menopause
menopause

Everyone tells us that menopause is complicated, and many people have profited from our confusion. The idea that women don’t understand menopause, that we need special handling and in-depth instructions to take care of our bodies, has given rise to countless expensive, overly complex treatments that are inaccessible to most, and highly unnecessary for all. Here’s the truth: Menopause is not that complicated.

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Yes, there are a lot of different symptoms, and women experience unique combinations of them (the most common being hot flashes, mood swings, and lack of sleep). Most doctors have not been trained properly and have difficulty recognizing the concert of various individual symptoms as menopause. But there is one predominant cause of menopausal symptoms, and that is the loss of ovarian estrogen, which usually occurs when we are about 51 years old. We have estrogen receptors in almost every single cell of our bodies. Needless to say, when there is no more estrogen circulating, just about every part of our bodies is affected. Not just our vaginas, but our brains, our bones, and our hearts. (Not to mention our guts, our joints, our skin, and our hair.)

If the sudden absence of estrogen is the problem, then logic dictates that adding a little bit back into your body might be the solution. In fact, until 2002, this was common practice, and there are now FDA-approved generic bioidentical hormone treatments, available either as pills or patches, that not only treat the bothersome symptoms of menopause but also decrease your risk of developing osteoporosis and type 2 diabetes. (For the roughly 66 percent of us who still have our uterus at this age, daily progesterone is an essential sidekick to systemic estrogen.) There are also topical vaginal solutions that not only ease the very common vaginal dryness and pain but also decrease urinary frequency and urgency, and urinary tract infections.

Most doctors have not been trained properly and have difficulty recognizing the concert of various individual symptoms as menopause.

In 2002, a study called the Women’s Health Initiative (WHI) came out that demonized these solutions, and prescriptions for what had been one of the most commonly prescribed medications in the country plummeted overnight. The study created an enormous amount of unnecessary fear that estrogen caused breast cancer. That data has been reexamined and reexamined over the past 20 years, and, it turns out, that same data shows that for women who took estrogen alone, the risk of breast cancer was actually lower than for those who did not. In the meantime, millions of women were either taken off their estrogen or never even offered it. And since then, more studies have come out showing that not only does estrogen not cause breast cancer, it actually protects your brain, your bones, and your heart.

The damage done by that study over the past 20 years is immeasurable. In a recent podcast with Andrew Huberman, Peter Attia describes the WHI as “hands down the biggest screwup of the entire medical field in the last 25 years.” Many people agree with him. One of the main authors of the study, JoAnn Manson, published an excellent piece in The New England Journal of Medicine that decried the decline in hormone therapy prescriptions that occurred in the wake of the WHI. But the message has never cut through the noise. All the debate back and forth in the ensuing years has either been among the academics, who tend to debate the details rather than shouting the good news to us laypeople, or among the warring parties of the internet. And, like so many topics around women’s health, an intense and polarizing battle ensued, as millions of women suffered needlessly for years. Remember the heated conversations around natural childbirth, breastfeeding, working versus stay-at-home moms? Those vitriolic chatroom hot topics are nothing compared to the debate and confusion around menopausal hormone therapy (MHT).

I’m not a doctor, but the evidence is clear. The experts, including those at the American College of Obstetricians and Gynecologists (ACOG) and the North American Menopause Society (NAMS), agree: For the vast majority of healthy women, the benefits of MHT far outweigh the risks. Period. And the lack of clarity on this topic has caused much harm. Instead of taking health decisions out of the hands of women, as the medical establishment did when they simply stopped talking about menopause and hormones, it’s time to spread accurate information and give women the agency to make informed choices about their own menopausal health.

Menopause Myths Debunked

Myth: Estrogen replacement therapy (now known as menopausal hormone therapy, or MHT) causes breast cancer.

Truth: Estrogen replacement therapy does not increase your risk of breast cancer over your preexisting, baseline risk. The WHI study, the source of this myth, has been reevaluated, and this is what it shows—women who took estrogen alone (women with previous hysterectomies) had a 30 percent decrease in the incidence of breast cancer. The small, rare increased risk of breast cancer that was found in the WHI study is now understood to be related to the type of progesterone administered in that study. Micronized progesterone, now the most commonly prescribed type, has never been linked to an increase in breast cancer risk.

Myth: You need to test your blood, saliva or urine to know where your hormone levels are before you start hormone treatment.

Truth: Anyone who has not had a period in 12 months is in menopause. In menopause, your estrogen levels are flat at close to zero. A test is unnecessary. In perimenopause, the roughly four to 10 years leading up to menopause, your hormone levels change radically from hour to hour. A blood or saliva or urine test will only tell you what your level was at that moment in time.

Myth: Every woman needs an individual, customized blend of hormones, created just for her in a specialized lab. A really special formulation comes in pellet form and is injected under the skin. And the more expensive the mix, the more effective it is.

Truth: There are FDA-approved, pharmacy-dispensed, widely available standard doses of estrogen that help the vast majority of women. For some people, these doses are not enough, and they need to titrate up or down with the guidance of a medical professional. This usually consists of adjusting the dose and seeing how you feel. The right dose is when your symptoms are relieved.

Myth: I can only take hormone therapy for a few years. Or I am too old to start.

Truth: The North American Menopause Society changed its guidelines in 2022 to say that there is no time limit by which a woman has to stop taking hormone therapy. If she’d like to stop, she can try stopping, and if her symptoms persist, she can go back on. As for when to start, the ideal range is within 10 years of your last period. If you are past those 10 years, consult with your doctor about the risks and benefits of starting now.

Myth: The vaginal issues that can happen with menopause will resolve over time.

Truth: The genitourinary syndrome of menopause (GSM) includes dryness, itching, painful sex, urinary incontinence, and frequent UTIs, and will worsen over time if not treated. Systemic hormone therapy, particularly when started early, typically prevents GSM, but when symptoms persist or when systemic therapy is undesired or contraindicated, almost without exception, topical local estrogen can be used vaginally.

Myth: I can’t take hormone therapy because my mother had breast cancer.

Truth: Per the 2022 NAMS guidelines, there are very few contraindications for hormone therapy. There is a contraindication for those who have a personal (not family) history of breast cancer. Anyone’s risk for developing breast cancer is dependent on multiple factors, including not just family history, but weight, diet, alcohol intake, age at first pregnancy and more. Adding menopausal hormone therapy does not increase your risk over your baseline risk.

Myth: I can’t take hormone therapy because of the dangers of blood clots.

Truth: The risk of blood clots from taking hormone therapy is less than the risk that exists from taking oral birth control pills or from being pregnant. Even for those women who have a genetic condition that predisposes them to blood clotting, hormone therapy is possible and very likely safe when administered via transdermal patch.

Myth: My doctor has been my doctor for 20 years, and I am sure she will guide me through menopause in the best way.

Truth: Unfortunately, an entire generation of doctors was not taught the proper protocols and treatments around menopause. A study by the Mayo Clinic found that 20 percent of women’s primary care residents reported they had received no lectures in menopause and that fewer than 7 percent felt competent in managing menopause. It’s not the doctors’ fault. In many cases, menopause education is one lecture. And, unfortunately, for the few who have had any training since the Women’s Health Initiative’s findings in 2002, much of what they have been taught is incorrect.

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.

Anne Fulenwider is the former editor in chief of Marie Claire and the cofounder of Alloy Women’s Health, a digital health platform solving aging and the symptoms of menopause for women over 40.


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.