Navigating Menopause: The Questions Your Doctor Should Be Answering

Written by Jen Scheinman, MS, RDN, CDN

Jen Schienman, MS, RDN, CDN is a seasoned Registered Dietitian Nutritionist with over 20 years of experience in nutrition and wellness. She holds a master’s degree in Integrative and Functional Nutrition and has advanced training in hormone balance from the Institute of Functional Medicine. As an expert in women’s health, menopause, and longevity, Jen is dedicated to helping midlife women navigate hormonal changes, optimize their well-being, and build a foundation for a vibrant, healthy future. A sought-after speaker, writer, and media expert, Jen is on a mission to redefine what it means to age well.

Learn more about Jen at NextJenHealth.com and follow along at https://www.instagram.com/jenscheinman_nutrition/

 

 

Menopause is a hot topic these days, and not just because of the hot flashes and night sweats. Everyone from doctors to celebrities to your favorite social media influencers seems to be talking about this hormonal transition.

And while it’s great that menopause is finally getting the attention it deserves, all the chatter can sometimes leave women feeling more confused than empowered—especially when they turn to their healthcare providers for answers and come away frustrated and feeling unheard.

The truth is most doctors aren’t trained well in menopause management. Even your gynecologist may only have a few hours of dedicated menopause education during their entire medical training. In fact, a 2019 survey found that only 20% of OB-GYN residency programs offer any formal menopause education at all.

That’s why it’s crucial to come to your doctor’s appointment prepared with the right questions to make sure you get the care and support you need. And if your doctor doesn’t have the answers, perhaps it’s time to find a menopause specialist.

This guide is designed for women in midlife experiencing natural menopause. However, some women may enter menopause earlier due to medical conditions or the surgical removal of their ovaries. If you’ve gone through early or surgical menopause, your healthcare needs may be different, so it’s important to have a conversation with your doctor to ensure your care is tailored to your specific situation.

 

 

Here are five essential conversation starters and some key questions to ask your doctor about natural menopause.

1. How Do I Know If I’m in Menopause?

First, let’s understand the difference between perimenopause and menopause. While the terms are often used interchangeably, menopause is actually one day in your life. It’s the day that you have gone 12 full months without a period. After that, you are postmenopausal.

Perimenopause, on the other hand, is the time leading up to menopause, when hormones begin to fluctuate and decline. This phase can last anywhere from a few years to over a decade and is often marked by irregular periods, hot flashes, sleep disturbances, mood changes, and other symptoms as the body adjusts to lower estrogen levels.

It’s not easy to pinpoint precisely when perimenopause begins. Some women start noticing changes in their late 30s or early 40s, while others may not experience significant symptoms until their mid-to-late 40s.

Ask your doctor:

• Are there tests that confirm if I’m in perimenopause or menopause?
• How can I tell if my symptoms are related to menopause or another health issue?
• What changes should I expect in my menstrual cycle before it fully stops?

While blood tests measuring hormone levels can provide some insight, they aren’t always reliable because hormone levels fluctuate daily. Instead, tracking your symptoms and menstrual cycle patterns can be one of the best ways to determine where you are in the menopause transition. If you’re unsure, discussing your symptoms with your doctor can help provide clarity and guide you toward the best strategies for managing this phase of life.

 

2. What Symptoms Can I Expect During Perimenopause?

Depending on who you ask, perimenopause symptoms can range from a handful to well over 100. The reason for this wide variation? Estrogen, a key hormone in women’s bodies, does far more than regulate reproduction. It influences everything from brain function and bone health to heart health and metabolism. As estrogen levels fluctuate and decline during perimenopause, a cascade of symptoms can follow, affecting nearly every system in the body.

 

Statistically, certain symptoms are more commonly reported during perimenopause:​

• Hot flashes and night sweats: Approximately 75% of women experience hot flashes, characterized by sudden feelings of warmth and sweating.
• Sleep disturbances: Anywhere from 16-47% of women complain of sleep disturbances during perimenopause.
• Mood changes: About 40% of women experience mood symptoms during perimenopause, including irritability, low energy, and mood swings. Depression and anxiety are also serious concerns during this time, as hormonal fluctuations can impact emotional well-being.
• Vaginal dryness and bladder problems: As estrogen levels decline, vaginal tissues may lose lubrication and elasticity, leading to discomfort during intercourse and increased susceptibility to urinary or vaginal infections.
• Cognitive changes: Many women report experiencing brain fog and problems with memory and focus during perimenopause.
• Weight gain & metabolic changes: Midsection weight gain, changes in blood sugar and cholesterol levels, despite no change in diet and exercise routine, are commonly seen during this time.

However, many of these symptoms are not exclusive to perimenopause and can be linked to other health conditions. Because of this overlap, tracking your symptoms and having an open conversation with your healthcare provider is essential.

Ask Your Doctor:

• Are my symptoms typical for perimenopause, or could they be related to another health condition?
• When should I be concerned about a particular symptom? At what point should I consider treatment?
• Are there any tests I should consider to rule out other conditions that may mimic menopause symptoms?

Every woman’s journey to menopause is unique. You may experience all, some, or none of the symptoms listed above, but keeping track of your symptoms and discussing them candidly with your healthcare team can help you find relief and the right treatment options for your specific needs.

 

3. Should I Consider Hormone Replacement Therapy?

Hormone Replacement Therapy (HRT) has been a topic of debate for decades. Once widely prescribed for menopause symptom relief, its reputation took a hit after the Women’s Health Initiative (WHI) study in the early 2000s linked it to increased risks of breast cancer, heart disease, and stroke. However, more recent research has identified several limitations to the WHI, which helped clarify the risks and benefits, showing that for many women, HRT is a safe and effective option when used appropriately.

HRT primarily works by replenishing estrogen (and often progesterone and even testosterone) to help manage symptoms of perimenopause. Newer data suggest that there may be benefits to HRT not just for symptom management but for preventive health as well.

The decision to use HRT is highly individual and depends on factors such as age, medical history, symptom severity, and personal preferences. It’s not a one-size-fits-all solution and is a personal choice based on how you feel today, your health risks, and your long-term health goals. However, it can be one of the most effective treatments for menopause symptoms when prescribed appropriately.

There’s a lot of noise, confusion, and conflicting opinions when it comes to HRT—especially around bioidentical, compounded, and prescription options. Each has its own considerations, and it’s important to have a provider who can clearly explain the differences and help you make an informed decision. Finding a trusted doctor who creates a supportive, judgment-free environment is key so you feel comfortable asking all your questions and discussing what’s best for YOU and your individual needs.

Ask Your Doctor:

• Am I a good candidate for HRT based on my medical history and symptoms?
• When is the right time to start HRT?
• What are the risks and benefits of HRT for me personally?
• Which hormones do you typically replace, and why?
• What types of HRT are available (pills, patches, creams, pellets, compounded), and which might be best for me?
• How do you determine the right dose for me?
• What side effects can I expect?
• How long can I safely stay on HRT?

 

If your doctor is hesitant to discuss HRT, uses a one-size-fits-all approach, or dismisses your symptoms without exploring options, consider seeking out a menopause specialist who is well-versed in the latest research. Making an informed decision about HRT can help you manage menopause more comfortably and protect your long-term health.

 

4. What Are My Non-HRT Options for Managing Menopause?

While HRT is an effective option for managing menopause symptoms, it’s not the right choice for everyone. Whether you’re unable to take hormones due to medical reasons or simply prefer a different approach, there are many non-hormonal strategies that can help you navigate this transition.

Several non-hormonal prescription medications are available to manage symptoms, and certain dietary supplements and herbal remedies have been used with varying degrees of success.

And, even if you choose HRT, lifestyle factors play a critical role in how well you move through this stage of life and set yourself up for healthy aging. Unfortunately, this is a time when your body no longer bounces back from poor choices as easily as it once did. In your younger years, you may have been able to get away with less sleep, a processed diet, or skipping workouts—but now, those habits can have a much greater impact on your energy, metabolism, and overall well-being. Prioritizing the right lifestyle choices can make all the difference in how you feel today and in the years to come.

Ask Your Doctor:

• What non-hormonal options are available for managing my symptoms?
• Should I be considering dietary supplements and herbs? Which ones? How do I choose safe and effective brands?
• What dietary changes should I be making?
• What type of exercise should I get, and how much exercise should I get?
• Can you recommend a dietitian, health coach, or other professional who can guide and support me with lifestyle changes?

 

5. How Does Menopause Impact My Overall Health?

Menopause isn’t just about losing your reproductive capabilities or dealing with symptoms like hot flashes and mood swings. It marks a significant shift in long-term health risks. Before menopause, estrogen plays a protective role in the body, supporting everything from heart health to bone strength and metabolism. But as estrogen declines, nearly every system in the body is affected, increasing the risk of chronic conditions such as metabolic disorders, muscle loss, osteoporosis, heart disease, and even cognitive decline.

Understanding these risks and taking a proactive approach with lifestyle changes and routine screenings can help protect your health for decades to come.

Your doctor should use this time to discuss the changes you might expect and how they can impact your overall health. For example, you may have always had perfect cholesterol levels, only to find that they suddenly shift into unhealthy ranges. Similarly, your blood sugar, bone density, or muscle mass may begin to decline, even if your lifestyle habits haven’t changed. Recognizing these shifts early gives you the opportunity to take preventive steps, whether through diet, exercise, or medical interventions, to help maintain your health and vitality in the years ahead.

Ask Your Doctor:

• What changes to my health status can I expect to see during this time?
• What screening tests should I be getting, and how often?
• How do my nutritional needs change at this stage of life?
• What can I do to protect my heart, bones, and brain health as I age?
• Are there specific lifestyle changes that can help lower my risk of chronic disease?

Menopause is a key time to reassess your health and take action. By staying informed, proactive, and working with a healthcare provider who understands menopause, you can take control of this phase and set yourself up for a healthier, stronger future.

 

 

Final Thoughts: Finding the Right Menopause Care

Navigating menopause can feel overwhelming, especially when many healthcare providers lack the training to properly address your concerns. But you don’t have to settle for feeling unheard or dismissed. Being informed and proactive in your healthcare is the first step toward getting the support you deserve.

If your doctor isn’t answering your questions or exploring all available options, it may be time to seek out a menopause specialist. The Menopause Society (NAMS) offers a Menopause Practitioner Directory where you can search for certified providers who specialize in menopause care, or you can seek out functional medicine doctors or women’s health-focused dietitians and coaches. Of course,  nothing beats a personal referral from friends, family or a trusted healthcare professional.

Before your next doctor’s appointment, take a few minutes to write down your top menopause concerns. Use this guide to form your questions, and know that if your provider isn’t giving you the support you need, there are plenty who will.