If you are among the many women who are taking the “grin-and-bear-it” approach to managing your menopause symptoms, you may be suffering needlessly. We know that menopause can feel down right daunting, but it doesn’t have to be that way. 

We recently spoke to a few of Gennev’s physicians (who are menopause specialists) for their responses to common questions and concerns that women raise within their practices.  You’ll notice much of their advice points back to “speaking with your doctor”.  That’s because menopause is a very individual experience, and as such, there is no one-size-fits-all remedy or treatment.  Having a comprehensive discussion with a menopause specialist about the symptoms you are experiencing can help uncover the treatments and therapies that will help you find relief, and start thriving again at this stage of life. 

Here are 6 tips for managing symptoms as shared by Gennev physicians who are menopause specialists.    

For better sleep, treat the symptoms that are keeping you awake

“That may mean hormone therapy for some who have bad night time flashes,” says Dr. Rebecca Dunsmoor-Su. “For others we often recommend cognitive behavioral therapy for insomnia.” Cognitive behavioral therapy is a style of therapy that identifies negative behaviors, and works to manage them in a more effective way. Cognitive behavioral therapy for insomnia very specifically tracks behaviors around sleep, such as when you go to bed, what you do when you wake in the middle of the night, what things you include in your bedtime ritual, as well as what you do when you wake in the morning. Ultimately the therapy will work to adjust those habits to improve your sleep.

Be careful about turning to sleep aids. “Sleeping pills are a temporary aid, and generally not the long-term solution,” says Dr. Dunsmoor-Su. Instead, try working with a Gennev health coach to optimize your wellness (nutrition, movement, mindfulness) and identify lifestyle modifications (such as a new sleep ritual) that will support better sleep.

Treat the cause of painful sex, not just the symptom

Painful sex can be a real problem with perimenopause and menopause. While there are a number of causes (including acute conditions, which require a physical exam to diagnose), much of midlife pain with sex is due to declining estrogen levels resulting in vulva and vaginal changes. The tissues become dry, thin and fragile over time. Dr. Lisa Savage shared, “This condition is called genitourinary syndrome of menopause or GSM. It is generally progressive; meaning, it gets worse over time. This dry, fragile tissue is inelastic and prone to infection and injury. Pain with penetration can be prohibitive not only because of the tissue condition, but also because of the development of vaginismus, which is an anticipatory, involuntary muscle contraction. Vaginismus makes penetration even more painful, thus a vicious cycle happens.”

While using lube for painful sex is critical and recommended, treating the cause and not just the symptoms is important. “To restore and maintain the tissue integrity, a menopause specialist will recommend systemic or vaginal estrogen,” shares Dr. Savage. “Plenty of patients need both, but in some cases, just one or the other is sufficient. Vaginal estrogen is not absorbed to any significant degree, so it is safe in almost everyone and can be used indefinitely.”

Even with estrogen therapy, lube is usually needed. Silicone-based lubricants tend to work better in mid-life, but couples should try out different kinds and find out what works best for them. And sometimes, a multi-pronged approach, including vaginal estrogen, lubricant and pelvic floor therapy may be necessary to fully restore a woman’s sexual function and enjoyment.

“On the enjoyment note, many women present with a primary complaint of low desire/low interest and when questioned further, they have pain,” shares Dr. Savage. “So, I ask… who would be interested in something that is painful? Our first priority when exploring a complaint of diminished interest in sex is acknowledging and treating pain. Only then can the rest of the multiple facets of desire be assessed and addressed.” “If you have pain with sex, don’t accept it as a new normal. Don’t grit your teeth and power through, sacrificing your own enjoyment,” says Dr. Savage. “Don’t minimize its effect on your interest in sex and don’t hesitate to get help. In almost all cases, it can be entirely remedied. Your sex life is important, and it can be better than ever in mid-life, so reclaim it.”

Get to the bottom of why you wake up to pee

We all know how annoying it is to wake up in the middle of the night to urinate. It can be difficult to fall asleep again after a trip to the bathroom. According to Dr. Carol Russell, “To decrease the chances this will happen try to limit your fluid intake at least 2 hours before going to bed. Do not have any caffeinated beverages 2-3 hours before bed as caffeine is irritating to the bladder and can cause an urge to void, even when your bladder is not really that full. Also, be sure to empty your bladder right before you lie down to sleep.”

It's time to see your doctor when frequent urination (and possibly bladder leaks) is impacting your sleep and your life. They will rule out any underlying conditions that may be a factor (like diabetes), and can recommend medications, hormones, biofeedback, or devices that may prove helpful. They may even suggest you visit with a pelvic floor specialist to help strengthen muscles and retrain your bladder.  

Bleeding post menopause?  Go see your doctor

If you are post menopausal (a year or more has passed since your last menstrual period), seeing blood can be scary.  According to Cleveland Clinic, bleeding could be a symptom of vaginal dryness, polyps (noncancerous growths) or other changes in your reproductive system. In about 10% of women, bleeding after menopause is a sign of uterine cancer. 

“Bleeding post menopause always requires a visit with your doctor to create a personal plan,” says Dr. Leasa Lowy. “We bleed for lots of reasons that are not scary but require some management. However, most importantly we want to make sure it is not an issue that needs more in-depth exploring such as cancer.” So, if you bleed post menopause, it is very important to connect with you doctor.

Approaching menopause?  Take vitamin D

Supplements can be a great, and necessary part of a woman’s life. But which ones should you take? And where should you get them? Dr. Wendy Ellis shared, “There are some nutrients, like vitamin D, which should be taken by all women as they approach menopause. Other nutrients, like B vitamins or CoQ10 – may be diminished by medications we take (birth control pills, statin medications, etc.). We may also take supplements if we are feeling under the weather and want to kick our immune systems into gear (think Vitamin C or zinc).”

Whether to take them or not is determined by where you live (think vitamin D in colder climates / northern latitudes), your age, and your medical history. Supplements can be an amazing addition to lifestyle choices for optimal health, but we can also take too many supplements – or take supplements that might interfere with our medications – so it’s important to check in with your doctor to determine what’s right for you.

How do you know of your supplement is good quality? Dr. Ellis tells us, “To determine if a product is a good one – you can look for the cGMP stamp. This is a certification of good manufacturing policy – which means that a third party has tested the product and ensures its quality and content is as listed on the label."

Positive lifestyle changes will help support your body in menopause

To help you feel your best, don’t discount how much making some meaningful lifestyle changes can help. Things like drinking more water to help combat fatigue, dry skin and dry eyes, as well as headaches, and taking a 15 minute walk every day to help lower stress and lift your mood are small changes that can make a big difference. “Adopting a healthy diet, getting adequate exercise each day, and maintaining social connections can go a long way towards feeling your best,” says Dr. Savage. If you need some help in adopting a healthier lifestyle, Gennev health coaches will create a personalized wellness plan for you to help with nutrition, movement, mindfulness, and provide some support and a level of accountability along the way.

No matter what symptoms you may experience in menopause, don’t put off getting the support that will help make this transition easier on your physical and emotional health. A 30-minute appointment with a menopause specialist can provide the advice and treatment options you need to take control of your menopause journey.  


The information on the Gennev site is never meant to replace the care of a qualified medical professional.  Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.


Ann Marie MacDougall

March 29, 2022

Medically Reviewed By

Dr. Lisa Savage

Board-Certified Obstetrician & Gynecologist

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