With insights from Dr. Elizabeth Gaida, OB/GYN at Door County Medical Center

As women reach their 40s and 50s, many begin noticing subtle and sometimes not-so-subtle body changes. These changes are often part of a natural life transition: menopause. Yet, despite being a common experience, menopause remains under-discussed, under-researched, and often misunderstood.

In honor of Women's Health Month, we sat down with Dr. Elizabeth Gaida, OB/GYN at Door County Medical Center (DCMC), to discuss what happens during menopause, how to navigate it, and why it's time we all started talking about it more openly.

What is Menopause, and Why Does it Happen?

Females go through menopause when the ovaries stop routinely developing a follicle and a mature egg each month."The cells in the follicle are what secrete estrogen and progesterone," explained Dr. Gaida. "Once a follicle stops forming, estrogen and progesterone production drop off, and that's when symptoms start."

These hormonal changes can lead to a range of physical and emotional symptoms. "Lack of estrogen in particular is what causes a lot of the menopause symptoms," Dr. Gaida said.

The most common and familiar symptoms include night sweats, sleep disturbances, hot flashes, and mood changes; however, joint pain, brain fog, and the loss of skeletal muscle and bone density are also indicators of loss of estrogen.

Over time, lower estrogen levels also affect vaginal, vulvar, and urinary health, a cluster of symptoms known as Genitourinary Syndrome of Menopause (GSM). These can include pain with sex, urinary urgency, and vulvar skin changes.

Although low progesterone levels generally do not cause symptoms directly, they can lead to sleep disturbances, particularly during the perimenopausal phase, which usually begins in a woman's early to mid-40s. What are the initial indicators of perimenopause? "Irregular periods, mood swings, and sleep problems. These are signs that ovulation isn't happening consistently anymore."

While fertility gradually declines during perimenopause and menopause, pregnancy remains possible as long as a period is experienced. A person is deemed post-menopausal after 12 consecutive months without a period.

Distinguishing Menopause from Other Health Issues

Since the body produces over 50 different hormones, pinpointing what's causing your symptoms isn't always straightforward. Dr. Gaida's advice: Track your symptoms in a notebook or on your phone and schedule a visit with a trusted physician. "These conversations are best in person and take time. These appointments are specific to your concern, not a standard well-woman exam."

She reiterates the importance of advocating for yourself. "If you don't feel heard, it's okay to seek a second opinion. You deserve care that makes you feel supported."

3 Common Misconceptions About Menopause

Misconception #1: More labs are better. Extensive lab panels recommended by some cash-based wellness clinics can be costly and do not result in improved diagnoses or outcomes.

Misconception #2: Birth control pills are bad for menopause. Combination hormonal contraceptives (CHC), which include both estrogen and progestin (a synthetic version of the hormone progesterone), can be very beneficial for women during the perimenopausal transition. CHCs offer contraception as well as menstrual regulation, which traditional post-menopausal hormone replacement therapy does not provide.

Misconception #3: Estrogen is dangerous. Transdermal estradiol is safe for most women and offers numerous health benefits, including maintaining bone density and skeletal muscle.

Navigating Symptoms

As the saying goes, the only way out is through. Dr. Gaida recommends a lifestyle-focused approach to manage symptoms.

• Exercise with resistance and balance training to maintain muscle and bone health. "Cardio is good for your heart, but maintaining muscle mass and bone density and reducing fall risk as we age is more important."

• Eat fewer hyper-processed meals. Choose a more plant-forward, whole-food diet with lots of fresh produce and healthy fats.

• Avoid alcohol, caffeine, and nicotine to reduce hot flashes. Yes, even wine!

• Stay hydrated with at least 80 oz of water per day.

• Prioritize sleep: 7–8 hours a night, with no screens two hours before bed.

• Practice mindfulness through daily meditation.

• Connect with a community of women going through the same experience.

And most importantly? "Talk to your doctor. We're here to help."

New Treatments to Know About

Dr. Gaida is excited about recent advancements in menopause care. "Fezolinetant (Veozah) is a brand new, non-hormonal medication approved by the FDA to treat hot flashes," she says. "We also have more options for transdermal estradiol, like patches, sprays, and gels, with improving insurance coverage."

• Progestin IUDs like Mirena or Liletta are increasingly used to protect the uterus in women using estrogen therapy.
• Vaginal estrogen is one of the safest therapies available and can significantly reduce postmenopausal urinary tract infections. "Most women can use it long-term with minimal risk."

That said, she stressed the need for continued research: "We need more studies on how treatments affect women differently than men. We also need a commercially available topical testosterone for women experiencing low libido due to menopause."

Start the Conversation

What does Dr. Gaida wish more people knew about menopause?

"That it's natural, but it can also be miserable, and that there are safe, effective treatments available," she said. "The more we talk about it, the more supported women will feel."

Menopause is universal, but your experience is personal. From the first signs of perimenopause to the years that follow, you deserve care that meets your needs.

To learn more or schedule a personalized consultation with Dr. Gaida or another member of our women's health team, call Door County Medical Center at (920) 743-5566.

Information Is Power

Stop going down the internet rabbit hole. To prepare for menopause, Dr. Gaida recommends relying on evidence-based, peer-reviewed sources. She suggests skipping social media and promotes the following resources:

• The Menopause Society: Formerly known as the North American Menopause Society.

• The Vajenda: The Vajenda blog by Dr. Jen Gunter. Further reading by Dr. Gunter: The Menopause Manifesto.

• Gennev: Menopause telehealth platform.

• Rosy: Evidence-based sexual health information.

• www.isswsh.org: International Society for the Study of Women's Sexual Health.

• www.acog.org/womens-health: The American College of Obstetricians and Gynecologists.