10 Questions to Ask Your Gynecologist About Menopause
Menopause can be a confusing time. Here's what to ask your doctor about symptoms like hot flashes and sexual changes, as well as treatments such as hormone therapy.
Finally, menopause is getting the attention it deserves. Now more than ever, women are sharing their experiences and exploring options to treat bothersome symptoms. Knowing what to expect and getting the support you need can make all the difference in the years you spend in perimenopause and menopause.
That’s why an open discussion with your gynecologist is a must, and if you know the right questions to ask you'll have a better time navigating the transition.
When to Talk to Your Doctor About Menopause
On average, women go through menopause at age 52, says Karen Adams, MD, the director of the Stanford Program in Menopause and Healthy Aging in Stanford, California.
“Since perimenopause [typically] starts in the early forties, that would be a good time to start the discussion,” she says.
Perimenopause is the transitional period that happens before menopause, when estrogen levels start to go down and some menopause symptoms such as hot flashes and irregular periods may begin.
Dr. Adams suggests seeking out providers with specific expertise in menopause.
“Unfortunately a lot of docs aren’t well versed in menopause, and patients may be told ‘It’s not hormones.’ Look on The Menopause Society website for a list of certified menopause practitioners in your area,” she says.
Menopause symptoms can be more than hot flashes: They can include mood disturbances, poor sleep, joint pain, weight gain, vaginal discomfort, vaginal pain with intercourse, and sexual dysfunction, says Adams.
“Preexisting problems in these areas can mean that menopause will be more symptomatic for that woman, so being proactive is key,” she says.
But you don’t have to wait until you have symptoms to start asking questions, says Adams.
Questions to Bring Up With Your Doctor About Menopause
Whether you're curious about managing symptoms, exploring treatment options, or understanding how menopause affects your overall health, asking questions — and getting answers — can help you feel more informed and empowered.
Here are 10 questions to guide your conversation about menopause.
How Will I Know When I’m Starting Menopause?
Sometimes symptoms can be very subtle, but the menopause transition (which includes perimenopause) may start off with changes to the menstrual cycle, says Traci Kurtzer, MD, a gynecologist at Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago.
“Those changes could be things like a decrease in the days between periods, or some might notice worsening premenstrual symptoms (PMS) or premenstrual dysphoric disorder (PMDD),” says Dr. Kurtzer.
Symptoms of PMDD start during the week before menstruation and end within a few days after your period starts. Common symptoms include depressed mood, hopelessness, increased anxiety, mood swings, and increased irritability.
"If a person has had a hysterectomy, is taking something that suppresses periods like birth control pills, or has a hormonal IUD, we don’t have the period to go by to tell us when you’re postmenopausal," adds Adams.
“In those cases we use symptoms to tell us what’s happening. Around 80 percent of people get hot flashes, up to 70 percent get mood disturbance, 60 percent get sleep disturbance, and 50 percent get joint pain or vaginal dryness, so we look for those symptoms,” she says.
Typically, labs aren’t used to determine what’s happening because in perimenopause hormone levels are so irregular, “they don’t tell us anything that your symptoms aren’t already telling us,” notes Adams.
Will I Have Hot Flashes? And What Helps?
Given that about 4 out of 5 women experience hot flashes at some point during menopause, chances are you will have them.
“There are both hormonal and nonhormonal ways to manage hot flashes,” says Adams.
Estrogen will take them away in about three weeks and may also help with other common menopause symptoms, she says.
The people who should not take estrogen are people with breast cancer or endometrial cancer, people with liver or gallbladder disease, people with unexplained vaginal bleeding, people who are pregnant, people who’ve had a heart attack or a stroke, and people who’ve had a blood clot in their legs, lungs, or brain, says Adams.
“Nonhormonal options are drugs like fezolinetant (Veozah), a once-a-day pill that blocks the neurons in the brain that trigger hot flashes. Another drug that works well is gabapentin, which we typically prescribe to take at night because it can be helpful for sleep,” she says.
Antidepressants can be used to treat hot flashes, but they often come with some unfortunate sexual side effects like decreased orgasm, says Adams.
Can Any Non-Drug Lifestyle Changes Help With Hot Flashes?
There is some evidence that lifestyle interventions or changes in behavior can help with hot flashes, says Adams. These interventions include:
Cognitive Behavioral Therapy (CBT) Four to six sessions of CBT have been shown to effectively reduce the number and severity of hot flashes.
Weight Loss Studies have shown that women with obesity are more likely to report more frequent and severe hot flashes than women who are at a healthy weight. Weight loss is also linked with a decrease in hot flashes and night sweats.
How Will Menopause Affect My Sleep?
Although more women report having hot flashes, women tend to report being more bothered by sleep disturbances than by hot flashes, says Adams.
“Treating night sweats can help with sleep, so estrogen can help, and progesterone also helps, since its side effect is drowsiness. The best treatment for sleep disturbance after managing night sweats is cognitive behavioral therapy for insomnia,” says Adams.
Sleep issues may also be caused by other conditions, such as sleep apnea and restless legs syndrome (both more common in menopausal women), so you’ll want to rule those out, she says.
Are There Solutions for Loss of Libido?
Low libido is complicated, and many factors are involved, says Adams.
“It can be related to medical issues, medications people are on, pain with sex, decreased arousal or orgasm, partners’ sexual issues, relationship issues, drugs or alcohol, stress, or fatigue,” she says.
Treatment of low libido involves getting to the source of the problem and typically isn’t due to just menopause alone. Drugs to treat low libido, like flibanserin (Addyi) or testosterone, generally have low efficacy and don’t work as well as behavioral approaches, says Adams.
What Can I Do About Pain During Sex?
Between 13 and 84 percent of menopausal women experience pain during sex, but experts believe the condition is rarely evaluated or treated.
There are three steps to managing painful penetration in menopause, says Adams.
Over-the-counter vaginal moisturizers can be used three times weekly to make the vagina more plump and moist.
Lubricant with sexual activity is important. “Water-based lube should be used with latex condoms or silicone vibrators, but otherwise, coconut oil is my favorite lubricant. It’s cheap, smells great, and promotes a healthy vaginal microbiome,” says Adams.
Prescription topical estrogen products, which can be a cream, tablet, suppository, or ring, can thicken the vaginal tissue and cure painful penetration.
Kurtzer suggests seeking out an expert in menopause and sexual dysfunction.
Will I Need to Change My Diet to Keep From Gaining Weight?
It’s unfair but true: when women go through menopause and they eat the same and exercise the same, they gain weight, says Adams.
“This is because metabolic changes that happen in menopause tend to slow our metabolism, marble our muscle with fat, and cause weight to settle around the midsection,” she says.
Adams suggests adopting a whole-food, plant-based diet to maintain a healthy weight.
Half your plate should be fruits and veggies, a quarter whole grains, and a quarter beans, peas, and legumes.
Minimize animal products such as meat, eggs, and dairy, and try to go whole-food, plant-based, or both a few days a week.
Can Hormone Therapy Help With Menopause Symptoms Beyond Hot Flashes?
“Estrogen also gives other benefits by treating other menopausal symptoms like poor sleep, low mood, and vaginal pain with penetration. Plus estrogen improves bones, making osteoporosis less likely,” says Adams.
“Menopausal hormone therapy is an individualized decision based on a discussion we each should have with our doctor, who knows our health history best,” says Kurtzer.
That being said, women going through the menopause transition should know that hormone therapy does not need to be feared or demonized as it has been over the past 20 years, she says.
“For many, many women, hormone therapy has been a lifesaver that helped them through a difficult transition period,” says Kurtzer.
Should I Take Supplements During or After Menopause?
There’s generally no need to take a lot of supplements during menopause, says Adams. While individuals should talk to their doctor before taking any supplements, she recommends the following:
Vitamin D, 1,000–2,000 IU per day, because we absorb it less from the sun as we age.
Calcium should be a total of 1,200 mg per day, but no more than 500 mg in a supplement because more than that will tend to deposit in the heart.
Glucosamine chondroitin can help with joint pain if that’s a problem.
“Otherwise it’s best to ‘eat the rainbow’; and get your fiber and minerals and anti-inflammatory compounds through your diet,” she says.
Will I Still Need to Get Regular Pap Tests During and After Menopause?
Guidelines for preventive screening tests, like a Pap smear for early detection of cervical cancer, don’t necessarily change as soon as someone goes through menopause, but they can change somewhat over time, says Kurtzer.
“There are some recommended adjustments to screening tests based on age, with Pap smears not required for some individuals over 65 years of age, if they are considered low risk with a history of regular screening before,” she explains.
Periodic pelvic examinations are still important for checking on the other body parts (breast, vulva, vagina, uterus, ovaries) that can develop conditions, says Kurtzer.
Other Ways to Get Support During Menopause
Knowing what to expect and feeling supported can make a big difference in your menopause journey.
In addition to your provider, there are great online resources to educate yourself about menopause.
This organization offers evidence-based information on menopause, including symptoms, treatments, and lifestyle tips. They also have a directory to find healthcare providers specializing in menopause.
This national nonprofit aims to change the conversation around menopause so that women can get the information they need and the healthcare they deserve.
The Takeaway
Start discussing menopause with your gynecologist in your early forties to better navigate symptoms and treatment options during perimenopause and menopause.
Both hormonal and nonhormonal treatments may help manage menopause symptoms, including lifestyle changes, cognitive behavioral therapy, and medications like fezolinetant and gabapentin.
Hormone therapy can alleviate various menopause symptoms beyond hot flashes, including mood disturbances, sleep issues, and vaginal pain, and should be individualized with your gynecologist.
Regular screenings like Pap tests and pelvic exams remain important after menopause — consult your doctor for tailored recommendations based on your health history.
Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.
She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.
Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.
When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.
Becky Upham has been professionally involved in health and wellness for almost 20 years. She's been a race director, a recruiter for Team in Training for the Leukemia & Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.
She majored in English at the University of North Carolina and has a master's in English writing from Hollins University.
Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.
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