Picture this. It’s Friday night, and you’re finally ready for the sleep you’ve been craving all week. But at 2 am, you’re stricken awake by sudden flashes of heat, drenched in so much sweat you might as well be in the Amazon rainforest. The next day, your mood is swinging faster than a pendulum, and you’re about ready to fight whoever forgot to take the chicken out of the freezer. In all seriousness, this rollercoaster is what menopause can feel like for many women, and these are just a few of the symptoms.
Menopause can be a frustrating and difficult time for many women, from figuring out how to manage symptoms to understanding the changes their bodies are going through. That’s why we reached out to Dr. Soma Mandal, a board-certified internist, bestselling author, and OHOW advisory board member dedicated to transforming women’s health in midlife.
We asked Dr. Mandal some frequently asked questions about managing menopause symptoms and advocating for yourself throughout this journey. Keep reading for her expert advice.
HORMONE REPLACEMENT THERAPY
OHOW: What misconceptions do you most often encounter about Hormone Replacement Therapy (HRT)?
Dr. Mandal: One of the most common misconceptions I hear is fear of HRT stemming from a major 2002 Women’s Health Initiative study that was widely misunderstood. Many patients still believe HRT raises the risk of breast cancer and heart disease, when in fact the data is far more nuanced. For most healthy women under 60, or within 10 years of starting menopause, the benefits of hormone therapy- relief from hot flashes, improved sleep, bone protection, and better quality of life- often far outweigh the risks.
Another frequent misconception is that menopause symptoms simply have to be endured. In reality, there are effective, proven treatments available.
OHOW: How do you approach conversations with your patients about hormone replacement therapy (HRT)?
Dr. Mandal: I approach HRT conversations by first listening carefully to each patient’s individual symptoms, history, and concerns. I believe in shared decision-making and presenting the evidence clearly. Patients feel empowered to make informed choices rather than making decisions driven by fear.
LIFESTYLE CHANGES MAY HELP
OHOW: Are there non-hormonal strategies or lifestyle changes that can meaningfully improve menopause-related symptoms?
Dr. Mandal: Absolutely. Lifestyle changes can make a real difference. Regular aerobic exercise and strength training help reduce hot flashes, support bone density, improve mood, and promote better sleep.
A diet rich in calcium (dairy and leafy greens) and vitamin D (fatty fish) is important for bone health, while cutting back on alcohol, caffeine, and spicy foods can reduce hot flashes for some women.
Mind-body approaches such as cognitive behavioral therapy (CBT), mindfulness, and yoga have shown real benefit for mood changes, anxiety, and sleep problems.
For women who cannot or prefer not to use hormones, non-hormonal medication options such as certain antidepressants or the recently FDA-approved fezolinetant are also available and effective for hot flashes and night sweats.
LONG-TERM HEALTH CONSIDERATIONS IN MIDLIFE
OHOW: What are the long-term health considerations associated with menopause, such as bone health or cardiovascular risk?
Dr. Mandal: Menopause brings significant changes to a woman’s long-term health. The drop in estrogen speeds up bone loss, raising the risk of osteoporosis and fractures. This is why bone density screening and getting enough calcium and vitamin D become so important.
Heart disease risk also rises after menopause, since estrogen had offered some protection before. Cholesterol and blood pressure should be checked more closely. There is also growing evidence linking menopause to changes in brain health and a higher risk of depression.
Genitourinary syndrome of menopause (GSM) is another under-recognized but very treatable condition that affects quality of life. GSM causes vaginal dryness, urinary urgency, and frequent infections. Taking steps to protect your health during this transition can greatly reduce long-term problems.
OHOW: How should patients think about prevention and health maintenance during and after this transition?
Dr. Mandal: I encourage my patients to see the menopause transition as a chance to invest in their future health. This means staying current with recommended screenings, mammograms, colonoscopies, bone density scans (DEXA), and heart health checks. Building and maintaining muscle through strength training becomes especially important as metabolism changes.
Prioritizing sleep, managing stress, and maintaining a strong social support network are equally vital for overall well-being. I also stress the importance of ongoing conversations with your healthcare provider. Menopause is not a one-time conversation, it’s an evolving part of your care that needs regular check-ins and adjustments over time.
ADVOCATING FOR YOURSELF
OHOW: What advice would you give to someone who feels their symptoms are being dismissed or minimized by healthcare providers?
Dr. Mandal: My advice is to advocate for yourself and don’t give up. You deserve to be heard and to receive thorough care. If you feel dismissed, it is entirely appropriate and important to seek a second opinion or find a provider who specializes in menopause care. The Menopause Society (formerly NAMS) has a directory of certified menopause practitioners who can offer expert, evidence-based guidance.
Come to appointments prepared: keep a symptom diary, write down your questions, and don’t leave until you feel your concerns have been genuinely addressed. Bringing a trusted family member or friend for support can also help. You are not “just getting older”, your symptoms are real, they are treatable, and you deserve care that reflects that.
Dr. Mandal has written two books on menopause, Dear Menopause, I Do Not Fear You! And Midlife Masala. She also hosts a podcast called Soma Says on YouTube, where she interviews experts in women’s health, wellness, and midlife. You can find Dr. Mandal’s website and other resources below.
Resources
Find a Healthcare Practitioner- The Menopause Society
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