Expert Q&A: What You Need to Know About Menopause Now

Suzanne Gilberg-Lenz, MD, a board-certified obstetrician-gynecologist, is on a mission: To help us get us comfortable talking about menopause. The author of Menopause Bootcamp: Optimize Your Health, Empower Your Self, and Flourish as You Age, Dr. Suzanne also recently opened The Pelvic Health Initiative at her Los Angeles practice. Here, she talks to Origin about why menopause is “puberty in midlife,” how celebrities (and Gen X) are changing the conversation about it, and what she wishes every woman knew about their pelvic health.

We spend so much Money & effort trying not to get accidentally pregnant — How is the end of fertility not seen as a positive thing in our culture?

Dr. Suzanne: Well, that's a great question…I think it’s a combination of misogyny and ageism. It's a deadly duo.

That's one of the reasons that I not only support people with practical information, but assist them in saying the word [“menopause”] out loud. Because when we silence it, when we accept the narrative that it's the end, that we're no longer viable, that we're invisible, that we're dried up, all this bullshit that we're fed, we're participating in that. We actually do have a choice to reject that and celebrate our own narrative.

You said you think the way we view menopause is starting to change. What was the inflection point for that?

A lot of celebrities are in the 45 to 60 category and I think they’re fed up. I do think that #MeToo…opened up a lot of behind the scenes conversations that people were already having.

A lot of the women now who are being loud and proud about [menopause] are women of my generation, Gen X… I think there's something about our generation that's unique…We do our own thing…And I think we're like, “Excuse me, no.. We're going to do it our way.“

Part of my mission is I want people to enter into [menopause] with preparation and not with fear. Fear and anxiety are no way to approach anything, let alone a major physiologic developmental stage. We've certainly got work to do…We don't talk about menopause, but menopause is not a disease. I call it the puberty of midlife.

Which menopause changes or symptoms tend to take people by surprise?

My top two would be burning mouth and frozen shoulder.

Dry skin in general starts to happen, but dry mouth and burning mouth are definitely a phenomenon we see a lot of. And also joint pain and muscle aches. Those are ones that people don't always identify.

What new promising treatments for menopause symptoms are you most excited about?

What I'm most excited about is that the conversation is opening up. People are starting to really understand that it’s not “one size fits all” and that what works for your friend is not necessarily going to be the best thing for you. And what works for you now in six months or eight months may have to change.

If we start to reframe [menopause] as just the next phase of our lives and here's the toolkit and here are the people who are trained to partner with you on that journey, then I think we're much better off.

We always hear that menopause leaves you “dried up” with dry skin and a dry vagina. Are we all really destined to lose all of our moisture after age 50? Can you help us separate the myths from the truth?

Estrogen receptors exist in pretty much every cell in your body. You’ve got estrogen receptors in the lining of your blood vessels, which is why we have a change in our heart disease profile and risks as we get older and we go into menopause. We have them in our brain. And we have them in our vaginal tissue and in our urinary tract. Yes, estrogen has an impact on skin and particularly collagen production and elastin production. So the combination of loss of collagen and elastin and gravity has an impact.

But to view it as “drying up” — that's also part of that narrative of “drying up and blowing away.” Sure we do have dryness. Also, you don't have to experience that! There are things you can do…Menopausal hormone therapy…vaginal estrogen… There are also tons of products out there, whether they're lotions, hyaluronic acid, personal moisturizers, beauty products…

The market for menopause products is ballooning. Which ones are worth it?

For dryness specifically, Revaree and Luvena, which contain hyaluronic acid, are really good. They’re not the same as lube. [These products] basically bring moisture into the [vaginal area] and help you retain it.

When [vaginal tissue] is thinner and drier, you can have pain and get infections. So [moisture] really is beneficial for maintaining health and comfort.

I’m a medical advisor for a company called Kindra, which also makes a lot of really nice products for dryness. Their vaginal lotion is pH balanced and doesn't have harsh chemicals, petrol products, or parabens. They also make a nice body wash.

Tell us about the Pelvic Health Initiative you've created at Women's Healthcare of Beverly Hills.

We evaluate for problems like incontinence, sexual and overall pelvic pain or dysfunction, vaginal and urinary dryness, or so-called “GSM” – genitourinary syndrome of menopause. Then, we address these problems in a comprehensive manner by diagnosing specifically and correctly, and creating a unique treatment or management plan.

What inspired you to focus more on pelvic floor dysfunction?

Pelvic health is an area that has been largely under-explored. When it comes to incontinence and sexual dysfunction, women take 6+ years to even bring it up in the doctor's office. They're ashamed or they don't think there's anything they can do about it.

We refer to Origin for pelvic floor PT, sex therapists, nutritionists and dieticians, fitness trainers and coaches, and mental health therapists. We also have doctors in our practice who specialize in surgeries that address pain and incontinence. Just as we do in our general OB/GYN practice, we take the entire person into account to create holistic solutions that can evolve over time as the patient’s need does.

We brought some devices into the office and… people really appreciated it because they already knew us and felt safe with us…So we just built it out. It's like ‘If you build it, they will come.’ It's been really exciting.

What do you wish every perimenopausal woman knew about their pelvic floor?

I wish they came into this phase with some awareness. Most of us don’t even know our own anatomy, let alone how critical this part is! They should know 1) that it’s a structure that supports the pelvic and abdominal cavity contents and is part of the elusive “core.” 2) It can be weak and contribute to incontinence, both urinary and fecal. 3) It can be too tight and cause pelvic or sexual pain. 4) There are ways to help these issues!