10 Questions to Ask Your Gynecologist About Menopause

Now more than ever, women are sharing their menopause experiences and exploring options to treat uncomfortable symptoms. Understanding what to expect and getting the support you need can make all the difference throughout your time in perimenopause and menopause.

For this reason, an open discussion with your gynecologist is a must, and knowing the right questions to ask will help you better navigate the transition.

You’ve reached menopause when you have 12 months without a period. On average, women go through menopause at age 52, says Karen Adams, MD, the director of the Stanford Program in Menopause & Healthy Aging in Stanford, California.

“Since perimenopause [typically] starts in the early forties, that would be a good time to start the discussion,” Dr. Adams says. She 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: Adams says that symptoms might also include:

• Mood disturbances
• Poor sleep
• Joint pain
• Weight gain
• Vaginal discomfort
• Vaginal pain with intercourse
• Sexual dysfunction

“Preexisting problems in these areas can mean that menopause will cause more symptoms for that woman, so being proactive is key,” she says.

Whether you’re curious about managing symptoms, exploring treatment options, or understanding how menopause affects your overall health, getting answers from your healthcare provider before menopause starts can help you feel more informed and empowered.

Here are 10 questions, and some background on what to expect during this time, to guide your conversation about menopause.

1. How Will I Know When I’m Starting Menopause?

Sometimes symptoms can be very subtle, but the menopause transition (which includes perimenopause) may start with changes to the menstrual cycle, says Traci Kurtzer, MD, medical director at Trauma Informed Solutions for Healthcare and a board-certified ob-gyn in Chicago.

“Those changes could be things like a decrease in the days between periods, or some might notice worsening premenstrual symptoms or premenstrual dysphoric disorder (PMDD),” says Dr. Kurtzer.

• Depressed mood
• Hopelessness
• Increased anxiety
• Mood swings
• Increased irritability

“If a person has had a hysterectomy, is taking something that suppresses periods like birth control pills, or has a hormonal IUD [intrauterine device], we don’t have the period to go by to tell us when you’re postmenopausal,” says Adams.

If you aren’t experiencing a period, you and your doctor will rely on symptoms of perimenopause and menopause to try to understand what’s happening, as most people experience similar symptoms.

“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. “[Labs] don’t tell us anything your symptoms aren’t already telling us,” says Adams.

2. Will I Have Hot Flashes? And What Helps?

“There are both hormonal and nonhormonal ways to manage hot flashes,” says Adams.

Estrogen will help reduce them in about three weeks and may also help with other common menopause symptoms, she says.

However, estrogen therapy isn’t for everyone. 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 shouldn’t take estrogen, 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 unwanted sexual side effects like decreased orgasm, says Adams.

3. Can Any Nondrug Lifestyle Changes Help With Hot Flashes?

There is some evidence that natural remedies for hot flashes, like lifestyle or behavioral changes, can help, says Adams. These interventions include:

• Four to six sessions of cognitive behavioral therapy have been shown to effectively reduce the number and severity of hot flashes.

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• Weight loss studies have shown 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.

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• Quit smoking and avoid alcohol use as these can make menopausal symptoms, like hot flashes, worse.

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4. How Will Menopause Affect My Sleep?

Although more women report having hot flashes than sleep disturbances, women tend to report being more bothered by the inability to get a good night’s sleep, 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.

Adams advises that other conditions, such as sleep apnea and restless legs syndrome (both more common in menopausal women), can also cause sleep problems, so you’ll want to rule those out.

5. Are There Solutions for Loss of Libido?

Low libido is complicated, and many factors can affect your sex drive, 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 for low libido involves getting to the source of the problem, which typically isn’t due to 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.

6. What Can I Do About Pain During Sex?

There are three steps to managing painful penetration in menopause, says Adams.

• Over-the-counter vaginal moisturizers: These can be used three times weekly to make the vagina more plump and moist.
• Lubricant with sexual activity: Adams maintains this 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: These can be a cream, tablet, suppository, or ring, can thicken the vaginal tissue, and may help you manage painful penetration.

Kurtzer suggests seeking out an expert in menopause and sexual dysfunction.

“If one is not getting support from their primary care physician or gynecologist to discuss their concerns, they can go to the International Society for the Study of Women’s Sexual Health or The Menopause Society websites to locate specialists who will be more likely and able to help,” she says.

7. Will I Need to Change My Diet to Keep From Gaining Weight?

It’s unfair but true: When women go through menopause and don’t adjust their diet and exercise routine, weight gain can occur, 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. A few days a week, it’s also a good idea to minimize your intake of animal products such as meat, eggs, and dairy and focus on whole, plant-based foods where possible.

8. Can Hormone Therapy Help With Menopause Symptoms Beyond Hot Flashes?

“Estrogen therapy provides other benefits by treating other menopausal symptoms like poor sleep, low mood, and vaginal pain with penetration. Plus estrogen improves bone strength, making osteoporosis less likely,” says Adams.

“Pursuing menopausal hormone therapy is a personal decision based on a discussion we each should have with our doctor. They have an in-depth knowledge of our health history and offer advice based on our needs,” says Kurtzer.

That being said, Kurtzer advises that women going through the menopause transition shouldn’t fear or demonize hormone therapy, as has happened over the past 20 years. “For many, many women, hormone therapy has been a lifesaver that helped them through a difficult transition period,” says Kurtzer.

9. Should I Take Supplements During or After Menopause?

You generally don’t 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 Take 1,000 to 2,000 IU per day, because we absorb less from the sun as we age.
• Calcium Intake should be 1,200 milligrams (mg) per day, but no more than 500 mg from supplements, because amounts above that tend to deposit in the heart.

“Otherwise it’s best to ‘eat the rainbow’ and get your fiber, minerals, and anti-inflammatory compounds through your diet,” she says.

10. 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.

Additionally, this new guidance allows for self-collected vaginal specimens that take place privately in a clinic or at home, without a healthcare provider present, to serve as HPV testing as part of screening for cervical cancer.

Periodic examinations are still important for checking on other body parts, like the breast, vulva, vagina, uterus, and ovaries, that can develop conditions, says Kurtzer.

The Menopause Society

The Menopause Society offers evidence-based information on menopause, including symptoms, treatments, and lifestyle tips. This organization also has a directory to help you find healthcare providers specializing in menopause.

Women’s Health Network

Women’s Health Network focuses on various women’s health issues, including menopause. This organization offers articles, resources, and information on managing symptoms.

American College of Obstetricians & Gynecologists (ACOG)

ACOG provides up-to-date information about menopause, including what to expect and treatment options.

Let’s Talk Menopause

Let's Talk Menopause is a national nonprofit that 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 your gynecologist should help tailor treatment to your needs.
• Regular screenings like Pap tests and pelvic exams remain important after menopause — consult your doctor for tailored recommendations based on your health history.