By Kathy Grega, APRN-CNP
Neighborhood Family Practice
For generations, women were expected to quietly “get through” menopause. Symptoms were minimized, treatment options were poorly explained, and many women were left wondering whether changes in their sleep, mood, memory or body were simply part of getting older.
That conversation is finally changing.
Menopause is reached after 12 consecutive months without a menstrual period, but the transition—called perimenopause—can begin years earlier. Because hormonal changes affect nearly every system in the body, symptoms can extend well beyond hot flashes.
Women may also experience:
- Sleep disruption
- Brain fog or difficulty concentrating
- Anxiety, irritability or mood changes
- Weight and body-composition changes
- Joint and muscle pain
- Vaginal dryness or painful sex
- Urinary urgency or recurring urinary tract infections
- Reduced sexual desire
These symptoms are real, treatable, and worth discussing with a health care professional.
Hormone therapy deserves an updated conversation
Hormone therapy remains the most effective treatment for hot flashes and night sweats. It can also help prevent bone loss.
For many healthy women who begin treatment before age 60 or within 10 years of menopause, the benefits may outweigh the risks. In 2026, the U.S. Food and Drug Administration approved updated labeling for several menopause hormone therapies, reflecting a more individualized understanding of their benefits and risks.
Hormone therapy is not appropriate for everyone. The decision should consider a woman’s age, years from last period, symptoms, whether she has a uterus and her personal and family history of breast cancer, blood clots, stroke and heart disease. The type and delivery method—such as a pill, patch or localized vaginal treatment—also matters.
The takeaway is not that every woman should use hormone therapy. It is that every woman deserves an informed conversation rather than an automatic yes or no.
Women have more nonhormonal options
Women who cannot or prefer not to use hormones also have options. There are several non-hormonal options to treat hot flashes.
Fezolinetant, for example, targets the brain pathway involved in regulating body temperature. It is FDA-approved for moderate to severe hot flashes. A provider will help determine if these are appropriate based upon health history.
Women should also be cautious with supplements and compounded “bioidentical” hormones. Natural does not automatically mean safe, and these products may lack reliable evidence or consistent dosing.
Vaginal and urinary symptoms are treatable
Declining estrogen can affect the vagina, vulva, bladder and urinary tract—a condition called genitourinary syndrome of menopause.
Symptoms may include dryness, burning, painful sex, urinary urgency or repeated urinary tract infections. Unlike hot flashes, these problems often continue or worsen without treatment. Low-dose estrogen can help the health of vaginal and urinary tract issues. Lubricants and moisturizers may also be helpful.
Focus on strength, not simply weight
Women gradually lose muscle and bone as they age, and menopause can accelerate that process. Muscle protects balance, mobility, metabolism, and independence, while bone loss increases the risk of fractures.
Walking is excellent for the heart, but healthy aging also requires strength and balance exercises. Adequate protein, calcium, and vitamin D may help, depending on a woman’s individual needs.
Treat menopause as a health checkpoint
Heart disease remains the leading cause of death among women. Midlife is an important time to review blood pressure, cholesterol, blood sugar, sleep, physical activity, bone health, and recommended cancer screenings.
There is no single menopause plan that is right for every woman. Good care begins with listening to and looking at the whole person.
Menopause may be natural, but suffering through it is not required. With better information and an individualized plan, women can use this transition to build a stronger, healthier next chapter.
Neighborhood Family Practice provides comprehensive, respectful care for women throughout every stage of life. If menopause symptoms are affecting your health or quality of life, schedule an appointment to discuss your concerns and treatment options.
