Debunked! The 6 Most Popular Menopause Myths

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My favorite posts on Facebook are those where someone asks their followers for their opinion on which outfit to wear to a family event or their high school reunion. I love how everyone weighs in, and while they are opinionated, they are usually kind and supportive. (“Maybe go with the blue sheath instead of the peasant dress with puffed sleeves and cherries on the skirt. It looks incredible on you!”)

The posts that I struggle with are those in which someone asks for medical advice. The response is well-meaning, but the misinformation that is authoritatively given makes me a little crazy. Every once in a while, I weigh in, but it would be a full-time job to respond to every comment. This is especially true when it comes to information on menopause. As the author of many books on menopause and women’s sexual health, I feel compelled to debunk the myths that frequently pop up on social media, and with my patients, or that even your own doctor may have told you.

If you have had a blood clot, you can’t take hormone therapy.

It is true that oral estrogen slightly increases the risk of developing a blood clot and should be avoided by women who have developed a blood clot in the past. However, transdermal estrogens, which include patches, sprays, lotions and gels applied to the skin, do not increase the risk of blood clots. This includes women with a genetic predisposition to forming blood clots, such as those with a Factor V Leiden deficiency. A transdermal estrogen is preferable if there is a prior history of blood clots, a hereditary risk of blood clots, obesity, high blood pressure, diabetes, elevated cholesterol or triglycerides, liver disease, gallbladder disease, metabolic syndrome, smoking or if someone is starting hormone therapy after the age of 60.

Local vaginal estrogen, such as creams, rings, vaginal tablets and suppositories, which are prescribed to treat vaginal dryness, painful sex and urinary symptoms such as urgency and recurrent urinary tract infections, is a different story. Not one study has ever shown an increased risk of a blood clot from the use of local vaginal estrogen. There is no increased risk, and women with a history of blood clots can safely use those products.

Bioidentical estrogen is less likely to cause breast cancer than other forms of estrogen.

While bioidentical estrogen has some advantages over other forms of estrogen, when it comes to the reduction of breast cancer risk, bioidentical estrogen is not always the best.

Despite what your sister, friend, manicurist or even a doctor might have told you, we have known for over 20 years that women who take post menopause conjugated estrogens have a 21 percent reduction in breast cancer. If a woman is using estrogen and develops breast cancer, she is 40 percent less likely to die. In other words, estrogen is protective. But all estrogens are not the same. The specific form of estrogen with the dramatic decrease in breast cancer was conjugated estrogens, used by participants in the Women’s Health Initiative (WHI). Similar data for bio-identical estrogens does not exist. Furthermore, in a recent study, women with a new diagnosis of ductal carcinoma in situ were given conjugated estrogens for three to five weeks, and tumor activity decreased.

Hot flashes are harmless.

It’s not unusual for women to be told that hot flashes are temporary and it is best to just “tough them out. ” But advice such as "dress in layers'” and “carry a fan” is inappropriate, given the irrefutable evidence that persistent moderate to severe hot flashes are associated with serious medical conditions such as cardiovascular disease, osteoporosis and weight gain. Persistent insomnia in mid-life women, often as a direct result of night sweats, is associated with a 70 percent increased risk of a heart attack or stroke.

Hot flashes don’t just impact quality of life; hot flashes impact length of life. It is one of the many reasons that women who take estrogen post menopause have a 30 percent decreased risk of dying compared to women who do not take hormone therapy. Fortunately, there is an abundance of safe, effective hormonal and non-hormonal options to put out the fire.  

You have to stop hormone therapy after five years.

Women commonly are told by their doctors that “You should only take hormone therapy for a short time.” This arbitrary recommendation, although often found on otherwise credible websites, is not supported by science or data.

The fact is, most women can safely take hormones until death. In a study of 10,000 women who extended hormone therapy into their 60s, 70s or 80s, there was a 22 percent decrease in mortality, and a significant reduction in breast cancer, colon cancer, uterine cancer and lung cancer. The Menopause Society research states that “Hormone Therapy does not need to be discontinued in women aged 60 or 65 years."

Just to be clear, continuing hormone therapy after 60 is not the same as starting hormone therapy after 60.

Most bone is lost post menopause.

In the United States, there are 10 million women with osteoporosis. Most of these women have no idea they are at risk for a potentially life-changing or even fatal fracture until they undergo a screening bone density (DEXA scan) at the recommended age of 65. But here’s the thing: by that time, it’s often too late. The most rapid bone loss begins two years before menopause and continues for two to three years afterward before slowing down. Up to 20 percent of bone loss occurs during perimenopause and early postmenopause. But, if you are at high risk for osteoporosis due to a family history of osteoporosis, a history of fracture, alcohol use or smoking, your insurance may cover an earlier DEXA scan. Ditto certain medications or medical conditions, such as thyroid disease or diabetes. So, talk to your doctor and find a reason to get screened earlier!

Water-based vaginal lubricants are best.

Not all lubricants are the same, and some are far more vagina-friendly than others. Most women assume that a water-based lubricant is the safest, because … it’s water! Many doctors recommend water-based lubricants. The shelves of the drugstore are loaded with them. However, in addition to often being sticky and gloppy, popular water-based lubricants usually contain additives and preservatives that can cause irritation, tissue damage and dehydration. You read that right. Using the wrong lubricant can actually dry out your tissues more!

Your best bet is to use a silicone-based lubricant. Silicone-based lubricants are non-irritating, long-lasting and super slippery. Use it early and often.

What surprised you most about menopause? Let us know in the comments below.