Menopause Common Questions

What is menopause?

Menopause is a time when your ovaries stop producing estrogen and your female hormones become completely depleted. Once you stop having your period for one year you are officially in menopause. The average age a woman enters menopause is 51yr but menopausal symptoms can start in your 40years when hormonal fluctuations begin. During this time there are hormonal, physical, and psychological changes happening that are completely disruptive to your life, often needing medical attention.

How are the most common symptoms of menopause?

The most common symptoms of menopause include irregular periods, hot flashes, sweating, insomnia, depression, anxiety, feeling apprehensive, weight gain or loss, fatigue, poor concentration, memory loss, vaginal dryness and heart palpitations. All of these disruptive symptoms affect your quality of life and can be improved with simple lifestyle modifications, medications specifically treating each symptom and hormone replacement therapy.

What causes hot flashes?

Hot flashes are one of the most common symptoms of menopause, affecting up to 80% of women, with some women experiencing more than 10 a day. A hot flash is an abrupt and sudden feeling of electric heat in the upper chest, neck, and face, accompanied by sweating and feeling flushed, lasting up to 5 minutes. Hot flashes that occur at night are called night sweats. Hot flashes occur when the body’s temperature regulator, known as the hypothalamus, is negatively affected by decreased estrogen levels seen in menopause. The brain’s thermostat is completely offset causing the body temperature to fluctuate triggering erratic hot flashes.

What causes weight gain?

Most women can handle the hot flashes, night sweats, insomnia, mood swings, anxiety, depression, fatigue, even low sex drive but it is the weight gain that takes women to the edge of the cliff.

There are many reasons women gain weight in menopause:

Decreased estrogen levels after menopause leads to an increase in total body fat which results in a decrease in lean body mass. As we age, our muscle mass decreases while our fat increases. These changes also cause your metabolism to slow down. Some experts believe you need to eat 200-300 calories less a day to maintain your body weight.

Aging alone causes weight gain-on average women will gain 1.5 pounds/year during their 50’s and 60’s. Weight gain is also accompanied by an increased tendency for central fat distribution -meaning abdomen, hips, thighs, and buttock–in women in midlife. The bottom line is if you continue to eat the same number of calories as you usual do, do not increase your physical activity and lose muscle mass with age… you are destined to gain weight.

Lifestyle choices and changes also contribute to weight gain. As women age, they tend to be more sedentary and more stressed which also contributes to weight gain. The disruptive hormonal changes of peri-menopause and menopause including fatigue, insomnia, depression, and other mood changes doesn’t set the stage for us to hit the gym on a daily basis.

Genetics always has a hand in weight gain which can be even more frustrating.

Why do sleep problems specifically occur for women as they enter menopause?

It’s common for women to experience sleep disturbances as a result of the typical symptoms of menopause including hot flashes, night sweats, depression, anxiety and other mood disorders. When estrogen is no longer produced by the ovaries hot flashes occur causing a quick and intense heat sensation all over the body accompanied by sweating. Up to 85% of women experience hot flashes occurring in the middle of the night causing insomnia. Hot flashes can last 3 to 6 minutes making it difficult to go back to sleep, affecting the overall quality of sleep. The majority of menopausal women experience insomnia, snoring and bouts of sleep apnea. Insomnia ultimate leads to daytime fatigue which is disruptive and a cause of concern.

When should I be concerned about my sleep during menopause?

Every woman’s transition into menopause is different. When sleep disturbances affect your quality of life it’s time to see your health care provider to talk about treatment options. Symptoms that are disruptive and life changing need to be addressed. If hot flashes are the cause of your insomnia, you can try relaxation techniques, acupuncture and other lifestyle changes first. If they fail, it’s most effective to start hormone replacement therapy which is completely safe in low-risk women.

Alternatively, insomnia can be treated with relaxation techniques, sleep aids such as melatonin, Ambien, Lunesta or hormone replacement therapy.

How does regular exercise help you lose the weight gained during menopause?

As we age, it is harder for us to lose weight. The hormonal upheaval of menopause tends to make weight gain in the usual places—abdomen, thighs, hips, and buttocks—a common complaint. Hormonal chaos, along with aging, genetics, and lifestyle choices, makes losing weight all the more challenging.

Most women can handle the hot flashes, night sweats, insomnia, mood swings, anxiety, depression, fatigue and even a low sex drive but it is the weight gain that takes women to the edge of the cliff!!

All the symptoms of menopause can impede a women’s ability to workout. Irregular periods make it hard to know when the best time of day to work out is. Hot flashes and night sweats make the thought of working out and breaking a sweat less desirable. Emotional upheaval including depression and anxiety also prevents trips to the gym or putting on your tennis shoes. Heart palpitations also scare menopausal women from doing any activity that increases the heart rate.

It is completely unanimous that there is a long list of benefits from regular exercise. Exercising as little as 30 minutes, 3 days a week can show immediate health benefits. Aerobic exercises such as brisk walking, jogging, bicycling, and swimming are especially helpful for menopausal women. These types of activities help with weight loss or allow women to maintain a healthy weight. Keeping track of your steps, aiming for 7,500-10,000 a day, will make you more accountable and successful in monitoring your daily activity. If you are not ready for aerobic exercise stretching and simple exercises that help with balance and stability are useful.

Weight bearing and muscle strengthening exercises build bone. Weight bearing exercises are those exercises where your feet and legs support your body weight. Low impact exercise such as fast walking, elliptical and stair stepping machines, not only build muscle and endurance but also build the amount and thickness of bone. High impact exercises include running/jogging, jumping rope and high intensity aerobics. Strong muscles increase blood flow and send key nutrients to help maintain healthy bone.

Starting slowly is recommended for menopausal women. Getting into a regular routine is the best strategy. Regular exercise improves metabolism, increases heart rate, improves breathing and body temperature all contributing to a better blood circulation strengthening the heart. Regular exercise also improves your energy, mood, and emotional stability. Exercise makes you feel more confident and helps ease stress when dealing with menopausal symptoms. Sleep patterns show improvement as well.

Regular exercise improves metabolism, breathing, energy and emotional stability. Exercise makes you feel more confident and helps ease the stress of menopausal symptoms. It strengthens your heart and improves your sleep patterns. Exercise abstinence not only puts you at risk for heart disease, high blood pressure and other chronic health problems, it leads to weight gain, obesity, fatigue, insomnia, and depression, all of which worsen the transition into menopause. Exercising as little as 30 minutes, three days a week can show immediate health benefits. Keeping track of your steps, aiming for 7,500 to 10,000 a day, will make you more accountable and successful in monitoring your daily activity.

Weight bearing and muscle strengthening exercises build bone. Weigh bearing exercises are those exercises where your feet and legs support your body weight. Low impact exercise such as fast walking, elliptical and stair stepping machines, not only build muscle and endurance but also build the amount and thickness of bone. High impact exercises include running/jogging, jumping rope and high intensity aerobics. Strong muscles increase blood flow and sends key nutrients to help maintain healthy bone.

What lifestyle suggestions do you have to help lose weight during menopause?

A diet focused on fresh fruits, vegetables, whole grains, and fish, with limited alcohol intake and little red meat (similar to the Mediterranean diet) not only benefits your heart, it improves cognitive function. The Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate and is proven to help menopausal symptoms. No downside there.

Eat 200-300 calories less a day to maintain your current weight. Be mindful of eating a colorful, healthy, and well-balanced diet including fresh fruits, vegetables, whole grains, and fish. If you must cut calories chose those with less nutritional value, such as fats and alcohol. Eating a healthy diet will also have other health benefits such as reducing the risk of heart disease, stroke, diabetes, high blood pressure, high cholesterol and improve cognitive function.

Limit Alcohol Consumption. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and, now we know (drum roll please), worsens hot flashes—and, by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise and depress many of you. It is recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate.

Sleep is necessary for everyone. In a perfect world, getting at least seven hours a night is ideal. Getting adequate amounts of sleep restores the body and improves energy levels. Sleeping well improves mood, reduces mental stress, anxiety, depression, irritability, and brain fog. Quality sleep helps maintain a healthy weight and makes exercising much easier.

Create an over 50yr support team-I am sure your close friends are going through the same frustrating challenges regarding unwanted weight gain. Use your friends and family as a support team to make permanent healthy lifestyle and dietary choices that will promote healthy aging and defeat the battle of the budge.

What are some tips to help my libido during menopause?

In menopause, estrogen and testosterone levels plummet negatively affecting your sexual desire, vulva, vagina, bladder, and clitoris, making sexual activity challenging. Estrogen plays a key role in women’s sexual function, maintaining the genital tissue sensitivity, elasticity, secretions, pH balance and microbiome flora, urinary continence, pelvic muscle tone and joint mobility. When you enter menopause and lose estrogen and testosterone, physical and mental changes occur, some symptoms faster than others. Pain with vaginal penetration, trouble having orgasms and inadequate vaginal lubrication are some of the reasons women’s sexual desire is decreased.

Over 60% of women will report losing their libido and 30% will stop having sex all together. Women are being bombarded with physical and emotional symptoms that directly affect their mood in the bedroom. The truth is many women rather be doing laundry than having sex with their partner.

What are some treatment options to help my libido?

Menopause is brutal for the sexual wellness of the 50-60 million dealing with this normal hormonal cycle. Using vaginal estrogen, vibrators, vaginal dilators, a great lube helps with some of these disruptive symptoms caused by menopause. Even though testosterone is not FDA approved, it can help with sexual desire and arousal for some women. One of the FDA approved medications, Addyi, can also be used to help increase sexual desire for menopausal women.

I have trouble having an orgasm and those I do have are not as strong. What do you suggest?

Since there is less blood flow to the vulva and clitoris. Orgasms can take longer to happen and may not feel as intense. Keeping the vulva and vagina moisturized is a step in the right direction. There is some truth to “if you don’t use it, you’ll lose it”. The more stimulation the vagina gets the more natural lubrication will occur which is helpful to maintaining a healthy vagina. A vibrator is also a great way to improve sexual function, satisfaction, sexually related distress, and genital sensation…it’s a win-win in my opinion!

Give your vagina a voice so you can continue to have a healthy sexual relationship with yourself or a partner during menopause.

All women, especially those in menopause need a vibrator and here’s why.

It can be harder to have an orgasm after 50year, has anyone noticed?

During menopause there is less blood flow to the vulva and clitoris. Orgasms can take longer to happen and may not feel as intense. Keeping the vulva and vagina moisturized is a step in the right direction. There is some truth to “if you don’t use it, you’ll lose it”. The more stimulation the vagina gets the more natural lubrication will occur which is helpful to maintaining a healthy vagina. A vibrator is a great way to improve sexual function, satisfaction, sexually related distress, and genital sensation…it’s a win-win in my opinion!

Why you need a vibrator in menopause, especially!

The vibrator was not originally intended to be a sex toy. Vibration therapy was originally used to treat sexual problems for women and men. In the late 1800’s, vibration therapy was used to treat erectile and ejaculation dysfunction, low desire and inability to have an orgasm. You may be surprised to learn that up to 20% of women have never had an orgasm. Vibrations delivered to the vulva, vagina, testicles, scrotum, perineum and anus significantly and positively improves sexual desire, sexual arousal and orgasm. Vibration increases blood flow and stimulates the complex nerve fiber pathways-superficially on the skin and deeper in the erectile tissue.

Clitoral and erectile tissue sensation fades as women grow older due to less blood flow to sensitive and fragile genital tissue. As a result, it can take longer to become aroused, along with longer stimulation and the need for lubrication, to have an orgasm. This is where vibrators can help. They can provide the needed stimulation in order for you to orgasm.

Vibrators have long been a taboo and the best kept secret. Vibrators are not typically regarded as a medical device by mainstream society but can be classified by the FDA as therapeutic devices to treat sexual dysfunction/sexual problems—because vibrators have been shown to provide sexual health benefits for people!!…The time is now to bring the vibrator out of the closet. Genital vibrator use is associated with increased openness in people’s thoughts and attitudes about sexual activities generally and about themselves as sexual beings

It’s time to embrace our sexuality and enjoy using whatever type of sex toy turns you on.

Reassuring statistics are vibrator use.

The new results are based on two studies, one surveying more than 2,000 women and the other more than 1,000 men (ages 18 to 60), both of which are published this week in the Journal of Sexual Medicine.

More than 50 percent of women participants had used a vibrator, with nearly one in four having done so in the past month.
More than 70 percent of women reported having never experienced any side effects associated with vibrator use. (Those side effects that were reported were typically rare and of a short duration, including mild genital numbness, irritation, or inflammation.)
About 45 percent of men, both gay and heterosexual, reported incorporating a vibrator into sexual activities.
Of men who have used vibrators, 10 percent had done so in the past month, about 14 percent in the past year and about 21 percent more than one year ago.
Men who reported having used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam.
Men who had used vibrators recently also scored themselves higher on four of the five factors used to measure sexual function (erectile function, intercourse satisfaction, orgasmic function and sexual desire).

“The study about women’s vibrator use affirms what many doctors and therapists have known for decades — that vibrator use is common, it’s linked to positive sexual function such as desire and ease of orgasm, and it’s rarely associated with any side effects,” said study researcher Debby Herbenick, associate director of Indiana University’s Center for Sexual Health Promotion.

Why does noticeable vaginal dryness begin in a women’s 40’s?

Hormonal changes over the decades also influence the integrity and elasticity of the vulva and vagina. Dryness of these areas is a common consequence of the hormonal collateral damage of the decline in estrogen production. Estrogen fluctuations during peri-menopause can cause vaginal dryness and becomes worse, when estrogen is completely gone, during menopause. As you age and lose your subcutaneous fat in your body, the fat in the vulva also decreases making the lips looks thinner and the tissue more prone to dryness.

With peri-menopause and menopause there is the loss of estrogen nourishing and hydrating the vulva and vagina causing the tissue to become dry, pale and dehydrated. The labia of the vulva can become fused and the clitoris and vagina shrink. The labia become less full, losing its fatty pads and the skin loses its collagen. The end result is lighter or darker appearing labia that ultimately sag. The medical term for this is genitourinary syndrome of menopause (GSM), formerly known as atrophic vaginitis.

What’s with the debilitating vaginal dryness of menopause?

Genitourinary syndrome of menopause (GSM) is the newer term that describes vaginal dryness, burning and irritation and sexual symptoms including lack of lubrication, discomfort or pain with sexual intercourse and urinary symptoms including urgency, pain and frequency with urination. Only 25% of women with GSM talk about their symptoms with their healthcare provider. 33% of women don’t discuss GSM at all. Skin dryness involving any part of your body is uncomfortable and annoying, especially when it comes to the sensitive skin of the vagina. Persistent vaginal dryness causes itching, burning and pain can create emotional and physical disruptions in your daily life activities.

GSM does not have to ruin a sexual relationship with your partner if you start using vaginal estrogen or vaginal hyaluronic acid regularly. Keeping the vulva and vagina hydrated and moisturized with products designed specifically for this sensitize pH balance area must be a priority. I have always said that women need to treat their vulva and vagina like their face, using specially designed products to clean, hydrate and moisturize these delicate areas every day.

What’s the best advice to keep the vulva and vagina hydrated and moisturized before menopause causes worsening genital dryness?

Creating your personal daily hygiene routine with specific products used is important to create. A healthy vagina needs the same hygienic attention as any other part of the body, similar to the way we care for our face. The skin of the vulva and tissue inside of the vagina is susceptible to dryness if not taken care of properly. When your body is adequately hydrated the vulva. including the labia majora and minora, is less prone to dryness and the inside of the vagina will be moist and well lubricated.

There are known offenders, such as childbirth, hormonal changes including postpartum, perimenopause and menopause, which lead to chronic symptoms such burning, itching, vaginal infections, urinary tract infections and painful sex.

Skin dryness involving any part of the body is uncomfortable and annoying, especially when it comes to the sensitive skin of the vagina. Persistent vaginal dryness causes itching, irritation, burning and pain that leads to emotional and physical disruptions in daily life activities. Discomfort, avoidance and pain with sexual activity also becomes a common problem.

Keeping the skin hydrated, clean, and cared for will help prevent dryness. Other helpful daily hygiene rituals include using a gentle, non-fragranced soap and natural skin moisturizer daily, especially ones made specifically for the vagina. Taking a 20-minute warm bath with a handful of extra virgin coconut oil 3 to 4 times a week will also rehydrate the skin of the body and vulva. Using internal vaginal moisturizing suppositories every 2-3 nights will help nourish and soothe the delicate skin inside the vagina. Adding oral or vaginal pro-biotics to your daily regimen will also keep the vagina hydrated and in complete balance and harmony.

Keeping the body hydrated helps keep the vagina hydrated too. The amount of water needed each day will depend on how active you are, if you have any medical problems and the climate you live in. In general, you need to drink at least 8-8 ounces glasses or about 2 liters of water a day. Water is vital for every system in our body, making up 60% of body weight, so constant replenishing is essential. Alcohol and caffeine should be consumed in moderation since both cause dehydration of the skin and cause dryness of the vagina. Finding your favorite sexual lubricants are great additions to vaginal dryness during intimacy.

Dryness can also occur in menopausal women who are not taking oral or vaginal estrogen which results in burning, dryness and pain inside the vagina, especially with intimacy and penetration.

If you are experiencing on going vaginal dryness, irritation, recurrent vaginal and urinary tract infections, it’s important to see your health care provider to help you strategize with helpful treatment options. You should never suffer in silence!

What can be done for vaginal dryness during menopause?

Vaginal dryness is a common and disruptive symptom of menopause. It’s a hallmark sign of genitourinary syndrome of menopause (GSM), formally known as atrophic vaginitis. The tissue of the vagina becomes thin, dry, irritated and tears easily with vaginal penetration with the loss of estrogen. You will also develop symptoms of bladder frequency, urgency and urinary tract infections.

It’s important to remember to moisturize the vulva and vagina in the same way your take care of your face. Ideally, you want to start moisturizing your vulva and vagina at an earlier age.

Helpful remedies for vaginal dryness and painful intercourse caused by GSM include vaginal estrogen, which is the most effective treatment for GSM. Non-hormonal prescription Ospermifene (Osphena), DHEA suppositories and laser therapy are also treatment options. Other over the counter vaginal moisturizers, hyaluronic acid, and lubricants can be effective if you are looking for more natural remedies but vaginal estrogen or DHEA will prevent GSM from taking control of your vagina and bladder.

The old adage, “if you don’t use it, you’ll lose it” can apply to GSM.

Regular sexual activity and vaginal stimulation — with or without a partner —helps maintains healthy vaginal tissues in women after menopause.

What are some hygiene routines and lifestyle habits that may contribute to genital dryness before it gets worse during menopause?

Loss of estrogen during menopause makes vulva and vagina dryness that much worse. The years leading up to menopause can be used to prevent vulva and vagina dryness by knowing what commonly used feminine products promote changes of this delicate area of the body.

Every day unsuspecting feminine rituals can disrupt the pH balance and irritate all areas of the vulva and vagina causing vaginal dryness. The list is long and some of the common offenders may surprise you.

Common irritants you may or may not realize are problematic:

Fragrant soaps, bubble bath liquids, bath salts, talcum powder
Detergents, fabric softeners and dryer sheets
Sanitary wipes and pads
Warming gels and scented lubricants
Nylon underwear or bathing suits
Rubber products such as diaphragms and condoms
Latex allergy
Saliva or semen
Spermicides such as foams, creams and jellies
Feminine hygiene sprays, tampons or deodorant pads
Creams or ointments applied to the vulva
Shaving and waxing the hair around the vagina
Medications including the Birth Control Pill, Accutane, allergy and cold medications and certain antidepressants are common contributors to vaginal dryness.

Persistent vulva and vaginal dryness cause itching, burning, infection and pain could create emotional and physical disruptions in your daily life activities.

Make the changes in your daily feminine care now, to minimize the drying effects that the normal hormonal cycle of perimenopause and menopause create.

What can I do for my shrinking and collapsing vagina-in menopause?

Shrinking and collapsing vaginas need a voice too! Many women suffering from vaginal shrinkage or atrophy usually do not have regular vaginal penetration. Lack of penetration, combined with GSM, can result in a shrinking of the vaginal opening which I have coined the Collapsed V. A survey found that 45% of women have never actually had an honest conversation about their vaginal dryness with their health care provider. They may have resigned themselves to sexual intercourse only once or twice a month or on “special occasions,” giving the term “birthday sex” a whole, new despairing meaning.

The good news is these disruptive vagina changes can be reversed. To begin the process of opening up again, literally (and perhaps figuratively), vaginal dilators may be employed to stretch the vaginal opening. Usually the process involves use of a dilator for 20-30 minutes, three to five times weekly, gradually increasing the size, with the goal of making vaginal penetration easier on the tissue. I created the first and only award-winning vaginal dilators that you can wear (compared to traditional dilators where you need to be lying down to use them) which has improved comfort, compliance and faster results, at keeping the entrance of the vagina more accommodating and less painful during vaginal penetration. Used in combination with twice weekly estrogen cream therapy, symptoms related to vaginal atrophy may be reversed, allowing painless (and, with luck, enjoyable) intercourse. As long as you’re 100% committed to improving dryness, you might try soaking in an extra virgin coconut oil bath for 20-30 minutes a day as a pampering addendum to treating dry skin, not only in genital area, but for your entire body. Using my silky serum vulva skin moisturizer also keeps this delicate area moisturized since menopause causes thinning of this area as well.

Alternatives to conventional dilators can be found not only at a local sex toy store in the form of dildos or vaginal vibrators, I don’t care if you use a cucumber or zucchini (of course covered by a condom) but traditional vaginal dilators are recommended. If you do however choose a ubiquitous form of produce, make sure you use a condom on it to avoid unwelcome bacteria. A pea-size dollop of topical lidocaine applied to the entrance of the vagina also helps in avoiding pain when introducing anything into a sensitive vagina, be it vegetable or mechanical. Because some of my less adventurous patients don’t know where to begin, I have gone online in my office with them, in order to scroll through dildos on goodvibrations.com, a great, accommodating online sex store that caters to women. While we’re perusing the endless array of toys, I ask these shyer patients of mine to try and approximate their husband or partner’s “size.” I tell them to decide on a favorite color, choose a special lube and pick a vibrator.

I’m proud to say that most of these patients report back with promising results after conventional vaginal estrogen therapy combined with a little fun (perhaps in the form of a classic purple dildo). Realize that when you enter menopause it’s not just the vaginal pain and dryness that can ruin a perfect date night, it’s the worry of vaginal collapse from infrequent intercourse. If you are having problems not only with dryness, but vaginal shrinkage and pain, please talk to your health care provider. Many doctors are not comfortable talking about sexual issues and if that is the case, find one who is comfortable doing so. Keep in mind that creative strategies are not only fun, but may be a necessity. The perimenopausal and menopausal women deserve sexual enjoyment in the bedroom but you have to be an active participate in this area.

Can vaginal estrogen treat recurrent UTI’s in menopause?

It’s true, vaginal estrogen saves women from recurrent urinary tract infections (UTI). It’s been found that women who use vaginal estrogen regularly, decrease their incidence of recurrent urinary tract infection by over 50%. Most women associate UTI’s with sexual intercourse but for women in menopause who have GSM they are more prone to UTI’s.

In a ground breaking study, 5638 women were studied for recurrent UTI’s. For those women who had close to 4 UTI’s a year, there was a 52% decrease in UTIs after using vaginal estrogen regularly for one year.

These results showed a significate reduction in recurrent UTI’s when vaginal estrogen was used regularly. This study proved that vaginal estrogen can treat women with recurrent UTI’s.

Vaginal estrogen is the first step in treating women with symptomatic GSM and, especially those suffering from UTI’s. There is no downside to this safe and effective treatment option.

How to navigate depression, brain fog, and fatigue — this is the first time I have experienced this in my life?

We always hear about hot flashes, night sweats, irregular periods and insomnia classically linked to menopause but there are other symptoms equally annoying but less talked about. Menopausal symptoms occur as a result of low estrogen levels which can also cause a drop in serotonin and dopamine levels leading to cognitive changes including memory loss, poor concentration, brain fog and depression. Normal aging also contributes to memory and brain fog issues so the overlap makes these symptoms seem more pronounced.

Vyvanse and other ADHD medications can be helpful with menopausal symptoms related to staying focus, organized, managing time, improving concentration, forgetfulness, and memory, also known as “foggy brain”. Even if you have not been officially diagnosed with ADHD in the past, menopause can throw you into an ADHD-like state.

A woman’s natural estrogen supply is protective against developing depression. Hormone replacement therapy can be helpful with some of these symptoms, especially if it is a new onset of depression. Menopause can worsen a woman’s depression or can bring out a depression a woman did not know she had. Talking to your healthcare provider or therapist can help you navigate these symptoms and consider starting a new antidepressant or increasing the dose of one that a woman is currently taking.

How do antidepressants help with menopausal symptoms?

Some antidepressants have been found to lessen menopausal symptoms including hot flashes, night sweats, mood swings, depression, and anxiety. Unfortunately, some of the side effects of antidepressants, such as low libido and weight gain, can discourage their use. As long as the benefits outweigh the risks, it’s a viable treatment option worth exploring.

What are other non-hormonal alternatives in treating menopausal symptoms?

There are medications including Gabapentin and Clonidine which are not FDA approved for menopausal symptoms but can help minimize hot flashes. Side effects of both include dizziness, headaches which drowsiness may feel more disruptive than hot flashes.

Acupuncture and relaxation techniques including mindfulness, biofeedback, hypnosis, cognitive behavior therapy, yoga and Tai Chi may be helpful in controlling mood swings, depression, anxiety, hot flashes, and other mild symptoms of menopause.

There are many safe alternatives and supplements to use to treat common symptoms of menopause. You may be surprised to know that there are many scientific studies showing certain herbs to be helpful in managing the symptoms of menopause. Passionflower extract, L-Theanine, Chasteberry, Royal Jelly, Ashwagandha, Rhodiola, phytoestrogens, Ginseng, Black Cohosh, Evening Primrose oil, Hops, Lemon balm, Red Clover, Shatavari, Tribulus, Valerian, Wild Yam, Dong Quai root, St. John’s wort, Chromium, Fenugreek, Ginkgo Biloba Leaf Extract, Chamomile, Maca Root and CoQ10 are some of the better researched herbs shown to combat symptoms and improve your life. Although herbs are not FDA approved like pharmaceutical medications, well-regulated supplements can be as effective as, if not safer than, prescription medication.

What lifestyle habits will help me combat the symptoms of menopause?

A healthy lifestyle goes a long way at any time in your life, but especially in this later chapter of life. Inactivity, unhealthy diet (fast food!), smoking, obesity, excessive alcohol consumption…if you are still waiting to remedy any of it, now is the time! All of these factors only make menopause worse than it needs to be. There are simple adjustments you can start to make as soon as you put this book down.

A diet focused on fresh fruits, vegetables, whole grains, and fish, with limited alcohol intake and little red meat not only benefits your heart, it improves cognitive function. The Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate and is proven to help menopausal symptoms. No downside there.
Ditch the fast food, fast! The saturated fats and excessive sodium in fast food gives you no “value” whatsoever, in fact, depression is more common in those who eat fast food regularly. Within weeks of removing this food, you will show a decrease in cholesterol levels and even a decrease in weight gain.
Removing or decreasing “sweets” in your diet will not only limit your calorie intake; it will often reduce your intake of fat. A reduction of sugary foods will immediately reduce blood sugar, which will help in decreasing the bloating and water retention so common in menopausal women.
Limit Alcohol Consumption. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and, now we know (drum roll please), worsens hot flashes—and, by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise and depress many of you. It is recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate.
Stay hydrated. About 55% of adult, female bodies are made of water. A good goal is to never feel thirsty as thirst is your body’s way of telling you that you need more fluid. Dehydration requires your body to work harder to perform even the most basic functions which can lead to fatigue. Dehydration can also cause nausea and difficulty concentrating. Choose water or caffeine-free tea or coffee and avoid sugary or high calorie drinks.
Avoiding hot and alcoholic beverages and avoiding hot and spicy foods also helps prevents mild to moderate symptoms of menopause.

Harmful lifestyle habits including smoking, inactivity, eating an unhealthy diet (including fast food!), obesity, excessive alcohol consumption and not sleeping well all contribute to making menopausal symptoms worse.

Can Cannabis/THC help with menopausal symptoms?

Despite up to 80% of peri-menopausal and menopausal women using medical marijuana to help alleviate common symptoms including hot flashes, mood swings and insomnia, there are no long-term medical studies to support benefits versus potential risks. Medical research often lags behind new treatment options for disruptive hormonal symptoms, yet use with caution until science can prove its safety.

What’s the link between menopause and bone health?

Osteoporosis is a disease affecting the bones. The bones become brittle, weak and fragile causing a decrease in quality and strength leading to fractures and broken bones. Women are 5 times more likely to develop osteoporosis than men.

In the United States, although women only have twice the fracture rate of men, they sustain 80% of hip fractures because older women far outnumber older men.

Osteoporosis is a skeletal disorder characterized by loss of bone mass, deterioration of microarchitecture, and a decline in bone quality, all of which led to an increased vulnerability to fracture.

Bone is live tissue, constantly being built and broken down. Estrogen, calcium and vitamin D are part of the building blocks important in keeping bone tissue healthy and strong. When women go through menopause and lose estrogen, the building material of bone is weakened and puts women at risk for osteoporosis. Deficiency in calcium and vitamin D also contribute in making bone prone to this silent disease.

Prevention is the perfect way to avoid weak bones which put you at risk for osteoporosis. Whether you are in your 20’s, 30’s or 40’s, making sure you have enough daily dietary calcium is an important step in building strong bones and preventing this disease the effects older women.

Taking calcium supplements is not needed for most healthy women and can have some serious health risks including kidney stones. Vitamin D can be essential in promoting bone health, calcium and phosphate absorption, muscle strength/function and maintaining healthy teeth.

Osteoporosis cannot be cured but the process can be slowed down and improved with medication. Medications used to treat osteoporosis put the brakes on bone deterioration. Some medications can maintain bone density, strengthen bone and decrease the risk of fractures and breaking bone.

What is the connection between menopause and heart health?

Heart disease is the most common cause of death among women throughout the world, affecting 1 in 3 women. Plus, it’s the leading cause of death in women.

Menopause does not cause heart disease but there are risk factors that occur around this same time that increase your risk. They include a high fat diet, smoking, obesity, diabetes and high blood pressure that catch up with you in your 50’s. It’s around this time in a woman’s life that you need to pay attention to your risk factors for heart disease. Estrogen has a positive effect on your heart prior to menopause. The American Heart Association does not recommend taking HT to prevent heart disease.

Prior to going into menopause, the hormone estrogen has a positive and healthy effect on blood vessels and blood flow. Once you enter menopause, estrogen levels plummet and you experience hormonal and physical chaos happening at the same time. The decrease in estrogen levels during menopause may increase risk of heart disease but does not cause cardiovascular disease. Hormone therapy is not recommended to treat or prevent heart disease but can be used to treat other disruptive symptoms of menopause including hot flashes, night sweats, insomnia and mood changes.

What is the connection between menopause and memory loss?

We always hear about hot flashes, irregular periods and insomnia classically linked to menopause but there are other symptoms equally annoying but less talked about. Menopausal symptoms occur as a result of low estrogen levels which can also cause a drop in serotonin and dopamine levels leading to cognitive changes including memory loss, poor concentration and a short attention span.

Vyvanse and other ADHD medications can be helpful with menopausal symptoms related to staying focus, organized, managing time, improving concentration, forgetfulness and memory, also known as “foggy brain”. Even if you haven’t been officially diagnosed with ADHD in the past, menopause can throw you into an ADHD-like state.

The risks of taking Vyvanse for menopausal symptoms include addiction and abusing the stimulate effect of this group of medication. Weight loss, loss of appetite, feeling more energetic and euphoric makes these medications popular for these added benefits. Other side effects include trouble sleeping, nervousness, dizziness, skin numbness, irregular heartbeat, headaches, nausea, and vomiting.

Do hot flashes indicate a higher risk of Alzheimer’s Disease in menopause?

All women go through menopause and 80% of them will experience hot flashes and other vasomotor symptoms. A recent study showed a link or an association between hot flashes and vasomotor symptoms and a higher risk of Alzheimer’s disease.

Alzheimer’s disease affects 2/3 of women compared to men. There are many other risk factors, including diabetes, high blood pressure, chronic obstructive pulmonary disease, older age, sedentary lifestyle, poor sleep, unhealthy diet, and genetic risk factors, that are also associated with an increased risk of Alzheimer’s disease.

Educating yourself on all the risks associated with Alzheimer’s disease is helpful in learning ways to prevent it. Eating a colorful and healthy diet similar to the Mediterranean diet, exercising 150 minutes per week, minimizing alcohol intake, not smoking, sleeping 7-8 hours a night, and practicing mindfulness, will reduce your risk of chronic medical problems and your risk of Alzheimer’s disease.

You would never be faulted to see a doctor about your risk of Alzheimer’s disease. Some risks you may be aware of, while other risks, you may not be. Being female gives you ground to see your healthcare provider about your risk of Alzheimer’s disease and provide guidance on lifestyle habits to prevent it.

As we age, there are a multitude of health conditions and issues that we have to pay attention to. Empowering yourself to identify ways and lifestyle habits to minimize these life-threatening medical conditions should be at the top of your priority list.

How does menopause affect women’s ability to exercise?

Many menopausal women feel tired and fatigued. Exercise is the last thing on their mind. Weight gain is also a common complaint that limits women from wanting to exercise. Weight gain makes women feel more lethargic and less inclined to want to work out. Other symptoms including poor concentration, feeling depressed and anxious affects women’s motivation to work out.

A menopausal woman should only avoid exercises that she is not fit enough or prepared to participate doing. Any type of exercise is worth doing since being inactive not only puts you at risk for heart disease, high blood pressure and other chronic health problems but it also leads to weight gain, obesity, fatigue, insomnia and depression. All these symptoms worsen the transition into menopause.

If you have any type of bone loss associated with aging and menopause, I would avoid exercises that may increase the risk of falling or create instability.

Are there certain types of exercise that are especially good or effective for women during menopause?

It’s completely unanimous that there is a long list of benefits from regular exercise. Exercising as little as 30 minutes, 3 days a week can show immediate health benefits. Aerobic exercises such as brisk walking, jogging, bicycling and swimming are especially helpful for menopausal women. These types of activities help with weight loss or allow women to maintain a healthy weight. If you are not ready for aerobic exercise stretching and simple exercises that help with balance and stability are useful.

Starting slowly is recommended for menopausal women. Getting into a regular routine is the best strategy. Regular exercise improves metabolism, increases heart rate, improves breathing and body temperature all contributing to a better blood circulation strengthening the heart. Regular exercise also improves your energy, mood and emotional stability. Exercise makes you feel more confident and helps ease the stress when dealing with menopausal symptoms. Sleep patterns show improvement as well.

How much more calcium should I be taking during menopause?

The normal recommended daily allowance (RDA) of calcium is dependent on age, gender, and reproductive status. Ideally a woman wants to consume 1000 to 1200 mg of calcium per days starting in her teen years. Women 19 to 50 should be consume 1000mg of calcium a day. There is no need to ramp up your calcium intake in anticipation of menopause and bone density changes.

In the United States, it has been estimated the dietary intake of elemental calcium varies between 750 to 850 mg in women. Elemental calcium refers to the actual amount of calcium in a supplement. The best source of calcium is from food and not supplements. If you drink one glass of milk or eat one cup of yogurt you would receive 300 mg of calcium. Adding a couple servings of fruit and green leafy vegetables would easily complete your daily calcium requirements.

Examples of dietary calcium:

Plain low-fat yogurt, 8 ounces – 415 mg of calcium
Mozzarella, part skim milk, 1.5 ounces – 333 mg of calcium
Yogurt with fruit, 8 ounces – 384 mg of calcium
Milk, nonfat, 8 ounces – 299 mg of calcium
Milk, 2% low-fat, 1 cup – 293 mg of calcium
Orange Juice, calcium-fortified, 6 ounces – 261 mg of calcium
Cheddar cheese, 1.5 ounces – 307 mg of calcium
Low-fat cottage cheese, 1 cup – 206 mg of calcium
Kale, raw, chopped, 1 cup – 100 mg of calcium
Ice cream, vanilla, ½ cup – 84 mg of calcium
Chinese cabbage, bok choi, raw, shredded, 1 cup – 74 mg of calcium
Broccoli, raw, ½ cup – 21 mg of calcium

There is growing evidence that for most healthy people your daily intake of calcium should come from food sources. Women need to learn the best ways to consume 1000 to 1200 mg of calcium per day to meet the recommended daily allowance. Until further research can be done to understand all the potential health risks, the use of calcium supplements are discouraged unless absolutely necessary.

Is menopause “just a phase” I will pass through?

Here’s the thing, menopause is the next chapter of your life, not a phase that you go in and out of like puberty. Many women believe that once the obvious and most common symptoms of menopause lessen—such as hot flashes, sweating, insomnia, depression, anxiety, apprehension, weight gain or loss, fatigue, poor concentration, memory loss, heart palpitations, exacerbation of migraines and vaginal dryness—menopause is done. Not so, rather, it may be just the beginning of your new “normal.” Yes, many of these symptoms do improve over time, but knowing that doesn’t help when you’re at the height of discomfort. All of these symptoms can disrupt the quality of life, but they can be lessened and, in some cases, eliminated with simple medication and lifestyle modifications.

As an women’s health educator, I am constantly talking to women and hearing new medical concerns and stories occurring due to aging and hormonal changes. As I transition into menopause, I have personally witnessed the bodily changes, both physically and emotionally, that occur with the lack of estrogen. It’s transformative and I am on a mission to improve the quality of life for all women of all ages. Aging should be embraced by women.

What is early or premature menopause?

Whether it’s on time, early or late, the word “menopause” can be terrifying and stop a woman in her hormonal tracks, especially if she is under 40years old. The average age of menopause is 51years old so for anyone under 50year it’s not on your radar that your ovaries can turn against you. Menopause is a natural condition where your ovaries stop producing estrogen that your body and vagina have, up until menopause relies on. When estrogen production stops so does your menstruation and fertility. Once you stop having your period for one year you are officially in menopause. Since the main function of estrogen is to support the development of the female body and the female secondary sexual characteristics, it only makes sense that when estrogen is gone, every part of our body that makes us female is affected, some worse than others.

Early or premature menopause occurs when the ovaries stop producing estrogen completely before the age of 40y. Hormonal symptoms and not having a period for one year will make early menopause a strong consideration. You probably haven’t heard much about early menopause because it only affects 1% of women in the US. Premature ovarian failure is the medical term used to describe this unpredictable condition.

What are the symptoms of premature ovarian failure?

Depending on how abruptly estrogen fluctuates and, ultimately shuts, off will determine how miserable your symptoms will be. Irregular and erratic periods are often the first sign of early menopause. Periods are unpredictable and confusing. They can be heavy, clotty or light and brown, lasting for days and weeks on end. Mild to severe period cramps can also occur with irregular bleeding.

Women will also experience hot flashes which are described as sudden bursts of heat in your face, neck and chest, causing you to sweat profusely. Hot flashes can last from 3 to 6 minutes, sometimes longer, and can affect your ability to sleep and function normally. Hot flashes turn into night sweats that affect your nighttime ritual. Other symptoms include insomnia, depression, anxiety, a sense of apprehensiveness, weight gain or loss, fatigue, poor concentration, memory loss, low sex drive, vaginal dryness and heart palpitations.

Each symptom alone is a handful, which means that the combination, is enough to make you question your sanity.

How is premature ovarian failure diagnosed?

Diagnosing early menopause is not only challenging for the health care provider but also for a young woman to understand. Since only 1% of women experience this uncommon hormonal assault, health care providers have to pay close attention to a woman’s symptoms, take a detailed medical history and perform the correct blood tests.

If a woman does not have a period for 12 months, has other symptoms of low estrogen and blood tests, mainly a follicle-stimulating hormone (FSH) and estrogen are consistent with menopause before 40yr old, early or premature menopause should be suspected. Other medical problems have to be ruled out including thyroid dysfunction, autoimmune diseases, and infections, to make a definitive diagnosis. Since these women are younger than the average age of those going through natural menopause, it’s best to repeat these blood tests in 3 to 6 months and continue close follow up with a menopause specialist after a suspected diagnosis.

What is the cause of premature ovarian failure?

Early menopause can be caused by a genetic predisposition, autoimmune diseases such as Lupus, viral infections—Mumps, Malaria, Varicella, TB, environmental toxins—smoking and chemotherapy, radiation or medications that can permanently damages the ovaries. Removing the ovaries surgically, before the age of 40, can bring about early menopause. Being underweight, anorexic or bulimic increases the risk of early menopause. For the majority of women going through early menopause a definitive cause is unknown.

What are there any long-term effects of premature ovarian failure?

Menopause completely shuts down your biological clock, meaning your ovaries will no longer produce healthy and viable eggs. At 50years old accepting the reality of old eggs is one thing, but being under 40yr is a whole other story. It can be emotionally devastating not being able to get pregnant naturally if early menopause occurs. We know you can carry a pregnancy at almost any age but the egg used would have to come from a donor.

Heart disease, affecting one in three women, is the leading cause of death among women throughout the world. Early menopause alone does not cause heart disease, but it amplifies the risk factors that increase the susceptibility to heart disease. Those risk factors include high fat diets, smoking, obesity, diabetes and high blood pressure, all of which catch up with you in your fifties. Additionally, estrogen levels—which have a positive effect on your heart prior to early menopause—plummet in menopause. This significant decrease in estrogen does not cause cardiovascular disease, but it may increase the risk. Women with early menopause have a shortened life expectancy mainly due to heart disease.

Osteoporosis literally means “porous bone.” It is a disease in which bones become brittle and fragile, making them more susceptible to fractures and breaks. Again, women hit the jackpot where osteoporosis in concerned, as they are five times more likely than men to develop the disease. Despite what you may think, bone is live tissue, constantly being built and broken down. Estrogen, calcium and vitamin D are part of the building blocks necessary to keep bone tissue healthy and strong. As women lose estrogen in early menopause, the building material of bone is weakened, thereby putting them at risk for osteoporosis. Deficiencies in calcium and vitamin D also contribute bone vulnerability. Prevention is the best way to avoid weak bones in the first place. Whether you are in your twenties, thirties or forties, making sure you have enough daily dietary calcium in your diet is the way to build strong bones and prevent this disease.

On a positive note, women with early menopause have a decreased risk of breast cancer.

Depression and anxiety are more common in women with early menopause as they learn to accept changes, both physically and emotionally, that were unplanned or expected.

What lifestyle changes can be done to relieve the symptoms of premature ovarian failure?

The life changing symptoms of early menopause and menopause are treated exactly the same way. Since younger women are affected by early menopause it’s more important than ever to make simple lifestyle adjustments to support healthy aging and make the hormonal upheaval less disruptive and stressful.

A healthy lifestyle goes a long way at any time in your life and especially with early menopause. Inactivity, unhealthy diet (fast food!), smoking, obesity, excessive alcohol consumption—if you’re still waiting to get a handle on any of those destructive habits, now is the time! Any of them will only make menopause worse than it needs to be. You can make simple adjustments right now—choose at least one of the following to start.

Maintain a diet focused on fresh fruits, vegetables, whole grains and fish, with limited alcohol intake and little red meat (similar to the Mediterranean diet). Such a diet not only benefits your heart, it improves cognitive function. In fact, the Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate in the world, and is proven to help early menopausal symptoms. Make sure you are getting enough calcium and vitamin D from your diet to help support bone density changes.

Remove or decrease fast food and sweets” in your diet. By doing so it not only helps to limit calorie intake, it often helps to reduce sodium and fat intake. A reduction in these types of foods will immediately reduce blood sugar and cholesterol, which will help in decreasing weight gain, bloating and water retention so common in early menopause.

Exercise. What can I say? What doesn’t it do? Regular exercise improves metabolism, breathing, energy and emotional stability. Exercise makes you feel more confident and helps ease the stress of early menopausal symptoms. It strengthens your heart and improves your sleep patterns. Exercise abstinence not only puts you at risk for heart disease, high blood pressure and other chronic health problems, it leads to weight gain, obesity, fatigue, insomnia and depression, all of which worsen the transition into menopause. Exercising as little as thirty minutes, three days a week can show immediate health benefits. Personally, I’m obsessed with my Fitbit because some days I can tend to be very sedentary. Keeping track of my steps, aiming for 7,500-10,000 a day, makes me more accountable and successful in monitoring my daily activity. It will do the same for you!

Weight bearing exercises—those exercises in which your feet and legs support your body weight—and muscle strengthening exercises build bone. Low impact exercise such as fast walking, elliptical and stair-stepping machines, not only build muscle and endurance but also increase bone density, as do high impact exercises like running, jogging, jumping rope and high intensity aerobics. Strong muscles increase blood flow and sends key nutrients to help maintain healthy bone.

If you’re still smoking, just stop, if not for the fact that smoking increases the risk of heart disease, stroke, lung cancer and death, but because it increases the frequency and severity of hot flashes! A recent study showed women who stopped smoking at least five years before menopause had a significant decrease in the severity and frequency of hot flashes.

Limit alcohol consumption. Limit it. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and (drum roll please) worsens hot flashes—by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise (or depress) you. It’s recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even if it’s just a habit of one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate.

Sleep is necessary. At least seven hours a night is ideal!

What natural remedies will help with my symptoms of premature ovarian failure?

If diet and lifestyle changes don’t help manage the symptoms of early menopause, there are safe alternatives and supplements to turn to. You may be surprised to know that there are many scientific studies showing certain herbs to be helpful in managing the symptoms of menopause. Rhubarb, Passionflower extract, L-Theanine, Chasteberry, Royal Jelly, Ashwagandha, Chromium, Fenugreek, Ginkgo Biloba Leaf Extract, Maca Root and CoQ10 are some of the more researched herbs shown to combat symptoms and improve your life. Although herbs are not FDA approved like pharmaceutical medications, well-regulated supplements can be as effective as, if not safer than, prescription medication.

Acupuncture has had mixed reviews on the hot flash front. Some swear that it’s helpful, while others report no relief. Since acupuncture has relatively no side effects if done correctly, I believe it’s worth trying.

Will hormone therapy (HT) help my symptoms of premature ovarian failure?

HT is recommended when early menopausal symptoms are disruptive and affect a women’s quality of life. For low-risk women, HT can reverse early menopausal symptoms and protect against bone loss and vaginal and bladder problems. It’s always about weighing the benefits versus the risks of HT. It’s best to use HT for the shortest amount of time and at the lowest dose under the guidance of a menopause specialist.

I believe quality of life is everything, so it’s important to try and manage the infuriating symptoms of menopause especially when it comes early!

Why you need to advocate for yourself especially in Menopause?

I am here to empower women to have courageous conversations about their bodies as you age and transition in menopause. You must come to your healthcare provider with your personal questions on how “the change, is changing you”. You deserve answers, guidance and treatment options that fit your personal needs.

I love encouraging women to take control of their health and well-being. I am challenging women and others to change the narrative on improving women’s healthcare needs, especially as we age.

Do I still need a Pap test and mammograms after menopause?

You definitely need to continue getting pap smear and mammogram testing once you are diagnosed with menopause. You should continue getting pap smears until age 65 unless you are high risk for cervical cancer, even if you have had a hysterectomy. Yearly mammograms are necessary until age 75y for low risk woman. Discussing your risk factors for both cervical and breast cancer with your healthcare provider.

Do I need to see my gynecologist yearly if I stop getting a period?

You still need to come in for annual visits whether you get a period or not. You may not need birth control or prenatal care for a pregnancy, but there are many other issues related to your female health care. There are conditions where symptoms may be subtle such as certain STI’s, like chlamydia and gonorrhea, urinary tract infections, bacterial infections and ovarian cysts, which are diagnosed during a pelvic exam.

Meeting with your ObGyn yearly gives a woman the opportunity to discuss other not too comfortable topics such as family planning, pain with intercourse, depression and domestic abuse. Seeing your ObGyn yearly can help you care for your overall health and well-being. I believe in the value of a yearly pelvic exam and a trip to the stirrups!

Menopause Common Questions

Do I still need a Pap test and mammograms after menopause?

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