Ashlee Williams, MD (Host): Hot flashes, mood swings, restless nights. Menopause can feel like a storm you didn't see coming. But you are not alone. And with the right knowledge, this transition doesn't have to be overwhelming. Let's shed the myths, embrace the facts, and make this next chapter one of strength, clarity, and support.

Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm joined by Dr. Marsha Solomon, a board-certified OB-GYN at Kaiser Permanente. We'll be breaking down what menopause really is, what you can expect, and practical ways to feel your best. Dr. Solomon, thank you so much for being here today.

Marsha Solomon, MD: Thank you, Dr. Williams. Thanks for having me.

Host: Yes, this is such an important topic. Okay. So, we always like to start with the basics. What exactly is menopause, and when does it typically begin?

Marsha Solomon, MD: So, menopause is defined as no period at all for 12 months. So, no bleeding, no spotting, no nothing for a consecutive 12 months. Sometimes you might make it to 11 months, and then a cycle comes back. Guess what? We have to restart the clock. You're not menopausal. Menopause is 12 months with no period.

Now, in the United States, the average age for menopause is around 51, but people can go into menopause or become menopausal as early as age 40. And so, it's extremely variable. And what makes it even more confusing for many women is that the symptoms of perimenopause, which is the transition period leading up to menopause, that can occur for several years before they become menopausal as well. So, it gets really confusing for folks.

Host: Yeah, I've definitely had the frustrated patient come in who says, "I've made it 11 months without my cycle and now I have to start count all over again." Okay. So, let's talk about how is menopause diagnosed.

Marsha Solomon, MD: So, menopause is diagnosed in a different way than a lot of other conditions. Generally, it's more by discussion. So with your healthcare provider, reviewing your cycles, your menstrual history, and what's been happening in your life medically over the past year or two, we're able most of the time to decipher whether or not you're truly menopausal.

So, we make that diagnosis. After you become menopausal, rarely, we can do a blood test to confirm that you are menopausal. But what happens sometimes is if you're not menopausal and your hormone levels are sort of fluctuating, this is sort of a snapshot of your hormones and sometimes it's just not completely accurate. So generally, it is a diagnosis made by history and by talking.

Host: I can imagine some of the symptoms of perimenopause and menopause overlap. Can you talk specifically about the symptoms of menopause?

Marsha Solomon, MD: Yes. And you're right, they do overlap. And I think that's what causes a lot of confusion in women because they're like, "Well, am I perimenopausal? Am I menopausal? I can't tell." And sometimes you can't because the symptoms don't change. So, it's important to point out that some women don't have symptoms at all. They might just stop having a cycle and feel completely fine. And of course, we're all jealous of those people. But the people who do have symptoms, these again can start in perimenopause and continue into menopause. The most common symptoms being hot flashes, night sweats. People might find that they're having mood changes or more mood swings. They might find that they feel more depressed or more anxious. Vaginal dryness or discomfort with intercourse is something that can also happen. People might find that they are having difficulty sleeping, so they might have more trouble falling asleep or staying asleep. I quite often hear the, "I go to sleep at the usual time, but then I'm up by 3:00 AM and I can't go back to sleep." That's common. We might also hear people talk about, "Listen, I follow a healthy diet and I exercise, but somehow I'm having more trouble maintaining my weight." There might be a little more of the "What's that word again? I can't remember." That's that brain fog that people talk about. There may be a little more of that as well.

Host: And I think one of the things that we don't talk about enough is the emotional and mental impact of menopause. Can you talk a little bit about that?

Marsha Solomon, MD: That's a really good point, Dr. Williams. It is really important for us to remember that while menopause is something that physically happens, like we stop having periods, it definitely does have an emotional component to it. Women might find that they have more irritability, changes in their moods, but also people who have a history of depression or anxiety might find that those symptoms start to recur once they hit menopause. Menopause actually increases your risk of depression by two times. And so, it's something that is extremely, extremely common. And if you find that your moods are worsening or you're feeling more depressed or more anxious, it's really important to reach out to your healthcare professional.

Host: So, menopause has come, what are some lifestyle changes that you can make to help with the symptoms? And what are some medical options for treatment?

Marsha Solomon, MD: Well, lifestyle modifications quite often will have something to do with what type of symptoms you're having, but the basic answer is try to be as healthy as you possibly can. So, healthy diet, following a healthy diet with lots of fruits and vegetables with lean proteins, healthy fats, whole grains, very important. A regular exercise regimen is also very important, so exercising at least three times a week, with weight-bearing exercise. Something I didn't mention previously is that women experience more bone loss or osteoporosis risk once they become menopausal as a result of their hormonal changes. And so, weightbearing exercise actually helps to keep your bones nice and healthy and strong, so that's very important.

For people who are experiencing hot flashes, things like avoiding spicy foods and dressing in layers and keeping a fan on you can also be very helpful. Sleep, sleep is something that is something we don't focus on enough, but trying to get enough sleep-- eight hours of sleep if you can-- is really, really important. Why? Because if you get enough sleep, that really can help with your mood, and it can also help with that brain fog. We all know how we feel when we're really tired and don't get enough sleep. Sometimes you just can't put your words together. So, sleep is very beneficial.

With respect to medications, there are a number of medications that we can use to help with menopausal symptoms. I'm sure many have heard about HRT or hormone replacement therapy. All of this comes into play because, once we go into menopause, our ovaries have significantly decreased the amount of estrogen and progesterone that they used to produce. And so, we don't ovulate anymore. And the replacement therapy is essentially replacing these hormones to help bring us back to more of a steady state. And that helps with hot flashes and with night sweats, and also with vaginal dryness and with bone health. And so, HRT, if you're a good candidate for it, can be very helpful.

Aside from HRT if you're not a good candidate for HRT or don't want to try that, there are numerous other medications that we can try such as an antidepressant. As I mentioned earlier, a lot of women undergo changes in moods. Their depression or anxiety might recur or increase. So, an antidepressant such as an SSRI can be very helpful. It can help with hot flashes and night sweats, which therefore helps with sleep, which is awesome. And it can also help with the depressive and anxiety symptoms or the mood symptoms people are experiencing. There's another medication called gabapentin that can help with hot flashes. There are vaginal estrogen options. If people have not so much of the other symptoms, but they have vaginal dryness because of estrogen deficiency, we can give vaginal estrogen. We can use non-estrogen options, vaginal lubricants, and vaginal moisturizers. So, there are lots of options to help with our menopausal symptoms.

Host: When do you recommend that someone come see their OB-GYN to talk about their menopausal symptoms?

Marsha Solomon, MD: That's a great question. I think as early as possible, you know, as we've been talking about, perimenopause or sort of your premenopausal transition period can begin many years before you become menopausal. And so, I would say from about 40 on, we should be starting to talk about what things to look for with respect to perimenopause and menopausal symptoms. And then, we can keep that dialogue going as we see each other and follow up and talk about options as you start to maybe develop symptoms.

Host: Are there any myths that you want to clear up about menopause?

Marsha Solomon, MD: Yes. Well, first of all, one of the myths is that menopause is like you go into menopause and you become this like old-- I don't know how to describe it-- like this old sort of decrepit person. That is not true. Menopause is not the end of life. It is just a part of our lives. That is a naturally occurring process, and you can be just as vital and just as active sexually and just as happy as you were premenopausally. So, that's one.

The second thing is that menopause ends. There is a myth that, you know, a lot of people believe that they go through menopause, and then for some reason within two years, it's over. Unfortunately, menopause is something that lasts for the rest of our lives. And so, it is something where that you always want to be keeping an eye on, you might develop symptoms when you're 75 years old, and that's okay. But it's just something to keep in contact with your healthcare provider about.

Host: So true, and I think it's important to know and to communicate that it's not just in your head. There are real physical and mental changes taking place in your body and to validate that.

Marsha Solomon, MD: Absolutely. You know, a lot of this stuff is invisible to others and people sort of just suffer alone as a result. And they need to know that, you know, we're here for you. We are here for you. You don't have to suffer by yourself, and it should be something that there's more knowledge on. And so, we're happy to speak to your families, your friends, anybody who needs more education in the area of menopause.

Host: Yes, we're all in this together. Well, thank you so much for this valuable insight, Dr. Solomon. Here are some key takeaways from today's episode: One, menopause is a natural life transition. It starts usually in your 40s or 50s and is officially diagnosed after one full year without periods. Two, symptoms can be both physical and emotional. Hot flashes, sleep issues, mood changes and brain fog are common, but every woman's experience is unique. Three, mental health matters too. Hormone changes can affect mood. And women with a history of depression or anxiety may notice symptoms returning during this time.

Four, there are effective ways to manage symptoms. Options include hormone therapy. There are also non-hormonal medications, lifestyle changes and stress reduction techniques. Five, you are not alone and support is available. Do not hesitate to reach out to your healthcare provider if symptoms are bothersome or if you have concerns. There are safe proven ways to feel better through menopause.

For more expert advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcasts. If you found this episode helpful, don't forget to subscribe and share it with others. Thank you. And from all of us at Kaiser Permanente, be well.