Dr. JoAnn Manson: Menopause myths, misconceptions, and facts
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Many people who go through menopause don’t know much about it, or may have misconceptions.
On June 17, 2025, SciLine interviewed: Dr. JoAnn Manson, a professor of medicine and women’s health at Harvard Medical School. See the footage and transcript from the interview below, or select ‘Contents’ on the left to skip to specific questions.
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Introduction
[0:00:19]
JOANN MANSON: Hello, I’m Dr. JoAnn Manson, I’m professor of medicine at Harvard Medical School and chief of the division of Preventive Medicine at Brigham and Women’s Hospital. I’m trained as an endocrinologist, and I do research primarily on women’s health, menopausal medicine, prevention of cardiovascular disease, and chronic disease.
Interview with SciLine
What is menopause?
[0:00:49]
JOANN MANSON: So, menopause is a natural phase of life when menstrual periods stop. That’s what the word means. It’s usually diagnosed when there have been no menstrual periods for about 12 months. The average age of menopause—at least in the United States—is about 51 years, and most women will go through menopause between age 45 and 55. About 1% of premature menopause, which is onset of menopause before age 40, and another 5% have early menopause between about age 40 and 44.
What are common menopause symptoms?
[0:01:41]
JOANN MANSON: There are changes and symptoms that can occur due to this decline in hormone levels, particularly the reduction in estrogen levels. So, the hallmark symptoms of menopause are hot flashes and night sweats, but there are many other symptoms that can occur, some interrelated with the night sweats and the other symptoms. For example, disrupted sleep that can lead to difficulty concentrating, brain fog, mood changes. Some women will also experience palpitations, joint pain. So, there can be many symptoms of menopause, but the hallmark symptoms are hot flashes and night sweats.
What is perimenopause, and what are the common symptoms?
[0:02:40]
JOANN MANSON: Perimenopause is a transitional phase to the onset of menopause. This is a phase of life when the menstrual periods become irregular and the hormone levels can fluctuate, often, wildly fluctuate. This phase of life usually lasts about five years. Sometimes can last 10 years, and can begin in the early 40s, where women start to have changes in their menstrual cycles. Can start out with a shortening, and then can become more of a lengthening, with longer periods of time between their menstrual bleeds, and then eventually will progress to menopause with 12 months or more without a menstrual period. During perimenopause, there can be some of the same symptoms of menopause, hot flashes, night sweats, some disrupted sleep, difficulty concentrating, brain fog and these other symptoms.
Is it possible to become pregnant during perimenopause?
[0:04:03]
JOANN MANSON: So, during perimenopause, when the menstrual periods are irregular and the hormones are fluctuating, sometimes very widely, women will still intermittently be ovulating. And that’s important, because it means that a woman can still become pregnant during the perimenopause if she’s intermittently ovulating, and it is a period of life when many women are surprised that they’re having a pregnancy and they thought that they were not ovulating any longer and not able to become pregnant. So that is something to keep in mind. You know, using contraception, if a pregnancy is not planned or intended, because it is still possible to become pregnant when there’s intermittent ovulation during perimenopause. As opposed to menopause, when ovulation is no longer taking place, and the hormone levels have declined much more dramatically.
Why has menopause been historically underrecognized and undertreated?
[0:05:23]
JOANN MANSON: I think that there have been many myths and misperceptions about menopause that have contributed to its under recognition and very little attention over the decades to the subject of menopause. One is that, in general, women’s health has been under studied and under addressed. So I think it falls into the same umbrella. But also, there’s this general perception that may have developed that most women do not have meaningful symptoms of menopause that doesn’t really have impact on quality of life, and therefore, you know, just grin and bear it and get through—it lasts just a short period of time. We’ve actually come to recognize that the menopausal symptoms last an average of 7.4 years, based on data from studies women across the nation, and for some women more than a decade. Also, there’s a wide range in symptoms, from very mild—not requiring any medication or prescription medication treatment—to moderate to severe. Really affecting sleep, disrupting and impairing quality of life, and daily activities. There’s a very wide range, but there has been a perception over the decades that menopause is just some symptoms, last a short time, and you know, the treatments are not really worth taking risks with and you know, just grin and bear it.
What treatments are available for menopause symptoms?
[0:07:30]
JOANN MANSON: Most women will have menopausal symptoms like 75% or more, but only about 20%, 25% would have symptoms that are bothersome or moderate to severe and would fall into the category of interfering with daily activities and actually affecting quality of life. For those women, there are a prescription treatments, including menopausal estrogen therapy and estrogen plus progesterone therapy. This is, you know, through prescription, the Women’s Health Initiative tested a specific formulation of oral conjugated estrogen and medroxyprogesterone acetate. But in recent, like in the past 15-20 years, we have transdermal, or patch estrogen delivered through the skin, which is presumed to be safer because it doesn’t go directly to the liver increase clotting factors. But overall, the Women’s Health Initiative, randomized trial, large scale trial of both estrogen alone in women with hysterectomy, because the only reason the progestogen is given is to protect the uterus against endometrial cancer, which is not necessary in a woman with hysterectomy. And then a parallel trial of estrogen plus progestin, we learned that the benefit risk profile was better for the younger women than the older women. So for example, women who were below the age of 60, women in the WHI were randomized between the ages of 50 and 79. If they were 50 to 59 in the trial, or within 10 years of the onset of menopause, they tended to have a more favorable benefit risk profile with hormone therapy than the women who were more distant from menopause. And it was particularly the women who were 70 or older, or were 20 or more years since the onset of menopause, who had very high risk of cardiovascular events on hormone therapy and less so a problem in the among the women in early menopause, their absolute risks were much lower. So generally, it is recognized that if a woman has moderate to severe or bothersome hot flashes, night sweats, and she’s below the age of 60, or within 10 years of onset of menopause, the benefits of hormone therapy are likely to outweigh the risk. It’s not completely free of risk, but the risks are infrequent, low, overall low, absolute risks, for example, of the heart attacks and strokes and blood clots, and the benefits that are received in terms of symptom management—improved sleep, improved quality of life—are likely to outweigh the risk.
What non-hormonal treatments are available?
[0:11:10]
JOANN MANSON: We also have non-hormonal options for women, increasingly over the years. This is for women who are not good candidates for hormone therapy. For example, they may have a history of breast cancer. They may have a history of blood clots in the legs or lungs. We have non-hormonal treatments, such as antidepressant medications, gabapentin. They’re a little less effective than the hormone therapy, but there’s still very good options, and more recently, a new class of medications that work in the brain in order to affect temperature regulation is the FDA approved drug is called fezolinetant, and that has been shown to be quite effective in reducing hot flashes and night sweats.
What are the benefits of education and open dialogue around menopause?
[0:12:19]
JOANN MANSON: It’s really so important that women feel empowered to talk with their health care providers and talk with each other about menopause—the symptoms they’re having and effects on quality of life—because there are treatments available, and if they remain silent, they’re not going to be able to access these treatments. Also, if they feel that they’re just not satisfied with the health care they’re getting because their clinician is not open to having these discussions, or does not seem informed about different menopause treatments, there are some options, such as going to websites. That one website that can be very helpful is the website of the Menopause Society at menopause.org. This website can help women to find a health care provider in their area, they can put in their zip code and find health care providers who have special interests, expertise in menopause management. This is if they’re not happy with the kinds of answers that they’re getting or discussions they’re having with their current health care providers. Also, this website has many resources to explain symptoms of menopause, some of the changes the body is going through during perimenopause and menopause and goes through risks and benefits of many of these treatment options.
