February 11, 2025
“Menopause is inevitable,” says Mary Claire Haver, MD. “100% of us, if we're lucky to live long enough, will lose the function of our ovaries.”
Dr. Haver, author of The New Menopause, appeared on The University of Kansas Health System’s Morning Medical Update to talk about menopause and the new MINT program at the health system.
What is menopause?
Menopause medically is defined as 1 year exactly to the day after your final menstrual period.
Mary Claire Haver, MD:
Menopause medically is defined as one year exactly to the day after your last final menstrual period. And so, everything before that is pre menopause or perimenopause, and the transition, and everything after that until we die is post menopause. So actual menopause is really just one day.
What are the symptoms of perimenopause and menopause?
Menopause can affect every organ system of the body. However, vasomotor symptoms such as hot flashes and night sweats are considered hallmarks, since not many other health issues cause them.
Other common symptoms are:
- Brain fog or memory issues
- Dizziness
- Gastrointestinal changes
- Heart palpitations
- Joint pain
- Sleep disturbances
- Skin, hair and nail changes
- Vaginal concerns, such as dryness, itching or painful intercourse
- Vision changes
- Weight gain
Carrie Wieneke, MD, clinical services chief of obstetrics and gynecology at The University of Kansas Health System, explains why menopause symptoms can be so widespread.
Carrie L. Wieneke, MD:
There's really estrogen receptors everywhere in our body, almost. So, when that changes, then everything that has an estrogen receptor is going to change as well.
How long do symptoms last?
Dr. Haver says white women tend to have 7 years of menopausal or vasomotor symptoms on average. However, African American women could have symptoms for 8 to 11 years.
It’s also important to know that while symptoms may improve, the effects of menopause and the severity of your symptoms can have long-term effects on your health.
Mary Claire Haver, MD:
Menopause is always going to affect your bones for the rest of your life. Menopause is always going to affect your brain, your general urinary system. The more cliche symptoms do tend to eventually end like the hot flashes. So, we're not sure we need a lot more study as to why do different ethnicities, different weight, different body types, different background and upbringing, have these differing, you know, symptomatology. And to be clear, hot flashes are a bell ringer. You know, women who have severe hot flashes have more serious cardiovascular disease, higher risk of stroke, more incidents of diabetes. So, it's not just annoying. They're incredibly annoying because I had them. But it's also, you know, a bell ringer for chronic disease.
Dr. Haver says this is a much bigger conversation.
“Women are less healthy than men after menopause,” she says. “We are having poor outcomes overall, poor quality of life, more nursing home admissions, higher cognition deficits and much higher frailty risk. We know menopause is kind of a starting point, but we need to talk about how we age healthier.”
At what age should you expect to go through menopause?
There’s no specific age range for onset of perimenopause. While the average age for menopause is 51.1 and most are through menopause by 55, Dr. Haver says we all go through menopause at different ages.
What should you do if you think you’re experiencing menopause symptoms?
Track your symptoms. Dr. Haver has trackers available in her book and on her website, but any method is fine to document your symptoms. Note dates and duration as well. It’s important to continue tracking even if you start treatments for the symptoms, so you can gauge how effective they are.
What are common treatments for menopause symptoms?
Treatment will largely depend on your specific symptoms and their severity. There are hormone treatments and medications to address libido changes. But most women benefit from lifestyle changes.
Dr. Haver says that perimenopause and menopause cause an increase in inflammation. So even with no changes in diet or exercise, women can expect to have an increase in their visceral fat – which is found around the organs. Visceral fat is biologically more active and more inflammatory. It is also linked to hypertension, diabetes and stroke.
One of the best ways to address that is by changing your nutrition. A specific change is to eat at least 25 grams of fiber per day.
Mary Claire Haver, MD:
So we know, looking at the data on the menopausal women who were studied, women who have diets higher in fiber, so 25 grams or more daily fiber per day, and most of that fiber should, if not all, should, come from food. They've looked at African American women and cognition scores and fiber intake, the benefits seem to max out for women around 32 to 35 grams per day. So we really, most women, are getting 10 to 12 grams in the Western diet. So we have, you know, a lot of things we can do there, which is increasing fiber intake, watching your added sugars. Sugars have gotten a bad rap through the Keto movement, but sugars found in natural foods, fruits and vegetables and dairy actually is wrapped up with so many other nutrients, protein, anthocyans, vitamins, minerals and fiber. You negate, you blunt the effects of the rise of sugar in your bloodstream, so your insulin levels are lower. So women who limit those added sugars, sugars added in cooking and processing and alcohol to less than 25 grams a day, tend to have less visceral fat.
Does more body fat cause more menopause symptoms?
No, says Dr. Haver. More body fat does not lead to more menopause symptoms, although that is a common myth.
“There's a lot of misconception that estrogen is stored in fat, or estrogen is created in fat. Fat cells do help convert some of the precursors to estrone, which is a very weak estrogen,” says Dr. Haver. “We're getting very technical, but that is a social media fallacy. And I don't want people to think that maintaining an unhealthy body fat is going to ease your symptoms, because there's no data to support that.”
What are bioidentical hormones?
About 22 years ago, researchers with the Woman's Health Initiative (WHI) warned that hormone therapy caused breast cancer which isn’t entirely true.
“That data has been reanalyzed, de-aggregated, looked at based on age, and it turns out the estrogen only arm saw a decreased risk in breast cancer,” says Dr. Haver. “But it really has perpetuated through press, through media, through medical teaching, and it stopped really most meaningful studies around aging women and hormones until now.”
Now physicians have the option to prescribe bioidentical hormones. These are chemically identical to the hormones your body would normally make.
"The majority of people are safe to take it," says Madhuri Reddy, MD. "I think the legacy of the WHI still lives on in some of the physicians who are not dealing with menopause all the time. We need to let patients know this is a safe option."
Hormone therapy can be delivered in a pill, patch, spray, gel and more.
Is there anything that puts you at risk for early menopause?
Yes. Dr. Haver says that women who have had a hysterectomy can expect to go through menopause 4 years sooner.
“Because of the disruption of blood flow to the ovaries that come from the uterus when we do a traditional hysterectomy, you're going to lose 4 years off the life of your ovaries,” she says.
Anything that causes additional inflammation is also likely to induce earlier menopause, such as smoking, radiation therapy and autoimmune disease.
What is the MINT clinic?
The University of Kansas Health System’s obstetrics and gynecology team has launched its Menopause, INtimacy and midlife Transition (MINT) program. This is a care program focused on meeting the healthcare needs of perimenopausal and menopausal patients. The MINT doctors have taken specialized training and earned certifications from the Menopause Society.
“Suffering through it (menopause) is not inevitable,” says Dr. Haver. “Find a provider, find a clinician who's educated, who can help you through this journey. There's only a few centers across the US, and there's one right here in Kansas. It’s pretty incredible that you've done that.”
New patients will be seen via telehealth to begin.
We offer a variety of appointment types. Learn more or call 913-588-1227 to schedule now.