10 Questions to Ask Your Gynecologist About Menopause
Menopause can be a confusing time. Here's what to ask your doctor about symptoms like hot flashes and sexual changes, as well as treatments such as hormone therapy.
Finally, menopause is getting the attention it deserves. Now more than ever, women are sharing their experiences and exploring options to treat bothersome symptoms. Knowing what to expect and getting the support you need can make all the difference in the years you spend in perimenopause and menopause.
That’s why an open discussion with your gynecologist is a must, and if you know the right questions to ask you'll have a better time navigating the transition.
On average, women go through menopause at age 52, says Karen Adams, MD, the director of the Stanford Program in Menopause and Healthy Aging in Stanford, California.
“Since perimenopause [typically] starts in the early forties, that would be a good time to start the discussion,” she says.
Dr. Adams suggests seeking out providers with specific expertise in menopause.
“Unfortunately a lot of docs aren’t well versed in menopause, and patients may be told ‘It’s not hormones.’ Look on The Menopause Society website for a list of certified menopause practitioners in your area,” she says.
Menopause symptoms can be more than hot flashes: They can include mood disturbances, poor sleep, joint pain, weight gain, vaginal discomfort, vaginal pain with intercourse, and sexual dysfunction, says Adams.
“Preexisting problems in these areas can mean that menopause will be more symptomatic for that woman, so being proactive is key,” she says.
But you don’t have to wait until you have symptoms to start asking questions, says Adams.
Whether you're curious about managing symptoms, exploring treatment options, or understanding how menopause affects your overall health, asking questions — and getting answers — can help you feel more informed and empowered.
Here are 10 questions to guide your conversation about menopause.
Sometimes symptoms can be very subtle, but the menopause transition (which includes perimenopause) may start off with changes to the menstrual cycle, says Traci Kurtzer, MD, a gynecologist at Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago.
“Those changes could be things like a decrease in the days between periods, or some might notice worsening premenstrual symptoms (PMS) or premenstrual dysphoric disorder (PMDD),” says Dr. Kurtzer.
"If a person has had a hysterectomy, is taking something that suppresses periods like birth control pills, or has a hormonal IUD, we don’t have the period to go by to tell us when you’re postmenopausal," adds Adams.
“In those cases we use symptoms to tell us what’s happening. Around 80 percent of people get hot flashes, up to 70 percent get mood disturbance, 60 percent get sleep disturbance, and 50 percent get joint pain or vaginal dryness, so we look for those symptoms,” she says.
Typically, labs aren’t used to determine what’s happening because in perimenopause hormone levels are so irregular, “they don’t tell us anything that your symptoms aren’t already telling us,” notes Adams.
“There are both hormonal and nonhormonal ways to manage hot flashes,” says Adams.
Estrogen will take them away in about three weeks and may also help with other common menopause symptoms, she says.
The people who should not take estrogen are people with breast cancer or endometrial cancer, people with liver or gallbladder disease, people with unexplained vaginal bleeding, people who are pregnant, people who’ve had a heart attack or a stroke, and people who’ve had a blood clot in their legs, lungs, or brain, says Adams.
“Nonhormonal options are drugs like fezolinetant (Veozah), a once-a-day pill that blocks the neurons in the brain that trigger hot flashes. Another drug that works well is gabapentin, which we typically prescribe to take at night because it can be helpful for sleep,” she says.
Antidepressants can be used to treat hot flashes, but they often come with some unfortunate sexual side effects like decreased orgasm, says Adams.
There is some evidence that lifestyle interventions or changes in behavior can help with hot flashes, says Adams. These interventions include:
Although more women report having hot flashes, women tend to report being more bothered by sleep disturbances than by hot flashes, says Adams.
“Treating night sweats can help with sleep, so estrogen can help, and progesterone also helps, since its side effect is drowsiness. The best treatment for sleep disturbance after managing night sweats is cognitive behavioral therapy for insomnia,” says Adams.
Sleep issues may also be caused by other conditions, such as sleep apnea and restless legs syndrome (both more common in menopausal women), so you’ll want to rule those out, she says.
Low libido is complicated, and many factors are involved, says Adams.
“It can be related to medical issues, medications people are on, pain with sex, decreased arousal or orgasm, partners’ sexual issues, relationship issues, drugs or alcohol, stress, or fatigue,” she says.
Treatment of low libido involves getting to the source of the problem and typically isn’t due to just menopause alone. Drugs to treat low libido, like flibanserin (Addyi) or testosterone, generally have low efficacy and don’t work as well as behavioral approaches, says Adams.
There are three steps to managing painful penetration in menopause, says Adams.
Kurtzer suggests seeking out an expert in menopause and sexual dysfunction.
“If one is not getting support from their primary care physician or gynecologist to discuss their concerns, they can go to the International Society for the Study of Women’s Sexual Health (ISSWSH) or The Menopause Society websites to locate specialists who will be more likely and able to help,” she says.
It’s unfair but true: when women go through menopause and they eat the same and exercise the same, they gain weight, says Adams.
“This is because metabolic changes that happen in menopause tend to slow our metabolism, marble our muscle with fat, and cause weight to settle around the midsection,” she says.
Adams suggests adopting a whole-food, plant-based diet to maintain a healthy weight.
“Estrogen also gives other benefits by treating other menopausal symptoms like poor sleep, low mood, and vaginal pain with penetration. Plus estrogen improves bones, making osteoporosis less likely,” says Adams.
“Menopausal hormone therapy is an individualized decision based on a discussion we each should have with our doctor, who knows our health history best,” says Kurtzer.
That being said, women going through the menopause transition should know that hormone therapy does not need to be feared or demonized as it has been over the past 20 years, she says.
“For many, many women, hormone therapy has been a lifesaver that helped them through a difficult transition period,” says Kurtzer.
There’s generally no need to take a lot of supplements during menopause, says Adams. While individuals should talk to their doctor before taking any supplements, she recommends the following:
“Otherwise it’s best to ‘eat the rainbow’; and get your fiber and minerals and anti-inflammatory compounds through your diet,” she says.
Guidelines for preventive screening tests, like a Pap smear for early detection of cervical cancer, don’t necessarily change as soon as someone goes through menopause, but they can change somewhat over time, says Kurtzer.
“There are some recommended adjustments to screening tests based on age, with Pap smears not required for some individuals over 65 years of age, if they are considered low risk with a history of regular screening before,” she explains.
Periodic pelvic examinations are still important for checking on the other body parts (breast, vulva, vagina, uterus, ovaries) that can develop conditions, says Kurtzer.
Knowing what to expect and feeling supported can make a big difference in your menopause journey.
In addition to your provider, there are great online resources to educate yourself about menopause.
This organization offers evidence-based information on menopause, including symptoms, treatments, and lifestyle tips. They also have a directory to find healthcare providers specializing in menopause.
This organization focuses on various women's health issues, including menopause. They offer articles, resources, and information on managing symptoms.
ACOG provides up-to-date information about menopause, including what to expect and treatment options.
This national nonprofit aims to change the conversation around menopause so that women can get the information they need and the healthcare they deserve.
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