Here are the top 5 misconceptions about menopause that I encounter in women’s health practice.
1. Hot flashes equal menopause.
No, not even close. While there are a few (very few!) women who suddenly develop hot flashes and ride off into a happy menopausal sunset, this is not usually the case. Hot flashes can occur for many years before and after menopause, and not all of them are due to plummeting estrogen. Here are some other causes of flashes and flushing that have nothing to do with menopause:
- Thyroid dysfunction, especially untreated hyperthyroidism and over-corrected hypothyroidism, i.e. too much thyroid replacement hormone
- Increased stress, anxiety, or panic attacks
- Medication side effects: Some chemotherapy drugs can cause hot flashes, as can tamoxifen (used to reduce breast cancer recurrence), raloxifene (used to treat osteoporosis), nitroglycerin (used for angina), and GnRH agonist medications like leuprolide and danazol (used to treat endometriosis or heavy bleeding caused by uterine fibroids)
- Spicy and hot foods, caffeine, and any food that causes a personal sensitivity or allergy
Severe and ongoing hot flashes for more than 2 years after menopause should prompt a cardiovascular health evaluation. Women with intense and prolonged vasomotor symptoms may be at higher risk for coronary artery disease and heart attack.
2. Menopause is a single event.
Unfortunately, no. Menopause is diagnosed when 12 consecutive months have passed with no menstrual bleeding, or the ovaries have been surgically removed. This timeframe does not always correlate with the frequency and intensity of menopausal symptoms like hot flashes and night sweats, insomnia, anxiety, vaginal dryness, urinary changes, and heart palpitations. Periods often cease, with or without other menopausal symptoms, only to resume later. And this can happen several times before true menopause. Many health providers still draw a blood level of FSH (follicle-stimulating hormone) as a diagnostic tool; a high level being used to confirm menopause. But even after a high FSH level, menstrual cycles sometimes resume. A single lab value should not be used as the only criterion of menopause. Periods may temporarily disappear for many reasons, including stress, illness, thyroid or pituitary dysfunction, pregnancy, or hormonal dysfunction caused by obesity, high insulin, or high androgen levels.
Low estrogen is a major cause of symptoms only from very late perimenopause on. Menopause occurs after several years of noticeable physiologic changes. The symptoms of perimenopause, including irregular periods, night sweats, disturbed sleep, and increased anxiety, are more likely to be due to falling progesterone and sporadic ovulation, along with fluctuating estrogen levels. Consequently, treating these symptoms with a birth control pill or other source of estrogen is not always beneficial, and never comprehensive. We should also nourish the body with healthy foods that reduce inflammation, support progesterone, and keep blood vessels elastic. Physical activity can be individually modified to support the changing needs of the bones, joints, muscles, and cardiovascular system, and to avoid hypoestrogenism. And we should never reduce a woman’s experience to her hormone status. There are many other factors at play. Changing roles and expectations in family and work life often occur at the same time as menopause. Women also come to terms with the end of bearing children or the possibility of ever bearing children.
4. My sex life will dry up with menopause.
Women’s sexual satisfaction increases with age, even if sexual desire wanes. In general, women over 40 are more sexually experienced and more confident in getting what they want out of their sex lives. Older women are more likely to lack a partner or have a medical condition that impacts sexual function, but this does not necessarily reduce satisfaction. Increasing age does not diminish sexual arousal or orgasm in women, either. If vaginal dryness is a problem, it can be treated with a vaginal moisturizer that is used a few times per week. Vaginal moisturizers are non-hormonal and a few are paraben-free. They work by drawing moisture into the vaginal mucosa to “plump up” the outer cell layers. Other non-hormonal options include Vitamin E oil and various plant-based creams and oils. Cultures around the world have used nutritional roots and tubers in the diet to promote female sexual function, including maca, kudzu, and Shatavari. Oral or topical estrogen replacement therapy may be appropriate for some women, especially when other approaches have failed.
5. Memory loss is a normal effect of menopause.
Menopause, in and of itself, is not to blame for forgetfulness, age-related memory loss, or dementia. An individual woman’s risk is much more complex, and is influenced by genetics, long term diet, vascular health, accumulated physical and emotional stressors, head traumas, and medication exposures. Hormone replacement therapy does not prevent cognitive decline or dementia, and may worsen cognitive function in older postmenopausal women. Read my post about brain fog and how to prevent it here.