Menopause 101: The Truth About Hot Flashes, Hormones, and More
Urogynecologist Ashley Winter, M.D. answers common questions and debunks persistent myths.
If you’ve ever wondered whether your brain fog, joint pain, disrupted sleep, or anxiety might be connected to menopause, you’re in good company. Despite an increased awareness of perimenopause and menopause, both women and health professionals have some misconceptions about how hormone changes impact their health. 1
We tapped urogynecologist Ashley Winter, M.D., to help increase understanding. In a recent webinar, she broke down everything you need to know about the menopause transition, from what’s really happening with your hormones to how hormone replacement therapy (HRT) can help you feel like yourself again.
Whether you’re in your early 40s and starting to notice subtle symptoms of perimenopause or it’s been years since you had your last period but are still curious about treatment options, this session was packed with science-backed insights, practical advice, and real talk on what actually works.
What You’ll Learn
- The difference between perimenopause, menopause, and post-menopause, and why symptoms can start earlier than expected
- How fluctuating hormones impact your brain, metabolism, heart, joints, sleep, and more
- Why hormone replacement therapy (HRT) can relieve symptoms and also improve longevity.
- How testosterone can help improve libido and muscle maintenance in menopause
- Lifestyle changes every woman should adopt in menopause
- How to advocate for treatment, especially if your doctor dismisses your concerns
- What to expect when starting HRT, and how long is safe to stay on it
- Which questions to ask if you’re starting HRT later in life
- How vaginal estrogen cream can ease vaginal dryness and prevent UTIs, even after 70
- Why pairing HRT with a GLP1 is beneficial for many women in menopause
Below, the top highlights, common myths debunked, and insightful community questions answered. To gain access to future webinars in real time, join the Hone Community.
Key Takeaways
1. Menopause is a whole-body experience
Estrogen, progesterone, and testosterone receptors are found throughout the body—in the brain, heart, joints, muscles, bladder, and more. During perimenopause, levels of estradiol, progesterone, and testosterone fluctuate wildly before declining, which is why symptoms can be so wide-ranging.
Common symptoms of menopause include:
- Hot flashes & night sweats
- Brain fog
- Depression, anxiety
- Heart palpitations
- Joint pain
- Low libido
- Painful sex
- Disrupted sleep
- Weight gain
- Hair, skin, and nail changes
- Urinary tract infections or incontinence
- A general sense of “not feeling like yourself”
2. Hormone replacement therapy (HRT) is longevity medicine
The gold standard for symptom relief, hormone replacement therapy (HRT), has also been shown to reduce all-cause mortality, lower rates of breast and colon cancer, and protect against osteoporosis and cardiovascular disease.
3. It’s never too early (or too late) to talk about HRT
The average age of menopause is 51, but it can happen as early as age 40 and still be considered normal. HRT can be started during perimenopause for symptom relief and protective benefits. Older women can start HRT if they’ve had a personalized risk assessment, including cardiac and bone health evaluations.
4. Testosterone matters
Though often overlooked, testosterone plays a key role in energy, metabolism, muscle maintenance, and sexual desire. Supplementing with testosterone in menopause can restore libido and energy.
Community Questions, Answered
Here’s what Dr. Winter said about some frequently asked questions raised by Hone Community members:
Is 45 too early to start HRT?
Absolutely not. Perimenopause symptoms are real, and if they’re affecting your quality of life, treatment can help.
Does weight lifting help with perimenopause?
Strength training supports bone density, lean muscle mass, metabolism, and healthy aging. It’s foundational alongside hormone therapy.
If I reacted badly to hormonal birth control, will I have the same side effects with HRT?
Not necessarily. Menopause HRT typically uses bioidentical hormones, which are structurally similar to the ones your body makes. Birth control pills use synthetic versions that can have more emotional and physical side effects.
Can you stay on HRT for life?
There’s no universal age cut-off. Continuing HRT should be a shared decision between you and your doctor. Many women use it, particularly vaginal estrogen well into their 70s and beyond.
Is testosterone cream as effective as testosterone injections?
It depends. Testosterone cream is often preferred for consistent absorption, but if it’s not effective, testosterone injections may be an option.
What lifestyle changes help perimenopause?
Eating a fiber- and protein-rich diet, vitamin D and iron supplementation (especially if you’re still bleeding), resistance training, and sleep. Dr. Winter’s approach? Focus on core strategies that are doable — perfection isn’t required.
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Editorial Policy: Science-Backed, Expert-Reviewed
The Edge upholds the highest standards of health journalism. We source research from peer-reviewed medical journals, top government agencies, leading academic institutions, and respected advocacy groups. We also go beyond the research, interviewing top experts in their fields to bring you the most informed insights. Every article is rigorously reviewed by medical experts to ensure accuracy. Contact us at support@honehealth.com if you see an error.
About the author
Tracy Middleton is the Senior Editorial Director at Hone and an award-winning health journalist and editor with more than 20 years’ experience. She is the former Editor in Chief and Brand Director of Yoga Journal and former Health Director of Women’s Health, and a member of the Association of Health Care Journalists.
