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Women tend to greet menopause with mixed emotions. They may be nervous about getting older or anxious about what they’re experiencing, physically and emotionally. To be sure, menopause is unlike anything you’ve felt before – and the transition can last for several years.

As an ob-gyn, I hear all sorts of questions about this time of life. Here are the top five questions I get – and my answers.

1. Should I start hormone therapy?

My patients either tend to be eager to start hormone therapy to ease their hot flashes, or already wary of it because of what they’ve read online.

Admittedly, there is a lot of scary information out there about hormone therapy and the risks of heart attack, breast cancer, and more. But the landmark 2002 study that raised some concerns about these risks was limited. The study looked at a unique population of older women. We now know that hormone therapy is generally a safe option, especially for women going through menopause in their 50s and younger.

Still, I recommend women try other methods first, especially for hot flashes: dressing in layers, carrying a portable fan, and sipping cold drinks. Avoid foods and drinks that can trigger hot flashes, such as alcohol and caffeine. Stop smoking and lose extra weight if you need to. Try meditation, which can make hot flashes less bothersome.

When these conservative measures and lifestyle changes don’t quite cut it, we consider hormone therapy. Certain types of antidepressants also can help with hot flashes.

2. How will menopause affect my sex drive?

This is a topic my patients are usually hesitant to bring up – understandably, it’s very personal.

The fluctuation of hormones during menopause can lead to vaginal dryness, which in turn causes pain during sex. Then women may find they don’t initiate sex anymore, for fear of this pain.

Vaginal moisturizers and lubricants can provide relief. If those don’t work, talk with your ob-gyn about topical or oral medications. (See Experiencing Vaginal Dryness? Here's what you need to know.)

Don’t be resigned to abstinence after middle age. With a little help, everything can work as you want it to.

3. Should I take natural supplements to treat my symptoms?

Ever seen an online ad for a product that relieves hot flashes? How about a natural remedy to improve your sleep during menopause? You may have also heard about “custom” compounded bioidenticals, which come from plants and resemble your body’s hormones.

The fact is, few plant and herbal supplements have been studied for safety or effectiveness. Know that these drugs are not well regulated. Some can contain dangerous levels of estrogen, progesterone, or even testosterone. Over-the-counter supplements also can have an effect on other medications you are taking or other medical conditions you have.

For these reasons, talk with your ob-gyn before taking supplements to treat your menopausal symptoms.

4. I haven’t had a period in years. Do I really need annual check-ups with an ob-gyn?

Yes, you should still come for your annual visit, no matter your age. You may no longer need birth control or prenatal care, but ob-gyns offer the full range of women’s health care. From screening for cancer and STIs (sexually transmitted infections) to discussing concerns about sex and urinary incontinence, your annual check-up can cover all aspects of your sexual and reproductive health.

5. Do I still need Pap tests and mammograms after menopause?

Yes to this one too. The recommendation is to continue with Pap tests until age 65, unless you have a risk factor for cervical cancer, such as HIV (human immunodeficiency virus). Even women who have had a hysterectomy may still need screening.

With mammograms, most women at low risk of breast cancer can stop at 75. In both cases, you and your ob-gyn should share information, talk about your wishes, and agree on when and how often you will be screened.

A New Stage

There’s a lot to learn about what happens to your body during menopause. Turn to your ob-gyn with questions – it’s what we’re here for. And don’t overlook the value of talking with your mom, sisters, and friends who have “been there.”

Rest assured: Menopause is just another stage of life, as natural as any other. With open communication, you can address any concerns you may have about your symptoms and get the help you need.

Published: October 2020

Last reviewed: October 2020

Copyright 2020 by the American College of Obstetricians and Gynecologists. Read copyright and permissions information.

This information is designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Read ACOG’s complete disclaimer.

About the Author
Shana Miles, MD, PhD
Dr. Shana Miles

Dr. Miles is an obstetrician–gynecologist, military physician, and fellow in minimally invasive gynecologic surgery at the University of Pittsburgh Medical Center Magee Women’s Hospital in Pennsylvania. She is a fellow of the American College of Obstetricians and Gynecologists.