When it comes to menopause, the questions can seem endless…and the answers in short supply. Is this…normal? What should this look like? Am I dealing right? Is there such a thing as dealing right? Luckily, we’re here to talk about all the things people don’t talk about—and this time, we’ve called in a real pro. Dr. Sherry Ross, women’s sexual health expert and author of she-ology and the she-quel, has answers to the most commonly asked questions that you submitted on our social channels. (As always, talk to your doctor if you have questions about your experience and before changing your lifestyle or trying any treatments.)

1. Why am I gaining weight? Is there anything that can help me avoid this?

As we age, it is harder for us to lose weight. The hormonal upheaval of menopause tends to make weight gain in the usual places—abdomen, thighs, hips, and buttocks—a common complaint. Hormonal chaos, along with aging, genetics, and lifestyle choices, makes losing weight all the more challenging.

Most women can handle the hot flashes, night sweats, insomnia, mood swings, anxiety, depression, fatigue and even a low sex drive but it is the weight gain that takes women to the edge of the cliff!! 

All the symptoms of menopause can impede a women’s ability to work out. Irregular periods make it hard to know when the best time of day to work out is. Hot flashes and night sweats make the thought of working out and breaking a sweat less desirable. Emotional upheaval including depression and anxiety also prevents trips to the gym or putting on your tennis shoes. Heart palpitations also scare menopausal women from doing any activity that increases the heart rate.

It is completely unanimous that there is a long list of benefits from regular exercise. Exercising as little as 30 minutes, 3 days a week can show immediate health benefits.  Aerobic exercises such as brisk walking, jogging, bicycling, and swimming are especially helpful for menopausal women.  These types of activities help with weight loss or allow women to maintain a healthy weight. Keeping track of your steps, aiming for 7,500-10,000 a day, will make you more accountable and successful in monitoring your daily activity. If you are not ready for aerobic exercise stretching and simple exercises that help with balance and stability are useful.

Weight bearing and muscle strengthening exercises build bone. Weight bearing exercises are those exercises where your feet and legs support your body weight.  Low impact exercise such as fast walking, elliptical and stair stepping machines, not only build muscle and endurance but also build the amount and thickness of bone. High impact exercises include running/jogging, jumping rope and high intensity aerobics.  Strong muscles increase blood flow and sends key nutrients to help maintain healthy bone.

Starting slowly is recommended for menopausal women. Getting into a regular routine is the best strategy. Regular exercise improves metabolism, increases heart rate, improves breathing and body temperature all contributing to a better blood circulation strengthening the heart. Regular exercise also improves your energy, mood, and emotional stability. Exercise makes you feel more confident and helps ease the stress when dealing with menopausal symptoms. Sleep patterns show improvement as well.

Regular exercise improves metabolism, breathing, energy and emotional stability. Exercise makes you feel more confident and helps ease the stress of menopausal symptoms. It strengthens your heart and improves your sleep patterns. Exercise abstinence not only puts you at risk for heart disease, high blood pressure and other chronic health problems, it leads to weight gain, obesity, fatigue, insomnia, and depression, all of which worsen the transition into menopause. Exercising as little as 30 minutes, three days a week can show immediate health benefits. Keeping track of your steps, aiming for 7,500 to 10,000 a day, will make you more accountable and successful in monitoring your daily activity. 

Weight bearing and muscle strengthening exercises build bone. Weigh bearing exercises are those exercises where your feet and legs support your body weight.  Low impact exercise such as fast walking, elliptical and stair stepping machines, not only build muscle and endurance but also build the amount and thickness of bone. High impact exercises include running/jogging, jumping rope and high intensity aerobics.  Strong muscles increase blood flow and sends key nutrients to help maintain healthy bone.

A diet focused on fresh fruits, vegetables, whole grains, and fish, with limited alcohol intake and little red meat (like the Mediterranean diet) not only benefits your heart, it improves cognitive function. The Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate and is proven to help menopausal symptoms. No downside there.

Eat 200-300 calories less a day to maintain your current weight.  Be mindful of eating a colorful, healthy, and well-balanced diet including fresh fruits, vegetables, whole grains, and fish.  If you must cut calories chose those with less nutritional value, such as fats and alcohol.  Eating a healthy diet will also have other health benefits such as reducing the risk of heart disease, stroke, diabetes, high blood pressure, high cholesterol and improve cognitive function.

 Limit alcohol consumption. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and, now we know (drum roll please), worsens hot flashes—and, by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise and depress many of you. It is recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate.

Sleep is necessary for everyone. In a perfect world, getting at least seven hours a night is ideal. Getting adequate amounts of sleep restores the body and improves energy levels.  Sleeping well improves mood, reduces mental stress, anxiety, depression, irritability, and brain fog. Quality sleep helps maintain a healthy weight and makes exercising much easier.

Create an over-50 support team—I am sure your close friends are going through the same frustrating challenges regarding unwanted weight gain.  Use your friends and family as a support team to make permanent healthy lifestyle and dietary choices that will promote healthy aging and defeat the battle of the budge.

2. What are some tips to help my libido during menopause?

In menopause, estrogen and testosterone levels plummet, negatively affecting your sexual desire, vulva, vagina, bladder, and clitoris, making sexual activity challenging. Estrogen plays a key role in women’s sexual function, maintaining the genital tissue sensitivity, elasticity, secretions, pH balance and microbiome flora, urinary continence, pelvic muscle tone and joint mobility. When you enter menopause and lose estrogen and testosterone, physical and mental changes occur, some symptoms faster than others. Pain with vaginal penetration, trouble having orgasms and inadequate vaginal lubrication are some of the reasons women’s sexual desire is decreased.

Over 60% of women will report losing their libido and 30% will stop having sex all together.  Women are being bombarded with physical and emotional symptoms that directly affect their mood in the bedroom. The truth is many women rather be doing laundry than having sex with their partner. 

Menopause is brutal for the sexual wellness of the 50-60 million dealing with this normal hormonal cycle. Using vaginal estrogen, vaginal dilators, a great lube helps with some of these disruptive symptoms caused by menopause. Even though testosterone is not FDA approved, it can help with sexual desire and arousal for some women. One of the FDA approved medications, Addyi, can also be used to help increase sexual desire for peri-menopausal women and possibly for those in menopause. 

Since there is less blood flow to the vulva and clitoris, orgasms can take longer to happen and may not feel as intense. Keeping the vulva and vagina moisturized is a step in the right direction. There is some truth to “if you don’t use it, you’ll lose it.” The more stimulation the vagina gets the more natural lubrication will occur, which is helpful to maintaining a healthy vagina. A vibrator is also a great way to improve sexual function, satisfaction, sexually related distress, and genital sensation…it’s a win-win in my opinion!

Give your vagina a voice so you can continue to have a healthy sexual relationship with yourself or a partner during perimenopause and menopause.

3. How can I navigate depression, brain fog, and fatigue? This is the first time I have experienced this in my life!

We always hear about hot flashes, night sweats, irregular periods and insomnia classically linked to menopause, but there are other symptoms, equally annoying but less talked about.  Menopausal symptoms occur as a result of low estrogen levels which can also cause a drop in serotonin and dopamine levels leading to cognitive changes including memory loss, poor concentration, brain fog and depression. Normal aging also contributes to memory and brain fog issues so the overlap makes these symptoms seem more pronounced.

Vyvanse and other ADHD medications can be helpful with menopausal symptoms related to staying focus, organized, managing time, improving concentration, forgetfulness, and memory, also known as “foggy brain”.  Even if you have not been officially diagnosed with ADHD in the past, menopause can throw you into an ADHD-like state. 

A woman’s natural estrogen supply is protective against developing depression.  Hormone replacement therapy can be helpful with some of these symptoms, especially if it is a new onset of depression. Menopause can worsen a woman’s depression or can bring out a depression a woman did not know she had. Talking to your healthcare provider or therapist can help you navigate these symptoms and consider starting a new antidepressant or increasing the dose of one that a woman is currently taking.

4. What are the treatment and supplement options for menopause symptoms?

Quality of life is everything. The severity and disruption of the menopausal symptoms will determine the type of treatment options. Treatment of menopausal symptoms is an individualized process and must be personalized for the disruptive symptoms.  

HORMONE REPLACEMENT THERAPY: Hormone replacement therapy (HRT) is most effective in treating disruptive hot flashes, insomnia or any menopausal symptoms negatively affecting a woman’s quality of life.  

Treating the symptoms of menopause is individualized and often based on personal philosophies for the various treatment options.  Doctors got it wrong in 2002 when the largest Women’s Health Initiative study, looking at HRT safety, was abruptly stopped when the risks appeared to outweigh the benefits. More than 20 years later, further studies show when HRT is started within 10 years of menopause or <60year, the risks are few and generally do not outweigh the benefits.   However, when HRT was started >60year, the reverse was true…the risks NOW outweigh the benefits. Dose and duration should be individualized and personal risk factors such as “the risk of venous thromboembolism, stroke, ischemic heart disease and breast cancer should guide use of HRT.  You may not be a candidate if you have any of these risk factors.

For low-risk women, HRT can safely reverse menopausal symptoms including hot flashes, sweating, insomnia, depression, anxiety, apprehensive feelings, fatigue, poor concentration, memory loss, vaginal dryness, and heart palpitations. It can also protect against bone loss. Those who should not take HRT include those with a personal history of breast, ovarian or endometrial cancer, a strong family history of breast cancer, a history of blood clots, stroke, heart disease, liver disease or untreated high blood pressure. Ideally, it is best to use HRT for the shortest amount of time at the lowest dose, under the guidance of a menopausal specialist.

ANTIDEPRESSANTS: Some antidepressants have been found to lessen menopausal symptoms including hot flashes, night sweats, mood swings, depression, and anxiety. Unfortunately, some of the side effects of antidepressants, such as low libido and weight gain, can discourage their use.  As long as the benefits outweigh the risks, it’s a viable treatment option worth exploring.

OTHER MEDICATIONS: Other medications include Gabapentin and Clonidine which are not FDA approved for menopausal symptoms but can help minimize hot flashes. Side effects of both include dizziness, headaches which drowsiness may feel more disruptive than hot flashes.

Genitourinary Syndrome of Menopause (GSM) causes vaginal dryness, irritation, pain, tissue thinning, burning, recurrent urinary tract infections, frequency, urgency, pain with penetration and difficulty achieving orgasm.

Vaginal estrogen is the most effective treatment for GSM. Prescription Ospermifene can also be used. Other over the counter vaginal moisturizers, hyaluronic acid, and lubricants can be effective if you are looking for more natural remedies. Non-FDA treatments include DHEA suppositories and Laser Therapy.

ALTERNATIVE TREATMENTS: Acupuncture and relaxation techniques including mindfulness, biofeedback, hypnosis, cognitive behavior therapy, yoga and Tai Chi may be helpful in controlling mood swings, depression, anxiety, hot flashes, and other mild symptoms of menopause.

There are many safe alternatives and supplements to use to treat common symptoms of menopause. You may be surprised to know that there are many scientific studies showing certain herbs to be helpful in managing the symptoms of menopause. Passionflower extract, L-Theanine, Chasteberry, Royal Jelly, Ashwagandha, Rhodiola, phytoestrogens, Ginseng, Black Cohosh, Evening Primrose oil, Hops, Lemon balm, Red Clover, Shatavari, Tribulus, Valerian, Wild Yam, Dong Quai root, St. John’s wort, Chromium, Fenugreek, Ginkgo Biloba Leaf Extract, Chamomile, Maca Root and CoQ10 are some of the better researched herbs shown to combat symptoms and improve your life. Although herbs are not FDA approved like pharmaceutical medications, well-regulated supplements can be as effective as, if not safer than, prescription medication.

CANNABIS: Despite up to 80% of peri-menopausal and menopausal women using medical marijuana to help alleviate common symptoms including hot flashes, mood swings and insomnia, there are no long-term medical studies to support benefits versus potential risks. Medical research often lags behind new treatment options for disruptive hormonal symptoms, yet use with caution until science can prove its safety.

5. Does the body react differently to certain foods and alcohol during this time? Foods that used to be okay are now causing me digestive issues. 

A healthy lifestyle goes a long way at any time in your life, but especially in this later chapter of life. Inactivity, unhealthy diet (fast food!), smoking, obesity, excessive alcohol consumption...if you are still waiting to remedy any of it, now is the time! All of these factors only make menopause worse than it needs to be. There are simple adjustments you can start to make as soon as you finish reading this.

•   A diet focused on fresh fruits, vegetables, whole grains, and fish, with limited alcohol intake and little red meat not only benefits your heart, it improves cognitive function. The Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate and is proven to help menopausal symptoms. No downside there.
•   Ditch the fast food, fast! The saturated fats and excessive sodium in fast food gives you no “value” whatsoever, in fact, depression is more common in those who eat fast food regularly. Within weeks of removing this food, you will show a decrease in cholesterol levels and even a decrease in weight gain.
•   Removing or decreasing “sweets” in your diet will not only limit your calorie intake; it will often reduce your intake of fat. A reduction of sugary foods will immediately reduce blood sugar, which will help in decreasing the bloating and water retention so common in menopausal women.
•   Limit alcohol consumption. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and, now we know, worsens hot flashes—and, by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise and depress many of you. It is recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate.
•   Stay hydrated. About 55% of adult, female bodies are made of water. A good goal is to never feel thirsty as thirst is your body’s way of telling you that you need more fluid. Dehydration requires your body to work harder to perform even the most basic functions which can lead to fatigue. Dehydration can also cause nausea and difficulty concentrating. Choose water or caffeine-free tea or coffee and avoid sugary or high calorie drinks.
•   Avoiding hot and alcoholic beverages and avoiding hot and spicy foods also helps prevents mild to moderate symptoms of menopause.

 Harmful lifestyle habits including smoking, inactivity, eating an unhealthy diet (including fast food!), obesity, excessive alcohol consumption and not sleeping well all contribute to making menopausal symptoms worse.