Women’s Health: Demystifying, managing, and treating perimenopause and menopause

Wellstar OB/GYN Dr. Paula Greaves and nurse practitioner Karin Hulon engage in a candid conversation with influencer and actor Rolonda Rochelle.

Rolonda Rochelle (Ro): I feel like menopause is this mystery. I’m happy to be here so you can help us break it down. How do you define it?

Dr. Paula Greaves: We need to strip away the myth of menopause. It is a physiological transition in every woman’s life that deserves full attention. It is defined as the complete cessation of menstrual periods for 12 consecutive months. The average age of menopause in the U.S. is 52. With life expectancy increasing, that means women will potentially live 40 percent of their lifetime in the perimenopausal and menopausal stage. Thus, the need to ensure continued quality of life during this time.

Ro: So then what is perimenopause?

Karin Hulon: Perimenopause is the time leading up to menopause. It’s those years when we’re aging, and our hormones are declining; basically, our estrogen and progesterone levels are in chaos. This is the time when women start having irregular periods, hot flashes, night sweats, mood swings, fatigue, brain fog, trouble sleeping, weight gain, and irritability. Symptoms can last for many years.

Ro: So, are the symptoms the same when you transition into menopause?

Karin: Yes, but they vary throughout the transition. In early perimenopause menstrual cycles usually become irregular with more frequent menstrual periods. Many women experience hot flashes and night sweats. As one gets closer to menopause, menstrual periods space out more. Hot flashes eventually fizzle out and stop after menopause. Genitourinary symptoms, such as vaginal dryness and urinary problems, do not improve but become increasingly worse.

Ro: I’m in that phase. I’m there.

Karin: You’re not alone.

Dr. Greaves: Estrogen is involved at the brain level in the regulation of body temperature. With menopause, estrogen levels decrease, and hot flashes occur. These symptoms are worse in African American women and can last for more than 10 years.

Ro: What are some other symptoms?

Dr. Greaves: Women can experience symptoms such as vaginal dryness, urinary incontinence, painful intercourse, frequent UTIs, and bladder or organ prolapse. Estrogen is involved in increasing blood flow to the vulva and vaginal area so when estrogen decreases, these symptoms may occur.

Ro: Is that all?

Dr. Greaves: Unfortunately, no. Women can also experience decreased libido, sleep disturbances, mood changes, and brain fog! You’re running around looking for your glasses and they’re on your face. Hair loss is another big thing. Hair growth slows down and hair loss increases, so we start having female pattern baldness. Additionally, skin changes with increased dryness occurs. Of course, weight gain is frustrating. While before, women could easily lose weight with exercise and diet, during menopause, it’s not as easy to lose the weight, especially truncal weight that is associated with other diseases later in life.

Ro: Can you tell us about the impact of menopause on mental health?

Karin: Women can feel isolated, ashamed, lonely, scared, and confused. They’re at an increased risk of depression—especially women who suffered post-partum depression. Women can also have sleep changes. Sleep affects every aspect of our life! Lack of sleep can cause irritability, memory issues, and more. We should be getting seven to nine hours a night.

Ro: Let’s talk about some of the misconceptions surrounding menopause.

Dr. Greaves: Years ago, there was a big women’s health initiative study. At the time, it created the myth that hormones could be harmful or cause cancer. So, many women who could have benefited from hormone therapy did not get treatment. The second misconception is that menopause is shrouded in mystery and shame. Women don’t talk about it. Even to the point that we wonder if it’s all in our heads, if we’re losing it or if we are not strong enough.

Ro: What advice would you give a woman in their early 40s who thinks they may be experiencing menopause?

Karin: Talk to your healthcare provider. It’s important to go to someone who specializes in women’s health—an ob-gyn, a midwife, or a women’s health NP. The estrogen you’re no longer producing needs to be replaced because early loss of estrogen can have some long-term health detriments. Also, if you’re having symptoms, it could be something else, like a thyroid disorder, depression, or abnormal bleeding not related to menopause. Whatever the cause, it needs to be determined so that you can be treated in the safest and best way.

Ro: Are there any lifestyle changes people can make to help manage menopause?

Dr. Greaves: Increased BMI has been shown to increase hot flashes. So, working on decreasing your BMI can help decrease hot flashes. Eating a Mediterranean diet that is rich in fruit and vegetables. Exercise helps with improved mood and sleep. Women should exercise 30 minutes a day five days a week. Also, drinking more water and less caffeine and alcohol. Smoking cessation is important because smoking accelerates menopause.

Ro: Once you go through menopause, is it still necessary to see your gynecologist?

Karin: Absolutely. As women, we have specialized needs throughout our lifetimes. We need our clinical breast exams, mammograms, cancer screenings, bone scans, colonoscopies, etc. Women should be getting pap smears until age 65. Even if you’ve had a hysterectomy and you no longer have a cervix or a uterus, you still need pelvic exams. We care for all of that.

Dr. Greaves: As women age, there is an increased risk for breast cancer and other cancers, cardiovascular disease, osteoporosis, dementia; so, we need to continue to screen women at all stages of life. Ob-gyns are equipped to screen for these problems as well. Menopause can sometimes masquerade as other diseases. Women need to find a provider who will listen and who has done their homework about menopause or any stage in their lives.

Ro: I’m going through menopause but am reluctant about treatment. What are my options?

Dr. Greaves: There’s a new buzz word, bioidentical hormones. Bioidentical hormones are FDA-approved, studied extensively, made by pharmaceutical companies, and are identical to what we have in our bodies. There are many safe, hormonal options for women. However, if a woman does not want or cannot receive hormonal treatment, then we identify and treat the specific symptoms. For example, if a patient complains of hot flashes, there are FDA-approved nonhormonal options, such as Brisdelle (a low-dose antidepressant) or Veozah. Veozah, which came out in 2023, is an NK3 receptor antagonist, so it blocks the binding of the brain chemical involved in triggering hot flashes. Additionally, there are many hormonal and non-hormonal treatments available for genitourinary and other symptoms of menopause.

Ro: What about over-the-counter treatments?

Dr. Greaves: Vaginal dryness can be treated with moisturizers or lubricants. For hair loss, I recommend Minoxidil or Nizoral, an anti-fungal dandruff shampoo that has been shown in some to help decrease hair loss.

Ro: What advice would you give for choosing the best care that’s right for you?

Dr. Greaves: Wellstar’s PeopleCare approach focuses on treating the whole person. And that’s what it’s really all about. Wellstar Women’s Health Service’s motto is “Every woman. Every time. At every stage of her life.”

Karin: Dr. Greaves and I are currently working on an initiative directed at treating women in perimenopause and menopause. It is important when you’re looking for a provider to find someone who specializes in women’s health. Find someone who will listen to you, who will make you feel comfortable, and who will treat you as an individual.

Ro: It’s about awareness. Every woman who lives long enough will go through menopause. We should be celebrating it.

Visit wellstar.org/menopause to learn more.

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