10 menopause myths the experts can’t stand

NEW YORK – Inescapable hot flashes. Hormonal chaos. Sexless partnerships. Such stereotypes of menopause are deeply ingrained, and few are fully accurate.

Menopause can produce symptoms in many parts of the body and sometimes in unexpected ways, said Dr Rebecca Thurston, an assistant dean for women’s health research and a professor of psychiatry at the University of Pittsburgh.

Gynaecologists, endocrinologists, urologists and other experts were asked about the biggest menopause misconceptions they had encountered. Here is what they want patients to know.

Myth 1: It’s just hot flashes

Hot flashes are a menopausal hallmark. Up to 80 per cent of women have them. But numerous lesser-known symptoms are also linked to menopause, including insomnia, mood changes, brain fog, vaginal dryness, joint pain and more.

That is largely because menopause is driven by changing levels of oestrogen, which affects all tissues. During perimenopause, the years leading up to one’s final menstrual period, oestrogen fluctuates wildly. After menopause, it settles at a low level.

Unfortunately, many people do not know the full range of symptoms this process can cause, said Dr JoAnn Manson, an endocrinologist and professor at Harvard Medical School. That means they may not realise a symptom is menopause-related, which can mean missing out on helpful treatments.

Myth 2: “Everything” is a menopause symptom

“Until recently, a lot of women’s symptoms were dismissed or misunderstood as something not related to our hormones,” said Dr Anna Barbieri, an ob-gyn and integrative medicine physician in New York.

But some doctors worry that there has been too much of a shift in the opposite direction.

“Now, the pendulum is swinging more towards ‘everything is menopause and perimenopause’. And that’s an oversimplification also,” Dr Barbieri said.

She noted, for example, that joint pain in middle age could be linked to declining oestrogen, but also to arthritis.

Dr Pelin Batur, a professor of obstetrics, gynaecology and reproductive biology at the Cleveland Clinic, said she had seen many cases in which patients and their providers attributed symptoms like fatigue to menopause, and did not do basic testing that would have revealed anaemia, thyroid problems or vitamin deficiencies as the real cause.

Myth 3: Hormone therapy is dangerous

Until 2002, medical providers routinely prescribed hormone therapy for menopausal symptoms. Then a highly publicised study found a small increase in breast cancer and blood clots among women taking oestrogen and progestin.

Hormone use plummeted, and many women still fear it.

In reality, experts said, the benefits – including relief from hot flashes and vaginal dryness, and reduced risk of osteoporosis – outweigh the low risks for most women in their 40s and 50s who are experiencing disruptive symptoms.

Some older women may also safely benefit, said Dr Lauren Streicher, a clinical professor of obstetrics and gynaecology at Northwestern University.

While there are people, like breast cancer survivors, for whom systemic hormone therapy is generally not recommended, these limits are pretty narrow, experts said.

And hormone therapy comes in many forms, so if one type does not work for a particular person, another might.

For example, oestrogen pills typically are not advised for people at high risk of blood clots because they can increase the liver’s production of clotting proteins. But oestrogen skin patches do not do that. And low-dose vaginal oestrogen for urinary and genital symptoms is safe for everyone, said Dr Rachel Rubin, a urologist specialising in sexual medicine.

Myth 4: Hormones are the only treatment option

Hormone therapy is “neither a miracle nor a poison”, said Dr Jill Liss, an associate clinical professor of ob-gyn at the University of Colorado School of Medicine. “It can be life-changing for some, unnecessary or even risky for others.”

And for those whom it does not help, experts emphasised there are alternatives.

Providers have long treated hot flashes with the anti-seizure drug gabapentin, the antidepressant paroxetine, cognitive behavioural therapy and breathing exercises. In 2023, the Food and Drug Administration (FDA) approved fezolinetant, which targets neurons that regulate temperature. And hyaluronic acid products can treat vaginal dryness.

Myth 5: “Natural” treatments are safer

Many women, fearing hormones, opt for herbs and supplements. But “just because something may be marketed as natural, that does not necessarily mean that it’s safe”, Dr Manson said. “Arsenic is also natural.”

Almost none of the supplements promoted by many influencers are supported by solid evidence, said Dr Nanette Santoro, chair of the department of obstetrics and gynaecology at the University of Colorado. And their production is only lightly regulated, which can lead to contamination.

After many women abandoned FDA-approved hormones, some chose another ostensibly natural treatment: “bioidenticals”, or hormones that match those the human body produces. Loosely-regulated compounding pharmacies that make them have claimed they are safer than conjugated oestrogen, derived from horses. But research does not back that up, experts said.

“Do you know the major reason the compounded hormones are safer than regular FDA-approved hormones?” joked Dr Mary Jane Minkin, a clinical professor of obstetrics, gynaecology and reproductive sciences at the Yale School of Medicine. “There’s no package insert telling you all the side effects.”

Myth 6: You just need to tough it out

Many patients are determined to ride out menopause without help. But researchers say that could lead to serious medical problems.

Women who have frequent or severe hot flashes are likelier than those who do not to develop cardiovascular disease, and those with more hot flashes during sleep tend to have poorer memory. Research is under way to determine why, said Dr Thurston, who has studied the topic.

Hot flashes can lead to poor sleep, which is linked to cardiovascular disease, diabetes and cognitive decline, but less-understood factors may be involved as well.

Vaginal dryness also increases the risk of urinary tract infections. Even asymptomatic people typically experience metabolic changes and lower bone density in menopause.

Women can get tests and treatments that may reduce their risk, several experts said.

And in general, menopause is a crucial time to pay attention to your health, including eating well, exercising and monitoring your blood pressure and cholesterol.

Myth 7: Symptoms don’t last long

Many women expect hot flashes to be short-lived, experts said, but they last more than seven years on average – sometimes much more.

Other symptoms can persist even longer. For instance, urinary tract infections in older women are commonly connected to menopause, but many women do not realise that, said Dr Elizabeth Evans, a urogynaecologist and professor at the University of Texas Health Science Center at San Antonio.

“You’ll have somebody who comes around who’s 70 and says: ‘I’m past all that. Why are we talking about menopause?’” Dr Evans said.

Symptoms can also start earlier than people expect. While 45 or later is typical for a final menstrual period, it is not abnormal to experience perimenopausal symptoms in one’s mid-to-late 30s, said Dr Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health.

“Women get gaslit a lot in this space, because if you have a 37-year-old going in complaining of mood issues, sleep issues, whatever, they’re told it’s not possible,” said Dr Faubion, who is also medical director of the Menopause Society.

Myth 8: Your sex life will never be great again

Pain during sex is common in menopause, and “people tend to have lower spontaneous desire”, said Dr Diana Bitner, chief medical officer and co-founder of True Women’s Health, a concierge clinic. That can create a self-perpetuating cycle in which “the less sex that happens, the less sex that is asked for”.

But this cycle is breakable. Experts said open discussions with patients were essential.

Moisturisers, lubricants and vaginal oestrogen can help with dryness and pain. And testosterone, while not approved by the FDA for menopausal symptoms, is prescribed off label for libido.

Myth 9: Perimenopausal women can’t get pregnant

It is a common scenario in Dr Batur’s practice, she said: A patient who had not had a period for months, and who believed she was in menopause based on unreliable lab tests, shows up pregnant.

Even if your periods are infrequent, you can get pregnant during perimenopause. In fact, a 2015 study found that, behind teenagers, women in their 40s were the second-most likely group to have an unplanned pregnancy.

“All it takes is one egg and one sperm,” Dr Batur said.

Pregnancy remains a possibility until you have finished perimenopause and gone a full year without a period (in the absence of another condition that affects your periods).

Myth 10: Going through menopause is always awful

Cultural representations of menopause are grim. Beyond the unpleasant symptoms, it is often characterised, Dr Thurston said, “as this time of decay and loss”.

But while the symptoms are real, they are not the whole story. Many women feel more authentic and self-confident, Dr Thurston added. “They care less about what other people think, and that’s very freeing.”

There are other benefits too. After all, who in possession of a uterus has not, while lying in the foetal position around a heating pad, longed for the misery to end? NYTIMES