As an obstetrician-gynecologist who specializes in menopause, Dr. Lisa Savage hears all sorts of questions related to the menopause journey, and what one may expect to experience both physically and emotionally.  Read on as Dr. Savage shares with us the top ten questions she is asked about menopause, along with her answers.   

When does menopause start and does it end?

The definition of menopause is a year without a period at an appropriate age, although it is generally preceded by months to years of menstrual cycle changes and other symptoms during perimenopause. Perimenopause symptoms can start in a woman’s late 30’s as the ovaries’ output of the hormones estrogen and progesterone starts to become variable and decline. The average age of full menopause is 51. Everything after the cessation of periods is called post-menopause. Symptoms such as hot flashes are usually worst during the transition time and do tend to taper off as time goes by.

Why is my sleep so disrupted at this stage of life?

Perimenopause and menopause can lead to major sleep disruption, not only from night sweats, but from a change in the architecture or stages of sleep. Sleep disruption can play a role in the “downstream” symptoms of menopause such as brain fog and irritability.

What about weight gain in menopause?

Why have I gained weight and what can I do to manage it? Mid-section weight gain is common and is partly an adaptation to the loss of estrogen from the ovaries, since estrogen can be “made” (converted from other hormones) in fat tissue. Sleep disturbance can also contribute to metabolic changes and weight gain. An examination of your nutrition habits is a must… since what worked before may no longer work… and a commitment to physical activity/exercise is more important now than ever.

Has menopause made me sad? Irritable? Moody? Anxious? Angry?

Mood issues can be exacerbated or appear for the first time during the menopause transition. The varying and decreasing levels of estrogen affect brain chemistry at the same time the brain is becoming less sensitive to estrogen. Also, social, professional and inter-personal roles may be at a crossroads during this stage of life. This confluence can lead to a variety of mood issues, which can be addressed in the context of what is contributing to them.

Where did my interest in sex go and how can I get it back?

Sexual interest in women is multi-factorial, and hormones are just one part of it. During perimenopause and beyond, decreasing estrogen levels can cause physical changes in the genitals, with less lubrication and thinner, more fragile tissue, which can lead to pain. Pain chases away desire, of course. The good news is that these physical changes can be remedied in several ways, most effectively by the use of vaginal estrogen. Once pain is relieved, the other aspects of desire can be addressed.  During the reproductive years, when you are still ovulating, the hormonal waves and cycles that occur can contribute to more interest at certain times. I call this “Mother Nature’s call to reproduce.” During those years, you might have more spontaneous desire than during mid-life, when you are no longer ovulating, and receptive desire may play a bigger role in your sex life. Desire, however, can be either spontaneous or receptive at any stage; all women are different. The good news is that are ways to re-kindle and support your interest in sex.

What is HRT and how can it help my menopause symptoms?

HRT is “hormone replacement therapy”. If started during the transition timeframe/within a few years of menopause, it can treat symptoms as well as have some long-term benefits, including bone, cognitive and heart health. Gennev physicians have the expertise to help patients weigh their options and are available for telemedicine appointments.

Doesn’t hormone therapy cause cancer?

The short answer is no, although a woman’s individual and family history must be taken into account. There is not one-size-fits-all regimen. Not all women need HRT and not all women can use it or wish to use it.  As with any medication, risk can be related to dosage and duration of use. In many women, the short and long-term benefits far outweigh any potential risk.

What does “bioidentical” mean and are bioidentical products better for me?

The term bioidentical takes us back to chemistry class. If a hormonal therapy is molecularly/structurally just like what your ovaries make, it’s considered bioidentical. There are conventional, FDA-approved products that happen to be bioidentical, but this does not mean they are safer or more effective than products that are not bioidentical. This term is sometimes confused or conflated with “compounded”, which means it’s made at the pharmacy according to a certain recipe. Compounded products are not FDA-approved and can be inconsistent in dosing and absorption, which is why we at Gennev don’t prescribe them. A product can be compounded AND bioidentical…or not. For the most part, these two terms are used in marketing, and are not interchangeable.

What are some non-medical ways to feel better during the menopause transition?

Lifestyle modifications such as a healthy diet, adequate exercise and social connections can go a long way towards feeling your best. Practical considerations such as dressing in layers and avoiding any identifiable hot flash triggers are also helpful. At Gennev, our health coaches can address these issues and offer support along the way.

I feel alone because nobody ever talks about menopause.  

Sister, you are not alone! Every woman will go through menopause and many of your peers/friends/co-workers can relate. At Gennev our mission is to support you in your experience, whether it’s physical, emotional, social or professional. We are an online clinic and resource, ready to make you part of an educated and empowered community of women. Welcome to our tribe! 

Speak to a Gennev board-certified physician to get your questions about menopause answered, and connect with other women just like you in our private community on Facebook to share experiences and offer support to one another.


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.



Gennev Staff

January 10, 2022

Medically Reviewed By

Dr. Lisa Savage

Board-Certified Obstetrician & Gynecologist

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