Maria and Oprah’s Discussion About Menopause Struck a Chord—So We Talked to Some of the Country’s Top Experts to Keep the Conversation Going

When Maria and Oprah sat down for an honest, unguarded conversation about what they call “The Big M”—menopause—no topic was off limits. From recognizing and treating the symptoms of perimenopause to understanding the specific health risks women who’ve reached menopause face, the duo (along with Drew Barrymore, Sharon Malone, MD, and Heather Hirsch, MD) answered questions for thousands of women everywhere.

Of course, they could only cover so much in the 45-minute chat (watch the exclusive clip from their conversation about new research regarding estrogen, menopause, and brain health here)—and we’ve heard from many of you who are grateful that menopause is finally getting its time in the spotlight and hungry for more information on the topic.

Which is why The Sunday Paper followed up with a handful of our go-to experts on The Big M. No matter where you are in the menopausal transition—or if you’re a man who wants to show up as a more knowledgeable, compassionate ally to the women in your life—read on. It’s time to radically reframe the way we think about menopause, which can only happen if all of us keep this conversation going.

The Expert: Lauren Streicher, MD, professor of Obstetrics and Gynecology at the Feinberg School of Medicine, Northwestern University, and author of Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat

“There are much higher levels of estrogen in the birth control pill than in Menopause Hormone Therapy (MHT).”

Ask many women in midlife what they think about taking MHT—a.k.a. hormone replacement therapy (HRT)—and there’s a good chance you’ll get a lot of heads shaking “no.” Hesitation around taking hormone therapy has persisted despite menopause experts trying to dispel many myths about MHT for years. Dr. Streicher is one of those experts. When she tries to assuage her patients’ fears about getting “so many hormones” in MHT, they’re shocked to find out the estrogen used in the pill (ethinyl estradiol) is 100 times more potent than the estradiol in MHT, says Dr. Streicher.

“I often prescribe low dose birth control pills to women in perimenopause, which can help to regulate their hormones and symptoms,” says Dr. Streicher. “Then, when it’s time to take those women off the pill at age 55 and transition to hormone therapy, they say, ‘Oh no! I don’t want to be on hormones!’ But what they don’t understand is that the estrogen in the Pill is far more potent than menopausal hormone therapy. When they learn this, they are floored.”

Yes, there are women who aren’t good candidates for hormone therapy, and timing is key when it comes to when you start (you should be younger than age 60, and within 10 years of your final period). “When patients ask me, ‘Would you go on hormone therapy?’ I say, ‘Of course I’m taking hormone therapy! I started with my first hot flash,’” says Dr. Streicher. “We all need to talk more about hormone therapy to normalize the topic.”

The Expert: Heather Hirsch, MD, founder of the Menopause & Midlife Clinic at Brigham and Women’s Hospital and author of the forthcoming Unlock Your Menopause Type Personalized Treatments, the Last Word on Hormones, and Remedies That Work

“Suffering through your symptoms doesn’t have to be part of the equation—and may actually lead to worse overall health.”

After appearing on the Oprah Daily conversation, Dr. Hirsch couldn’t believe how many women reached out with even more questions about perimenopause and menopause. “I got a lot of, ‘Oh my goodness, what a great conversation—when are you having another one to address weight gain, fatigue, mood issues, how hormonal shifts affect our bones and our hearts?’” says Dr. Hirsch. The feedback speaks to how much more education is needed about The Big M, she says, and how a growing number of women don’t want to suffer through this major hormonal transition.

“In fact, what I want more women to know is that we may do more harm to ourselves by suffering,” says Dr. Hirsch. “More perimenopause symptoms can be correlated with cardiovascular disease. We have compelling data to show the more sleep you lose, the shorter your life. Rather than taking an ‘I’m tough, I can stick it out’ mentality that society has engrained in women, I want you to speak up!

“Not only do you not have to suffer, but it might be better for your health if you don’t.”

The Expert: Mary Jane Minkin, MD, clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine

“Menopause is all in your head—specifically, your pituitary gland and your hypothalamus.”

When Dr. Minkin’s patients tell her that they’ve felt dismissed by other doctors, essentially told their telltale signs of perimenopause are “no big deal,” they were left feeling crazy—like their symptoms were all in their head. That’s when Dr. Minkin likes to give them a sassy, scientific comeback the next time they hear that: “The hormonal changes and symptoms you’re experiencing during perimenopause are happening in your head, specifically in your pituitary gland and your hypothalamus.”

When the ovaries start to downshift production during perimenopause—or, as Dr. Minkin likes to say, when they start to “poop out”—these brain regions essentially try to nudge the ovaries back into working. “They essentially say, ‘C’mon, you’re not making estrogen or progesterone, let’s get going!’ But your ovaries say, ‘Sorry, not gonna do it. We’re pooped,’” says Dr. Minkin. Sometimes this nudging works. Other times, it doesn’t. This helps to explain why your hormones can be totally erratic during perimenopause.

The good news is that once you officially hit menopause (when you’ve gone a full year with no periods), your hormones gradually stop fluctuating and your body adjusts to your new, lower levels of estrogen and progesterone. Translation: Symptoms tend to get a lot better.

The Expert: JoAnn Pinkerton, MD, professor of obstetrics and gynecology and the division director of Midlife Health at the University of Virginia Health System

“Finding the best treatment options for you should be individualized, which makes finding the right doctor very important.”

With so many symptoms that can surface and so many caveats to the treatment options available, it’s especially important to feel like your healthcare provider is a true partner during perimenopause and beyond, says Dr. Pinkerton.

“You want to make sure your provider listens to your history and symptoms and can give you an evidence-based approach to treatment options,” says Dr. Pinkerton. Unfortunately, menopause specialists can be tough to find. But it’s worth a try, considering many treatment options—especially hormonal ones—need to be individualized based on a patient’s age, stage of the menopausal transition, health history, and other factors, adds Dr. Pinkerton.

Professional organizations such as The North American Menopause Society (NAMS) and the International Menopause Society (IMS) maintain databases of healthcare providers who have this expertise, and you can use their online tools to plug in your zip code and find a specialist in your area.

The Expert: Heather Bartos, MD, an OB-GYN and menopause specialist in Frisco, Texas

“Menopause can be a freeing, beautiful time—especially if you go into it thinking it can be.”

Dr. Bartos is the first one to admit that the symptoms that strike most women going through perimenopause (hot flashes, heart palpitations, anxiety, extreme mood swings, the list goes on) are no picnic. “The hormonal hell so many women go through during perimenopause is like being in a raft riding down white-water rapids,” says Dr. Bartos. “But once you hit menopause, you’ve made your way down the canyon and you get to the lake, where it’s placid and beautiful. This makes it a great time to reassess and recalibrate.”

Are you as healthy as you’d like to be? Are you on target when it comes to your personal goals? Menopause is a time to actually pause—to take stock and make sure you’re where you want to be, says Dr. Bartos, adding that the Chinese term for menopause is “二春” (èr chūn), which translates to “second spring” or “second youth.”

“We need to start thinking of menopause like the Chinese do,” says Dr. Bartos. Consider the many ways this time in our lives is liberating. No more periods (the average woman has 450 periods over her lifetime if she hits menopause at age 51!) or worrying about birth control. No more PMS, cramps, or surprise cycles.

Any content published by The Sunday Paper is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. It should not be regarded as a substitute for professional guidance from your healthcare provider.

Question from the Editor: Did you watch Maria and Oprah’s conversation about The Big M? What are your lingering questions about this important topic?