PrimeCrush Hotflash: The 5 Things You Need to Know About Menopause By Dish Stanley

PrimeCrush Hotflash: The 5 Things You Need to Know About Menopause By Dish Stanley. From The New Pause Symposium co-hosted by The Swell & Stripe

Along with all the insight on menopause, and frankly, not at all inconsistent with it, were hundreds of women literally rebranding what it means to be us. They were smart, informed, hip, sexy women.

Last week I attended The New Pause Symposium in NYC co-hosted by The Swell and Naomi Watts’ new menopause wellness company, Stripes. It was a day of insights about menopause, with panels on everything from the status of research (critically overlooked and underfunded) to the medical establishment’s current understanding (continuing to emerge, at best) of how menopause impacts our bodies and lives, to sex after menopause (more intimate than ever, if that’s what you’re into, which readers of The Crush Letter know I am - more on that, including my one-on-one conversation with Emily Morse of Sex With Emily below).

A lot of camaraderie, optimism and laughter were dished out alongside the wisdom from leaders in the menopause field, but the alarming message, reiterated throughout the day, was that most women (and there are an estimated 64 million of us over 50)  are not getting the best advice out there on menopause from our medical practitioners. Worse than that, many of us are getting the worst advice, that is, advice in direct opposition with the latest studies and reports published by The Menopause Society, the leading resource on menopause for medical clinicians in the U.S. It was only formed by the way, in 1989. (Evidently women didn’t go through menopause before then.)

One of the things that prompted me to attend the symposium was this quote I had recently read about treating menopause from Philip M. Sarrel, professor emeritus of obstetrics, gynecology and reproductive services, and of psychiatry, at the Yale School of Medicine:

“Doctors are not helpful. They haven’t had training, and they’re not up to date.”

WTF? Scary.

The stats, according to AARP, are staggering: only 20% of ObGyn residencies in the U.S. offer menopause training, and half of ObGyn residencies felt they needed more education on menopause; 80% of graduating internal medicine residents felt incompetent to discuss or treat menopause. In contrast with the 64 million women in the US who are 50 or older, The Menopause Society had certified only 1300 practitioners as of a year ago.*

Despite those depressing facts, it was an uplifting, insightful and fun day, buzzing with the energy of forward movement and excitement over what is happening now. I felt as if I was in the hippest spot you could possibly be that Friday with the coolest people. Like I was at a resort in Tulum (circa the late 70’s when only the truly in-the-know knew) with women who were a mash-up of drop-dead serious, as well as smart, stylish and sexy. (I loved them all.) 

When all was said and done (including spicy margaritas, truth be told) though, there is critical information that needs to be further circulated to women, and everybody who loves us, more widely. Based on panels with leading experts in menopause, here are the most important insights you need to know:

1. Women need healthcare providers with specific training in menopause, who stay up-to-date with the expanding research. But it’s hard to find them.

It is shockingly difficult to find a medical practitioner who is educated on menopause. This is something I learned first-hand this year while searching for new doctors after a move. I hadn’t realized that my previous Primary Care Physician was such an aberration and, after a decade of informed care on my menopause symptoms, was utterly amazed to interview three separate PCP’s, all concierge doctors whose clientele were primarily women over 50, who cited what is now a widely debunked study on hormone therapy. “NEXT,” I thought after each one. Until I was in front of a PCP who at least owned her ignorance in what she referred to as a “developing area” and said, “But I will help you find an ObGyn who is up-to-date.”

Dr. Mary Clare Haver, an ObGyn who has published a nutritional and wellness lifestyle program for women in menopause called The Galveston Diet (which I have devoured), offers comprehensive information online around all aspects of menopause, including her Top Four Tips on Finding Topnotch Menopause Care. Most exciting, it includes a comparison chart for three new virtual providers of menopause care, Evernow, Alloy and MIDI, virtual options that may be the best route forward for any woman who does not live in a major urban area (or near a HerMD clinic, more on that below). I follow her Instagram account @drmaryclaire for help with all aspects of understanding menopause and have pre-ordered her upcoming book The New Menopause.

If you are lucky enough to live near one of its five locations, HerMD is a growing provider of comprehensive women’s healthcare that just announced that it closed an $18 million financing round to expand. If I lived near their offices I would sign up immediately, but I don’t so I follow HerMD on insta to stay on top of advances, such as EmpowerRF, a new technology to treat vaginal, vulvar and pelvic floor symptoms related to menopause.

2. Menopause is more than hot flashes, weight gain, vaginal dryness, fogginess and low libido. (As if that’s not bad enough!) Doctors are beginning to understand that the decline in estrogen, progesterone and testosterone that women experience from menopause is associated with a broad range of health issues, such as (but not limited to) heart disease, dementia, higher LDL (bad) cholesterol, osteoporosis, tinnitus and more. All of which should be considered distinctly for women through the lens of menopause (as compared to, for instance, men or non-menopausal women) in order to get the precise right care.  Menopause Matters lists 54 symptoms related to menopause.

Lower estrogen means lower bone density, which could mean bone fractures and osteoporosis, according to Dr. Vonda Wright, an orthopedic and mobility expert with an expertise in aging. “All musculoskeletal tissues have estrogen receptors, so it makes sense that menopause impacts your entire musculoskeletal system,” she says. Symptoms of menopause include loss of lean muscle mass, joint pain, rapidly progressing alzheimer’s, and according to Dr. Wright 80% of menopausal women will have musculoskeletal symptoms. For 25% of those, it will be devastating. You can find an excellent far-ranging conversation with Dr. Wright on A Certain Age podcast episode 153 hosted by the wonderful Katie Fogarty “You Aren’t Crazy. Menopause Causes Aches, Joint Pain and Impacts Your Musculoskeletal Health.” Among other things, Dr. Wright recommends a rigorous strength training program to keep muscles strong, and you can find information on her own weightlifting routine on her insta account here.

Doctor Lisa Mosconi, author of a new book The Menopause Brain, says that we need to adopt an outlook that menopause is “a complex journey marked by changes in our brains, as well as our bodies.” Estrogen is not just an “ovary thing,” she says, it is a “brain thing too.” Menopause affects the structure, function and chemistry of the brain. Regular physical activity fortifies the brain against diseases like Alzheimer’s, according to DR. Mosconi. Follow her here.

3. Every woman should consider vaginal estrogen, as well as Hormone Therapy (HT) (previously referred to as Hormone Replacement Therapy). 

Whether you ultimately decide to do either, for anyone experiencing hot flashes, sleep problems, low libido, vaginal dryness, fogginess or any of the other menopause-related symptoms, gaining an understanding of your potential for relief, as well as the actual associated risks, is worth a conversation with your ObGyn. HT that is appropriately tailored to you as a result of careful consideration with your ObGyn can greatly improve most menopause symptoms, including ones you are not aware of, such as osteoporosis.

“Vaginal estrogen and HT are separate therapies, do not address the same thing, and many doctors are flat-out wrong in their understanding of the risks,” according to Dr. Robin Noble, a practicing gynecologist on the Board of the nonprofit advocacy organization Let’s Talk Menopause. “These treatments are vastly under-utilized and many women are suffering needlessly,” said Noble. “Vaginal estrogen is appropriate for most women, and reduces vaginal dryness, redness and soreness, feeling an urge to urinate and pain during sexual intercourse.” Follow Dr. Noble here.

“There are so many exaggerated risks around hormone therapy,” according to menopause expert Dr. Heidi Snyder Flagg, founder of Spring ObGyn in NYC. “The risks of an adverse event for most women associated with hormone therapy if you take it for 10 years after your final period or up to 60 years old  is 1 in 1,000.” (You can hear it yourself from Dr. Flagg here.)

4. You’re probably not exercising enough, consuming enough protein, or doing enough strength training.

Peter Attia, author of the blockbuster book on longevity, Outlive, was interviewed by Co-Founder and CEO of The Swell Alisa Volkman, on what women most need to know on longevity. As readers of The Crush Letter know, Outlive has become a bible for me ever since a friend gave it to me in May, so I was on the edge of my seat for this conversation.

“The benefits of exercise outweigh everything else you can do - nutrition, diet, sleep, etc.,” said Attia. “And then, because of anabolic resistance as you age, you need much more protein than you think you do.” And strength training for a lot of things, including your bones.

In addition, Attia said, there’s an under-appreciated danger for people 50+ with taking the new diet drugs Ozempic, Mounjorno, etc., he said. “It’s malnourishment. It’s extremely difficult to get the amount of protein that’s critical for building longevity at this stage of life while taking these.”

5. Women can have the best sex of their lives as they age. And, we really (really) need to broaden our appreciation of what sex is. 

The climax (ahem) of the day for me was that it underscored the importance of continuing to think of ourselves as sexual as we age. As readers of The Crush Letter know, when I say “sex,” what I am really talking about is physical and emotional intimacy. Feeling close. Feeling safe. Feeling wanted. Laughing. Fumbling without embarrassment. I am talking about affection (actually, I talk a lot about affection - its importance as a through-line to loving as physical intimacy evolves with our bodies over time).

I was heartened and validated that The New Pause symposium included panels on the intersection of menopause and sex. And thrilled that the discussions of sex discussed it in its broader sense, and included topics we often cover here, such as lube (Everything’s Better Wetter (but check your lube ingredients!) and toys (our Crush Readers test and review sex toys for us as part of our PrimeCrush Sex Toy Project).

But a personal highlight was meeting Dr. Emily Morse, host of the podcast Sex With Emily. Dr. Morse (or Emily, as her followers call her) is a breath of fresh air, and she says “Older women rate high on sexual satisfaction for a reason: they know what they want.”

Our longstanding, recurring column AMPLIFY! The 12 Sex With Emily Episodes CRUSH Readers Should Get on Top of is a Reader favorite. Emily (as her fans call her) and I discussed our CRUSH series about her show, and she suggested further episodes — one on Sex + Life In Your 50s w/Dr. Wednesday Martin, another titled Best of: Orgasms & Oral (No Penetration Required), also Performance Anxiety & Performative Sex, and one with Esther Perel on Why Do Couples Stop Having Sex, as well as a couple on penis problems with urologist Dr. Edward Karpman (a written article that’s helpful is here). Also, just in, is an episode on How to Make Missionary Kinky. Highly relevant because according to our poll on Your Favorite Sex Position, it’s missionary. We will be expanding our AMPLIFY! column to include the above episodes.

Emily has a new book coming out Smart Sex, which you can order here. In the meantime, I want to encourage CRUSH Readers to ask Emily your own questions. Here’s how. Thanks Emily, we’re big fans!

And thank you to The Swell and Stripes, as well as all the other cool menopause warriors I met there, for an enlightening and exciting symposium. It was a day very well spent.

Here’s a list of the insta accounts of the menopause warriors mentioned in this article:

Dr. Mary Clare Haver - @drmaryclaire

Dr. Vonda Wright - @drvondawright

Lisa Mosconi - @dr_mosconi

Dr. Robin Noble - @robinbnoble

Dr. Heidi Snyder Flagg - @m_pause

Peter Attia - @peterattiamd

Dr. Emily Morse - @sexwithemily

If you’d like to support one of the nonprofits educating and advocating on behalf of women with menopause, check out these two:

Let’s Talk Menopause aims to empower women with the information they need to navigate menopause, and also advocates for the medical community to invest in additional education and better care for women through menopause.

In addition to the above, the National Menopause Foundation has announced a Women’s Midlife Health Policy Institute, which will engage policymakers on research and care initiatives. 

Both the National Menopause Foundation and Let’s Talk Menopause support the enactment of The Menopause Research and Equity Act of 2023 to bolster the study of menopause at the National Institutes of Health.

*According to the Cuyuna Regional Medical Center in Minnesota.

The Crush Letter
The Crush Letter is a weekly newsletter from Dish Stanley curating articles & intelligence on everything culture, love & connection for those over 45. Because midlife is a lot cooler than we thought it would be. If you’d like to take a look at some of our best stories go to Read Us. Want the Dish?

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