menopause

menopause
The Voorhes

Despite the many condolences I received on my 40th birthday (along with backhanded compliments like “It’s okay—you don’t look 40!”), I felt elated. I thought I had all the gifts I needed to take on my next decade: a sturdy marriage; sweet, kooky kids; a fun and fascinating career; and a body that functioned like clockwork. Two years later, family and work were still humming along fine, but my body was in full freakout, for reasons I couldn’t fathom. Unbeknownst to me, I had entered the hormonal hurricane of perimenopause.

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The symptoms made every facet of my life more difficult for more than a decade, and here’s the infuriating part: Every moment of suffering was unnecessary. If someone had handed me a blunt rundown of menopause basics on that big birthday, I would have gone in prepared, gotten the help I needed, and sailed toward 50 healthier, and more hopeful.

But no one did—not my doctor, my friends, or my mom, who was still white-knuckling her way through brutal hot flashes with zero medical support or treatment. So this is it: the to-the-point menopause manual I wish I’d been given, and my birthday present to every woman on (or near) her 40th birthday. It may not be the sparkly thing you want, but believe me, this knowledge is invaluable.

1. Buckle up. Things are about to get weird.

Starting, for most women, in their mid-40s, hormones—and most important, estrogen—begin to fluctuate. It’s called perimenopause, and it feels a little like an unfortunate plane flight. Estrogen has been cycling monthly for years but in such a predictable and smooth way, your body has gotten blasé about it—the way we all pay zero attention at takeoff and landing. Perimenopause, by contrast, is like a long stretch of powerful turbulence, when estrogen levels gyrate wildly and gradually drop. For at least 80 percent of women, the ups and downs cause dozens of symptoms, and not just periods that come late or early, lighter or gushingly heavy. Bottom line: If you think it’s your hormones, it probably is.

2. Your experience will be completely unique.

On average, perimenopause starts in your mid 40s, but it may kick off as early as your 30s or as late as your 50s. (Surgical or medical menopause is a reality for women at any age if they go through treatment for certain cancers or other conditions.) When your period has gone missing for a full year, you’re in menopause, but the fun doesn’t stop there. Symptoms morph, wax, and wane, and the whole shebang lasts a decade, on average. For an unlucky 10 percent, it’s a rest-of-their-life situation.

You might experience hot flashes and night sweats; insomnia; intense irritability, depression, or anxiety; vaginal dryness, painful sex, and urinary symptoms including UTIs; weight gain for no apparent eating/exercise reason. Those are just a few common ones; women grapple with myriad symptoms, some of them quite strange (tingling extremities, anyone?).

My special variety pack included hot flashes that battered me, day and night. I had to pee desperately about every 20 minutes. I also developed dry eyes. Oh, and stress felt stressier, relieved only by a religious jogging habit. When I snapped at my kids in the mornings, they would look at each other and say, “We need to run Mommy,” like the caretakers of a high-strung terrier.

The most frustrating part? I had no idea why my body and moods no longer made sense. If anyone had told me, “Don’t panic, Jill; it’s perimenopause,” I wouldn’t have felt so bedeviled, embarrassed, and, frankly, crazy. As they say, if you know, you know. And you’re more likely to get help, which brings me to some much better news…

3. There are really good, safe meds for all of this.

In fact, we’ve had FDA-approved solutions for symptoms of perimenopause and menopause for decades. Hormone replacement therapy—a.k.a. HRT or menopausal hormone therapy (MHT)—is the most effective treatment for relieving menopausal hot flashes, night sweats, vaginal dryness, painful sex, and recurrent urinary tract infections, according to the most recent guidelines from the North American Menopause Society (NAMS). Clinically, hormone replacement therapy has also been shown to be highly effective in relieving symptoms of insomnia, mood changes, and brain fog. And that’s not all! A large body of recent research shows that if women start HRT within 10 years of their last period or before age 60, they have a lower risk of heart disease and bone loss. HRT may also be connected to decreased risk of diabetes and weight gain. For the vast majority of healthy women, hormone therapy is safe.

4. Can’t take hormones? You can still get relief.

HRT isn’t for everyone. You’ll want to find alternatives if you have a history of stroke or certain types of blood clots, some types of heart or liver problems, or cancer that might be stimulated by hormones (including some kinds of breast and uterine cancer), or if you’re currently dealing with unexplained vaginal bleeding. If any of those apply for you, a trained clinician can guide you toward non-hormonal solutions for menopause symptoms. There are prescription drugs that improve hot flashes and SSRIs for mood, and virtually every woman can safely use localized vaginal estrogen, which is extremely effective for vaginal dryness, painful sex, and urinary symptoms. Also good for everyone: supplements, lifestyle changes, and various wellness therapies, including pelvic floor therapy (which is way more than kegels, and works wonders).

5. Don’t be surprised if your doctor looks at you blankly when you ask about this.

A measly one in five medical residents receives any training in menopause, and often that education amounts to an hour or two. So it makes me tack-spitting mad to report that your ob-gyn or primary care provider may decline to even discuss hormone therapy, or worse, suggest that your symptoms need to be “unbearable” to merit treatment. If so, move on, and keep talking until you’re heard. Ideally, you want to see a menopause expert who thoroughly understands your health history, what you’re going through, and all the treatment options. The problem is, for the 47 million women experiencing menopause in the U.S. right now, there are fewer than 2,000 NAMS certified practitioners. I cofounded a company to deal with this absurd shortage—we’re called Midi Health, and we’ve built a digital platform to provide insurance-covered care, delivered by trained clinicians, via telehealth. But where you get treatment isn’t the point, as long as you get it in the end. Tap into your friend network for recommendations, check the NAMS website for practitioners near you, search menopause docs on social media. (TikTok is a shockingly popular resource, FWIW.)

Once you’ve found a clinician who knows her stuff, expect some iteration on your way to feeling better. Hormonal therapies, and non-hormonal alternatives, come in a vast array of formulations, doses, and delivery methods. The many HRT options alone take some expertise and trial-and-error to get right. If you’ve ever had allergies, you know what I mean: First you try Claritin, then Zyrtec, maybe add eye drops and something naturopathic, until voilà, your sneezing and itching are under control. Similarly, the right cocktail of meds, plus supplements, lifestyle changes, and wellness therapies, can help any woman in menopause, no matter how complex her case.

You know you’re strong—you’ve proven that just by living in a female body for decades. But how much stronger could you be if you deleted menopause symptoms from your personal equation?

6. Your treatment can and should be covered by insurance.

I’ll keep this point brief: The FDA-approved hormone replacement therapy drugs most of us should be on are inexpensive, insurance-covered generics. You’ll find companies and concierge docs out there offering you expensive HRT subscriptions or specially concocted compounded hormone formulations. You can easily spend hundreds of dollars a month, out-of-pocket, on this kind of care. Don’t fall for it. My HRT costs $23 a month after insurance. My Midi visits are covered, minus a standard copay. Your costs will vary depending on your insurance and prescriptions, but coverage is what you should expect, and demand.

7. There’s no medal for toughing it out.

Maybe you’re thinking that your menopause symptoms aren’t so bad…that you can hack it without intervention. I will just point out: No one greets you at the finish line of life and says, “Congratulations! You endured decades of hot flashes and crappy sleep, without any medical help at all!” I know you’re strong. You know you’re strong—you’ve proven that just by living in a female body for decades. But how much stronger could you be if you deleted menopause symptoms from your personal equation?

I came to HRT late, thinking my remaining symptoms weren’t “bad enough” to warrant hormones. But when I looked at my bone density scan with my Midi clinician, neither of us liked what we saw: Osteopenia, a precursor to osteoporosis, had already set in. So just a few months ago, at age 56, I started on an estrogen patch and nightly progesterone, ostensibly to strengthen my bones (HRT is FDA-approved for that purpose). And then came the unexpected relief from symptoms I barely noticed anymore, like the frog that gamely swims in boiling water. Instead of struggling to nod off at night, using meditation apps and wind-down rituals and pops of melatonin, I fall into deep, dark sleep—the kind of rest I used to get and could barely remember. I’m less stressed, maybe because of all that yummy sleep, or maybe because progesterone is considered the relaxation hormones. And sex is better. Same partner, same basic moves, but the feels are stronger. I’ll leave it at that but just add that I wish I’d taken the HRT plunge sooner. Much sooner.

8. Actually, let’s double click on sex, because you are still sexy, and sexual, and deserve to feel amazing in bed.

More than 50 percent of us deal with vaginal dryness and painful sex during perimenopause and menopause. Women describe intercourse as feeling like broken glass, or similar to the first time having sex after giving birth. (I shudder at the memory.) Most don’t even seek treatment for sexual symptoms, which makes me crazy, because they are some of the easiest to treat and improve. At Midi, we prescribe vaginal estrogen to women who haven’t been able to have intercourse in years. They report feeling relief, and having amazing sex again, often within days.

9. Can we all talk about all this? Yes, and we must.

You’ll learn a lot on this menopause journey, just as you did through other hormonal transitions—puberty, pregnancy, post-partum. You got plenty of guidance at those moments, from school, the medical establishment, everyone. And you probably paid it forward, sharing your experience, your resources, any good intel you picked up with your friends. As you navigate menopause, please do the same. Drop any vestige of shame and talk to other women.

10. Finally, happy birthday, and welcome to a wild and wonderful life stage.

If you’re a mom, your kids are increasingly independent; you’re getting time back to pursue passions; you’re more self-accepting, less people-pleasing…and bonus: Pretty soon you’ll be done with f-ing periods! What’s not to like about your 40s? Yes, you need to focus on your health a bit more, but perimenopause and menopause don’t have to consume you. Take care of yourself, get the help you need, and enjoy the sweetness of this decade, and the ones to come. Because this life, right now, is your sparkly gift.

Any content published by Oprah Daily is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. It should not be regarded as a substitute for professional guidance from your healthcare provider.

Jill Herzig is the chief brand officer and cofounder of Midi Health, a virtual care clinic that treats women going through perimenopause and menopause.


In a refreshingly candid conversation with Oprah Daily Insiders, Oprah, Maria Shriver, Drew Barrymore, and doctors Sharon Malone, Heather Hirsch, and Judith Joseph, we set the record straight on all things menopause. Become an Oprah Daily Insider now to get access to this conversation and the full “The Life You Want” Class library.