Eight Things Most Women Don’t Know About Menopause

By Gustav Lo, MD, Founder & Chief Medical Officer of RegenCen

Most women know menopause means the end of periods – but beyond that, misconceptions abound. Here are eight facts about menopause that even well informed women often don’t know:

1. Menopause isn’t something you get through – it’s permanent.

Once your ovaries stop producing estrogen and progesterone, they don’t restart. It’s a new hormonal baseline – and not a healthy one. How you manage that shift (and how we treat it) determines much of your long-term health, from bone strength to brain function to how you feel every day.

2. Hot flashes usually fade, but the silent effects don’t.

Most women’s hot flashes and night sweats improve over time, but the real consequences of that hormone vacuum are silent and progressive. Tissues and other components of the body that depend on estrogen – vaginal walls, bladder lining, skin, blood vessels, and even brain neurons – begin to weaken or shrink. This can lead to dryness, urinary urgency, skin thinning and sagging, and brain changes such as memory, mood, and processing speed. Because all those take time to develop, women often don’t connect those declines to menopause. They may think it’s just getting older, and even medical providers may be telling you this, too.

3. Menopause accelerates aging – literally.

Studies show biochemical aging markers shift rapidly in women at menopause. Women lose bone density, muscle mass, and blood vessel flexibility rapidly. We’ve recognized for decades that menopause is a critical inflection point for aging prevention. But now we have good medical evidence for treatment that actually works – safely.

4. Sleep and mood changes aren’t just stress.

Falling estrogen, testosterone, and progesterone disrupt neurotransmitters such as serotonin and GABA (gamma aminobutyric acid) – the very chemicals that regulate sleep and emotional balance. Many women are surprised to learn that their new-onset insomnia or anxiety isn’t psychological; it’s biochemical. Poor sleep is the second most common menopausal complaint behind hot flashes.

5. Weight gain after menopause isn’t just aging.

Women gain an average of 12 to 15 extra pounds within five years after menopause, and it happens without eating more or exercising less. Estrogen largely maintains the female figure, so when it’s gone, extra weight ends up in the tummy and wrapping around your sides – the menopausal belt. The extra belly fat isn’t just cosmetic; it’s unhealthy because it raises inflammation, insulin resistance, and cardiovascular risk. And if someone says 12 to 15 pounds isn’t too much, have them hang a bowling ball on their belt for a day!

Bonus knowledge: Research shows that combining hormone replacement with newer medication options are highly effective against losing stubborn menopausal weight and keeping it off.

6. Heart disease risk rises sharply after menopause.

Younger women are protected by estrogen’s vascular benefits – improved lipid profiles, vasodilation, and reduced inflammation. But within five to 10 years after menopause, all those benefits are lost, and women’s heart and stroke risk equals that of men. Hormone loss, not lifestyle, drives much of that shift.

7. Vaginal and bladder symptoms are medical, not minor.

Up to 80 percent of postmenopausal women develop vaginal dryness, painful intercourse, urinary urgency, or bladder leakage, yet few seek help. These symptoms come from thinning tissues and reduced blood flow and are easily treatable with hormone therapy. Left untreated, they only worsen with time.

Bonus knowledge: Vaginal estrogen is the one kind of estrogen therapy that breast cancer patients can take safely.

8. Hormone therapy is safer – and more beneficial – than most women realize.

Decades of confusion after the Women’s Health Initiative (WHI) studies, which began in 1991, have left many fearful of estrogen. But newer analyses show that for healthy women within 10 years of menopause, hormone therapy reduces risks of heart disease by 30 to 40 percent and reduces the risk of osteoporosis, Type 2 diabetes, and even deaths from any medical-related cause. Hormone therapy is not for everyone – but it is helpful for the vast majority of women, and it’s far safer than staying uninformed.

Bottom line: Menopause isn’t the end of womanhood, but it is a turning point. There are solutions for every single one of these conditions. But on average, women will see six different providers before finding one who will help. Choosing the right provider is critical.

Menopause care today should go far beyond hot-flash management. Major strides in treatment have occurred in just the past three years. Look for a provider who stays current with evolving research, offers individualized options (including hormone and non hormone therapies), and views midlife as the start of a new health chapter, not a decline. A Menopause Society Certified Practitioner is a great starting point.

Gustav Lo, MD, is the Chief Medical Officer of RegenCen, a regenerative and anti-aging medical clinic specializing in hormone replacement and longevity medicine. RegenCen is a Menopause Society Certified Practitioner and has multiple locations in Florida, including Lake Mary and Winter Park.