Experts In This Article
- Jen Gunter, MD, OB/GYN, pain medicine physician, sexual health advocate, and New York Times bestselling author
In 2020, Berry launched RESPIN, a website dedicated to sharing knowledge and shedding stigma about menopause. She later played an important role on Capitol Hill, advocating for a new bill called the Advancing Menopause Care and Mid-Life Women’s Health Act, which was introduced to both the Senate and House of Representatives earlier this year. The legislation aims to invest resources into research, training, and education for menopause and other mid-life health concerns that affect women. Now, Berry is back with another advocacy project: partnering with MasterClass for a new course called “The Magic of Menopause,” which premiered on December 5 and is now available to watch with a membership.
Berry joins co-instructors neuroscientist Emily Jacobs, Ph.D., OB/GYN Jen Gunter, M.D., psychologist Lori Brotto, Ph.D., and psychiatrist Judith Joseph, M.D., MBA for a discussion on navigating menopause and understanding the transition to this next phase of life. We watched the class, and here are 10 things we’re begging you to know about it.
1. You’re not the only one who feels uninformed
If you grew up in the American education system, you probably had your first sex education class in fourth or fifth grade. But outside of the basics of your anatomy, puberty, contraception, sexually transmitted infections (STIs), and pregnancy, you may not have learned much about your body, especially as it gets older. To be fair, how many of us were really interested in what our bodies would look and feel like in our 40s and beyond? Still, that doesn’t mean that the education wasn’t necessary, because it absolutely is. And that’s likely why there’s still such a gap in knowledge about menopause.
One survey published last year in Post Reproductive Health found that 94 percent of women had never been taught about the menopausal transition in school, and 49 percent felt completely uninformed about menopause. Case in point.
Berry is also a part of this group of uninformed (or underinformed) group of women. In her class, she discusses how difficult it was for her to understand what exactly was happening to her body and explains that she didn’t know about perimenopause (and menopause) until she was five years into experiencing symptoms. (FYI, perimenopause can last up to 10 years.)
“It was frightening that if I had such little information, I only imagined how millions of women around the world had the same little information,” says Berry. So if you feel like you don’t know much about the transition to menopause either, remind yourself that you’re not on an island with a population of one. It’s a sea of people out there who aren’t aware of what happens during menopause, so it’s a good idea to keep reading and find out what more you need to know.
2. No one goes through menopause the same way
You might have been in fifth grade when you got your first period, but your best friend didn’t experience her first cramps until freshman year of high school. Or you might have had an uncontrollable craving for tomatoes when you were pregnant with your firstborn, but couldn’t even look at the sight of ketchup during your second pregnancy. Just like how experiences of menstruation and pregnancy can look different from person to person, so can menopause.
“Our experiences with menopause are just as individual as we are,” explains Berry. What age you start menopause, which symptoms you develop, and how you decide to manage your symptoms are all going to vary. So don’t play the comparison game with someone else going through menopause, instead, focus your attention on how your body feels and what you can do to ease the transition for you.
3. Menopause is actually just a single day
You may be surprised to know that menopause is a single event that happens on one day. You typically don’t know what day you experienced menopause until it’s the one-year anniversary of your last menstrual period. Don’t worry, we were confused at first, too. We hear people talking about going through menopause, which can often sound like it’s something that lasts for several years. But that’s not exactly true, so let’s break down each stage of your reproductive health:
- Reproductive phase: The period of your life that starts after your first period up until you begin perimenopause, which can last up to 40 years
- Perimenopause: The phase that occurs when you first start experiencing changes in your menstrual cycle until one year after your final period, which can last up to 10 years
- Menopause: The singular event that happens on the day of your last period, which occurs sometime between 45 and 55 years of age
- Postmenopause: The stage of your life that takes place right after menopause, which lasts for the remainder of your lifetime
4. Symptoms may not always be what you expect
Hot flashes. It’s always the first symptom you think of when you hear about menopause. And while it’s true that many people who go through menopause develop hot flashes, there are several other symptoms you might experience that you may not have expected. When Berry entered her stage of perimenopause, she talked about how the symptoms led to a very confusing period of her life. “I was turning into somebody that I knew I wasn’t, but I had no explanation as to why,” she says.
Dr. Gunter, OB/GYN, bestselling author of The Vagina Bible, The Menopause Manifesto, and Blood, and one of the co-instructors of the class explains that the confusion around symptoms is a common phenomenon. “I think a lot of people have been led to falsely believe that symptoms shouldn’t happen until your last period, but many, many people have symptoms before,” she notes.
Here are some symptoms you may know you’ll experience when you reach perimenopause and menopause, and a few that you might not know about at all:
- Hot flashes
- Menstrual changes, such as a longer or shorter duration of your period or heavier or lighter flow
- Night sweats
- Trouble sleeping
- Depression and anxiety
- Mood swings
- Joint pain
- Brain fog
- Forgetfulness or difficulty with memory
- Vaginal dryness
- Urinary incontinence or an overactive bladder
- Changes in weight
- Fatigue and lethargy
But why do these happen? When you enter the menopausal transition, your ovaries start to produce less and less estrogen—a sex hormone that regulates the female reproductive system but also plays an important role in other parts of your body, like your heart, brain, skin, urinary tract, and bones. So when you lose estrogen, your body will start to react with symptoms that occur when the loss of estrogen begins affecting other organs in your body (and not just your reproductive system). That’s why you see such a wide variety of symptoms listed above. But keep in mind: this doesn’t necessarily mean that you’ll experience every single one of these symptoms—these are just some of the more common signs.
5. There are a variety of treatment options to consider
Because menopause can cause an assortment of symptoms, you may want to consider all your options for symptom management. While several treatments exist, “estrogen is the gold standard,” says Dr. Gunter. Estrogen is a form of hormone replacement therapy, which is effective for a variety of perimenopause and menopause symptoms like hot flashes and night sweats (which are known as vasomotor symptoms). However, not everyone wants to go down the hormonal therapy route. Good news: other options are available.
In 2023, the U.S. Food and Drug Administration (FDA) approved a medication called Veozah (fezolinetant), which specifically treats hot flashes. However, healthcare providers can also recommend antidepressants like Paxil (paroxetine) and Effexor XR (venlafaxine) to offer relief to hot flashes and night sweats. Antidepressants, however, can also help treat symptoms of depression if you’re experiencing depressive moods during your menopausal transition. Other medications can also be prescribed off-label for vasomotor symptoms, such as Horizant (gabapentin), Lyrica (pregabalin), and Oxytrol (oxybutynin).
While these treatments all seem great, it’s important to understand which medications can benefit you the most. To learn which treatment options are safe and effective for you, talk to your healthcare provider for individualized recommendations.
6. Having a therapist on your healthcare team is a good idea
Most people who are experiencing perimenopause or menopause usually employ the services of healthcare providers like their primary care physician (PCP) and obstetrician-gynecologist (OB/GYN). But having a mental health professional in your repertoire of providers may be more beneficial than you think.
Dr. Joseph, a psychiatrist and co-instructor of the class, recommends working with a trained professional like a psychologist or therapist to help manage symptoms. Now you might be thinking, “Well, what can therapy do to help with menopause?” Turns out, it can do a lot.
The American Psychological Association (APA) explains that psychological and emotional support during menopause can help ease the transition to this next phase of life. Therapists can provide more education about menopause to help you feel more informed, offer stress management techniques to help reduce anxiety, depression, and irritability that menopause can cause, and teach you evidenced-based practices like metacognition and cognitive behavioral therapy to help you reframe any harmful thoughts and feelings you’re experiencing about menopause.
Convinced? If you’re ready to try therapy and don’t know where to start, contact your healthcare provider about any in-network mental health professionals they can refer you to. You can also ask for recommendations from loved ones or use online directories like the National Register and APA’s Psychologist Locator for mental health professionals in your area.
7. Libido can fluctuate, but sexual communication should remain constant
News flash: you’re still a sexual being even when you age. “We can learn to enjoy sex and feel pleasure well into the older years,” says Dr. Brotto, psychologist and co-instructor of the class. But, it’s worth noting that your libido can change during (and after) perimenopause and menopause.
Some people notice a spike in their sexual desire, while others may not want to engage in much sex at all. Wherever you fall on that spectrum is normal. But what’s most important is learning how to communicate your sexual needs with your partner, and talking through any sexual health concerns with your healthcare provider. However, sexual communication isn’t always easy, so these tips can help you get the conversation going:
- Create a safe space for you and your partner(s) to talk about your sexual needs
- Use “I” statements to explain what does (or doesn’t) feel good to you
- Be open with your partner(s) if you notice a change in your libido
- Recommend tools that can help make sex more comfortable for you, like lubricant if you’re experiencing vaginal dryness or pain after sex
- Talk to your provider about any sex concerns you have—and don’t feel ashamed to bring them up
Being vulnerable about your sexual well-being can sometimes be challenging. But if you start to recognize that your sexual health is just another component of your overall health, talking about sex and letting yourself enjoy it can become easier.
8. Your body composition is going to change—and that’s okay
One thing about your body is for sure: it’s going to change as it goes through the many different phases of life. As psychologist and co-instructor, Dr. Jacobs, says, “Everyone gains weight as they get older; that’s just a normal part of the aging process.” And undergoing menopause is no different.
As you start to lose estrogen and begin to experience hormonal changes during the menopausal transition, you may gain some unintended weight. Berry recalls thinking to herself, “I’m eating the same way I always used to eat, and then, [the weight gain] happened.” But there’s an important benefit of the slight weight gain, and it all has to do with keeping your brain healthy. Remember when we said that estrogen (or a lack thereof) can affect your brain and cause symptoms like anxiety and brain fog? Well, Dr. Jacobs explains that adipose tissue (aka your body fat) can release a hormone that mimics the role that estrogen plays in your brain.
However, the change in weight isn’t the only transition your body composition goes through: you may also experience some bone loss. But why, exactly? Estrogen is an important hormone that’s needed to build strong bones. Throughout your life, your body is in a constant cycle of building bone and losing bone. But when your estrogen source depletes, you’re losing more bone than you’re building, which can raise your risk of bone diseases like osteopenia (a decrease in bone density) and osteoporosis (a condition that causes your bones to weaken).
That’s why Dr. Gunter is such a proponent of talking about bone health much before you reach menopause. “You’re building your bone bank until you’re 27 or 28, and after [that] you gradually lose bone,” Dr. Gunter tells Well+Good. She notes that preserving your bone health throughout your life is key, not just when you’re entering perimenopause. Her advice? “If I could convince every young woman to start doing weight-bearing exercise and resistance training, that would be fantastic,” she adds. But remember, even if you’re older, it’s never too late to start adding these exercises to your routine.
9. Remember to involve your support system
Entering the menopausal transition can be an anxiety-inducing time, but it’s important to not let yourself suffer in silence. Cultural stigma around menopause has led many women to feel ashamed about their bodies and believe that menopause is the key that opens the door to a period of decline and a loss of importance in society. In reality, that’s just not true. Instead, Dr. Joseph recommends reframing the way we all view menopause. “I want you to look forward to getting older [and] dismiss the myth that you’re no longer valuable,” she notes.
This stigma is what prohibits women from sharing their experiences or concerns with their loved ones. But you need a space to talk about something that half of the global population goes through. So don’t be afraid of opening up a discussion. You don’t have to scream from the top of the mountains that you’re in menopause (although, you absolutely can!), you can also just bring up the topic with a trusted confidant like your sister, close friend, or partner. Allow yourself to feel heard and supported—and it’s okay to start small, as long as you’re starting.
10. Be your biggest advocate
If there’s one thing that Berry wants you to take away from this class, it’s that you have to advocate for yourself at every chance you get. “We have to realize it’s okay to put our health at the forefront of our life,” she says.
Unfortunately, many women are often dismissed when they talk about their symptoms with their providers. According to the 2022 KFF Women’s Health Survey, nearly 30 percent of women reported that their provider dismissed or ignored their concerns. But what can you do to change this? Berry has two important recommendations: 1) read about menopause so you can go into your appointments knowing what you need from your provider (browsing through The Menopause Society is a good start), and 2) don’t be afraid to switch your provider if you feel like you’re not being heard.
Self-advocacy can look different for everyone, whether that’s educating yourself, taking notes during your appointments, or getting a second opinion from another provider. Whatever it is you choose, listen to your body and trust yourself to know what it needs. Who says you can’t put yourself first during your second act, right?
Well+Good articles reference scientific, reliable, recent, robust studies to back up the information we share. You can trust us along your wellness journey.
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