystery and rarely discussed. Ask most Gen X women about their mother’s menopause experience, and most won’t remember much. Up until relatively recently, it was a topic that simply wasn’t discussed. Instead, many women struggled through the transition alone and with very little access to reliable information, support or medical advice. Is it any surprise that menopause myths and misinformation are everywhere? Here are four big menopause myths that you need to know about as you make your way through this life-changing journey. 

You’ll gain weight

Contrary to popular belief, weight gain after menopause isn’t inevitable. In fact, according to a study published recently ​​in the journal Science, after year 1 energy requirements drop about 3 percent a year until age 20, hold steady through midlife, and decrease again after age 60. “There tends to be a redistribution of fat [during menopause] and many people start to accumulate belly fat (visceral fat), instead of fat at their hips and thighs. So, shape may change, but menopause itself is not linked with weight gain,” says Jen Gunter, M.D., the author of The Menopause Manifesto.

Regular weight training, aerobic exercise, limiting alcohol and sugar, and maintaining a healthy diet filled with vegetables, fruits and lean protein can all help counter the gradual decrease in metabolism that we all face as we age. It’s worth noting that, ​​in general, women in menopause are more sensitive to carbohydrates, explains Tara Scott, M.D., of Revitalize Medical Group. She says that following either a modified keto diet or modified paleo/low carb along with time-restricted eating can help keep weight in a healthy range. “Make sure you don’t eat anything overnight for at least 12–14 hours most nights.”

Hormones are dangerous

The dangers of menopausal hormone therapy (MHT), formerly referred to as hormone replacement therapy (HRT), remain one of the most controversial — and misunderstood — myths of menopause. Safety, risks and benefits depend on who is taking it, how old they are, the reasons and the formulation.

“Standard prescription MHT with pharmaceutical preparations for women under the age of 60 and within 10 years of the final menstrual period is very low risk; transdermal therapy is the safest, and we recommend that is what women start with,” says Gunter. 

For people at low risk of breast cancer, transdermal MHT can be an excellent therapy for such conditions as hot flashes, osteoporosis and mild depression. However, starting at age 60 or more than 10 years from the final period, there is an increased risk of dementia and heart disease, and the risk outweighs the benefits. “The risks vary depending on the individual, which hormone you take, how you take it (oral vs. transdermal for estrogen), and the dose and duration of therapy,” says Scott. “This can be very confusing for a patient to navigate, so remember that the North American Menopause Society (NAMS) says that benefits outweigh risks between ages 50–60.”

Sex will suck 

A drop in estrogen and testosterone after menopause can result in vaginal dryness, reduced sensitivity and a decrease in the ability to become aroused. But that doesn’t mean you have to say sayonara to a healthy and enjoyable sex life. A good place to start if you are experiencing dryness is to find a good lubricant that you can use alone or with a partner. Hormones may also help with discomfort and pain during sex, so speak to your doctor about what is available and safe for you to use.

“Vaginal estradiol has been shown to help, and local therapy does not have the same risks as taking systemic hormone therapy,” says Scott. “Another newer therapy that has shown what I think is the best results is vaginal DHEA. It is FDA approved and called Intrarosa. In some studies, it showed to help all four phases of the sexual response cycle as well as painful intercourse and urinary symptoms. It is my first-line therapy for my patients.”

If you’re experiencing increased stress or depression, now might be a good time to reach out to a therapist who can address more complicated mental health issues that could be having a negative impact on your relationships and sex life.

And last but not least, consider experimenting with vibrators and sex toys, which, according to NAMS, can be helpful for some women experiencing issues with sexual function. Want more? Check out this extensive list of treatments for sexual problems during menopause. 

Menopause is the beginning of the end 

Not so, exclaims Gunter. “Menopause shouldn’t be viewed as the end of the race, but as a victory lap.” After all, by the time a woman reaches menopause, she has likely spent years dealing with menstruation, cramps, pregnancy (or trying not to get pregnant), infertility and pregnancy loss. “It can be a lot to navigate,” she says. “There is liberty in not having cramps or menstrual diarrhea. For those who partner with men who make sperm, there can be liberty in not worrying about getting pregnant. In addition, many women describe a clarity of thought once they complete their menopause transition.”

The bottom line is that it’s a new chapter — and certainly not the end of the story.