For decades, menopause was something women endured quietly. Today, new research, evolving treatment options, and more open conversations are changing how women experience this stage of life. In this episode of the FirstHealth and Wellness Podcast, host Gina Kaye sits down with Dr. Lisette Machin, OB-GYN, to discuss how perceptions of menopause have evolved, common misconceptions, and how women can take an active role in personalizing their care.
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Understanding Menopause Today
How Menopause Care and Treatment Have Changed
Dr. Lisette Machin: Well, it started probably way before the 1990s. There was talk with your provider about menopausal symptoms, very much an afterthought, not a focused visit at times. And women were given hormones.
A concerted study was then conducted in the '90s collecting information for women between 50 to 79 years old. Twenty thousand women were enrolled. This is the big study, the WHI study hosted by NIH, which looked at whether hormonal therapy was beneficial for cardiovascular health. That study was stopped in 2002 because it showed that there was increased risk for cardiovascular events and possibly some elevation in risk for breast cancer.
At that point, hormones stopped. No one wanted to use them because of the fear that they were detrimental to your health. And that was unfortunate because women who were going through a transition in their life were devoid of maybe benefits.
Now that we've looked at the study and had additional studies, we see that the right questions weren't asked. Also, medications have evolved to include different delivery systems as well as dosing. It has changed quite a bit because science has advanced. Critical thinking also went into understanding what was behind that study that caused such a pause, and women are benefiting now that we've looked at the information more closely.
Common Menopause Symptoms
What are the most common symptoms women experience today, and which ones are often overlooked?
Dr. Lisette Machin: What first comes to mind is some of the emotional part of it and then the physical manifestations. It ranges, and that's when you try to tease out with someone, "What are your priorities? What is affecting your life the most?"
Women complain about hot flashes, and that can lead to sleep disturbances. Not everyone will have the same symptoms or the same group of symptoms. Some speak of brain fog and difficulty concentrating. Others talk about weight gain and feeling like their metabolism has tanked.
Everyone is individualized. It's important to give women a list of possible symptoms, and she will identify which ones are affecting her the most and what concerns her most. Sometimes one symptom may be the result of another sign she was putting aside. We try to link them together and get a comprehensive picture of what's affecting her and what's most important to the patient.
Are women experiencing menopause differently today, or are we simply talking about it more openly?
Dr. Lisette Machin: I don't think the symptoms have changed. I've been practicing for 20 years, and I think the symptoms are the same. What has changed is our vocabulary around it and how we talk about it and receive information.
The experience itself may not have changed. The process is still very much the same biologically. But how we interpret it, engage with people around us, and connect with our communities is a lot different than it used to be.
These were conversations that were had quietly among older women and often not discussed openly. There certainly weren't commercials or celebrity advocates talking about menopause. In that way, the experience is different, but biologically it's the same.
Lifestyle and Menopause
Lifestyle Changes That Can Help Manage Menopause Symptoms
Dr. Lisette Machin: One of the things we have to understand is that we're all linked and that menopause is a systems issue.
If you're stressed, you're going to have more hot flashes. Your diet regulates how your body absorbs calories. We want a more protein-driven diet. We want resistance training, and that can help with sleep patterns.
It's really about taking a global look at the whole person and understanding how external factors affect you. Relationships, job situations, financial situations, everything around us affects us. How our body receives and responds to those factors needs to be understood in order to achieve effective results.
There's no magic pill that makes everything better. Hormones alone don't address all the other factors that influence a woman's health and well-being.
Are there things women can do in their 30s and 40s to prepare for a healthier transition?
Dr. Lisette Machin: Yes. Ideally, we want to be the best version of ourselves right now. That definitely sets you up for a better transition no matter what phase of life you're entering.
Even in the teenage years, it's important to establish good health habits. During our reproductive years, we want to know our family history so we can receive proper screenings. You're preparing like an athlete does when getting ready for menopause.
That means developing healthy habits, understanding your risk factors, and knowing what you're bringing to the table genetically. What are you predisposed to? What should you be working on?
Healthy habits, good mental health, self-care, and regular self-checks are essential. We tend to give so much of ourselves to others, but we need to develop our own self-awareness so we can prepare for the next phase of life.
Supporting Your Mental and Emotional Well-Being
Why is it important to address the emotional and psychological side of menopause, not just the physical symptoms?
Dr. Lisette Machin: It all feeds into the bigger picture.
I joke with my patients and ask, "Do you like the people around you, and do they like you?" Because those relationships feed us. They reinforce us and make us feel good about who we are and what we're doing.
The emotional part of menopause is just as important as the hot flash you're having. That's why self-inventory and self-care are so important.
These topics can and should be talked about. It's important to have a supportive provider team and supportive people at home who can understand that you're working through a transition and support you along the way.
Separating Menopause Myths from Facts
Common Menopause Myths and Misconceptions
Dr. Lisette Machin: The myth that menopause is simply a burden we have to endure.
I feel we often chalk it up as just part of aging. Yes, it is part of aging, and I think we can age gracefully and as healthfully as possible. But we don't have to accept being sad. We don't have to jeopardize our cardiovascular health or bone health because older generations experienced those issues.
For example, osteoporosis may run in your family, but that doesn't mean you can't change the course for yourself.
Sexual health doesn't have to be put on the shelf. Staying fit and maintaining activity shouldn't be viewed as impossible simply because we're aging. We want to be healthy, vibrant, and present for ourselves and the people who matter most.
Where are women often getting misinformed today?
Dr. Lisette Machin: I think misinformation comes from everywhere. It comes from peers, social media, and many other sources.
At the same time, social media has opened pathways for conversation and normalized menopause discussions in many ways. The important thing is to remain critical of the information you're receiving.
I want women to advocate for themselves and understand that there is no secret formula. Be cautious of anyone promising the best outcome with the least amount of work or investigation. Sometimes the quick fix is the most attractive, but if something seems too good to be true, it probably is.
Patients often come in with information they've found online, and as providers, we need to be receptive to that. I don't want to discredit it. I want to understand it and help patients become critical thinkers who can distinguish good information from bad information. Ask questions. Challenge your provider. I learn from my patients every day.
Advice for Women in Menopause
What is the one message you hope listeners take away from today's conversation?
Dr. Lisette Machin: Pick your team, be critical and open to all sources of information, and keep the conversation going.
It's not going to be one thing that helps. It's going to be looking at the whole picture. Talk to the people who matter to you about what you're experiencing.
I say that perimenopause and menopause are really about unveiling who you are and who you will become. There's a lot of freedom in that. Aging is a privilege. With it comes knowledge and experience.
I hope we continue to grow as a society and embrace the knowledgeable, wise women we are becoming. Don't fear this stage of life. It can be liberating. You can grow into your own, live a happy and full life, and become even better than you expected.
Learn More About Women's Health at FirstHealth
For more information about women's health services at FirstHealth, visit FirstHealth.org/GYN.
