If you menstruate, there will eventually come a time when your hormones—namely, estrogen and progesterone—downshift. While this typically happens naturally around your mid- to late-40s, it can happen earlier or later, depending on your body and overall health. After a few years (around age 52 on average, according to the Office on Women’s Health), the transition results in the end of your menstrual cycle—a life phase known as menopause.

Menopause—and the years leading up to it—can come with some pretty frustrating symptoms. But it’s not a disease that needs to be cured; it’s a normal part of life. Despite that (and despite the fact that one million people are going through it at any given time, per the National Institute on Aging), menopause still isn’t well understood.

In fact, a July 2023 online survey conducted in the U.K. and reported in BMC Women’s Health¹ found only 47 percent of respondents at various stages of menopause felt like they had the knowledge to manage their symptoms.

It’s in this lack of knowledge that menopause myths are often formed. Below, experts share six misconceptions they often hear about this life stage, plus the facts to know instead.

Myth: Only severe menopause symptoms require treatment

When your ovaries make less estrogen, you may have a range of symptoms like night sweats, sleeping problems, and vaginal dryness. These symptoms can be mild for some people but downright debilitating for others.

No matter the severity, many people with physical menopause symptoms don’t always feel empowered to seek treatment. According to the same BMC Women’s Health survey, 39 percent of respondents didn’t reach out to a doctor for help with their symptoms, in part because they didn’t think menopause was a valid enough reason to get care.

But this shouldn’t be the case, says Rajita Patil, MD, an OB/GYN and director of the new Comprehensive Menopause Care program at UCLA Health. “Not all menopause symptoms have to be severe to warrant treatment,” she says.

Take hot flashes, for example. They are a common sign estrogen has dropped and can happen multiple times per day or only a few times per month, per the American College of Obstetricians and Gynecologists (ACOG). And they’re hardly a minor inconvenience: Hot flashes can make daily activities uncomfortable and seriously interfere with sleep (when they happen at night, they’re often referred to as night sweats).

“On average, patients get hot flashes for seven to 10 years,” says Dr. Patil. “That’s a long time to wait it out to feel better.”

So don’t discount your doctor’s support when it comes to hot flashes and any other symptoms. Dr. Patil typically recommends lifestyle strategies to ease hot flashes, certain medications, and/or cognitive behavioral therapy (CBT), which has been shown to make hot flashes more tolerable, according to a September 2021 study in the British Journal of Health Psychology².

“Not all menopause symptoms have to be severe to warrant treatment.”—Rajita Patil, MD, OB/GYN

Myth: Hormone replacement therapy is dangerous

Many of the experts we spoke to said one of the most pervasive misconceptions about menopause they hear is that hormone replacement therapy (HRT)—a type of medication that replaces lost estrogen and potentially also progestin—is inherently risky and should be avoided.

While HRT isn’t right for everyone and there are concerns about long-term use (especially in people older than 60), HRT can be a safe and effective way to improve your quality of life, so it’s certainly worth asking your doctor about if you’re dealing with uncomfortable symptoms.

“Fears surrounding hormone replacement therapy can hold patients back from treatment and relief,” says Banafsheh Bayati, MD, an OB/GYN in Santa Monica, California, and the medical co-founder of Perelel.

For people at low-risk (that is, those who don’t have certain underlying health conditions), HRT can offer a number of benefits. It’s one of the best treatments available to ease hot flashes and night sweats and improve vaginal dryness. Systemic estrogen therapy (a higher dose of estrogen in the form of a pill, skin patch, gel, ring, cream, or spray) has also been found to help protect against bone loss, which can happen to some people during menopause, according to ACOG.

The goal isn’t to use HRT forever, though. Long-term use is where the risks can typically increase. People who take HRT for more than 10 years (or start it after age 60) are at a greater risk for developing conditions like heart disease, breast cancer, stroke, and blood clots, per the Mayo Clinic.

“Ideally, it’s best to use HRT for the shortest amount of time at the lowest dose under the guidance of a menopausal specialist,” says Sherry Ross, MD, an OB/GYN, women’s sexual health expert and author of the books She-ology and She-ology: The She-quel. Together, you and your doctor can discuss whether any form of HRT makes sense to try.

Myth: Hormones are your only treatment option

While the risks and benefits of HRT are often misunderstood, people in menopause should also know that other treatment options exist if they wish to go a different route. This is especially important news for those who shouldn’t take HRT—like anyone with a personal or strong family history of breast, ovarian, or endometrial cancer, says Dr. Ross.

“There are many other medical treatments [for menopause], and some don’t even involve medication,” says Dr. Patil. “There are other options out there.”

That can include antidepressants or elective estrogen receptor modulators (SERMs), both of which can improve hot flashes. Other medications offer benefits for hot flashes and insomnia, like the anti-seizure medication Gabapentin and the blood pressure medication Clonidine, according to ACOG.

And don’t underestimate the power of talk therapy. CBT “has been found to be extremely helpful for people going through menopause,” says Dr. Patil. As mentioned above, the British Journal of Health Psychology found CBT useful to ease hot flashes, and also depression symptoms related to menopause. The North American Menopause Society also recommends it as an effective non-hormone treatment.

If you need help finding a therapist that specializes in menopause, ask your OB/GYN for a referral, or search online for top-rated menopause specialists in your area.

Myth: “Natural” hormone therapy is superior

According to experts, there’s a dangerous belief that hormones derived from plant products—called compounded bioidentical estrogen and progesterone hormones—are safer or better than traditional HRT,  because they’re marketed as being more “natural.” But this is not true.

Compounded hormone therapy is mixed and sold at compounding pharmacies, which usually sell other herbal and natural medications. “There’s this notion that it’s more effective than what’s offered at retail pharmacies, or that it’s being ‘customized’ for them,” says Dr. Patil. “But this is a very unsupported claim.”

In fact, compounded hormone therapy may actually be riskier than traditional HRT. That’s because the U.S. Food and Drug Administration (FDA) does not oversee the purity of compounded biodientical hormones like it does with traditional HRT, meaning, we don’t know exactly what’s in them. For this reason, ACOG only recommends FDA-approved HRT, not compounded therapies.

Bioidentical hormone therapies also haven’t been tested in clinical trials in the same way traditional HRT has, adds Dr. Ross. “They’re marketed as being more natural, safer, and better for your body, but no medical studies support these claims,” she says.

What’s more, these so-called “natural” hormones tend to be more expensive. “Most people [buying bioidentical hormone therapies] don’t even know there’s FDA-regulated HRT at traditional pharmacies that’s way cheaper than what they’re paying for,” says Dr. Patil.

With traditional HRT, “we know exactly what’s going in them, and that they’re safe and effective,” she adds.

Myth: Your sex drive will disappear once you enter menopause

Unfortunately, there’s a bit of truth to this one. Plummeting estrogen and testosterone levels can affect your sexual desire. And lower levels of estrogen, in particular, can cause vaginal dryness, which can contribute to uncomfortable or painful sex. This is a common menopause symptom, as a May 2017 survey in the Journal of Sexual Medicine³ pointed out. It found that of the more than 2,000 Australian women ages 45 to 60 surveyed, over 69 had low sexual desire.

And it makes sense, seeing that “women are being bombarded with physical and emotional symptoms that directly affect their mood in the bedroom,” says Dr. Ross.

A major cause of this low libido is vaginal dryness—medically known as genitourinary syndrome of menopause (GSM)—which can be particularly frustrating. According to Dr. Ross, GSM can cause other symptoms during perimenopause and menopause, including the following:

• Burning and irritation during sex
• Lack of lubrication
• Discomfort or pain with sex
• Urinary pain or urgency

Despite these symptoms affecting everyday life, menopausal people are often hesitant (or even embarrassed) to bring them up in a medical setting. In fact, an older August 2009 study in Maturitas ⁴found that only about 25 percent of women with GSM symptoms mentioned them to their doctor.

But “these aren’t changes you simply have to accept,” says Dr. Ross. “Vaginal dryness does not have to ruin a sexual relationship with your partner.”

Medications like HRT can help improve vaginal dryness and painful sex, for example, as can non-medicinal strategies like vaginal dilators and lubricants. Vibrators can also make orgasms easier to achieve during menopause. “Some, or all, of these treatment options will improve a woman’s sex drive,” says Dr. Ross.

“Vaginal dryness is not a change you simply have to accept. It does not have to ruin a sexual relationship with your partner.” —Sherry Ross, MD, OB/GYN

Myth: You can’t get pregnant once you enter perimenopause

The transition to menopause is a gradual one. In the years leading up to it (a phase called perimenopause), your estrogen levels start to fluctuate and your menstrual cycle begins to slow down, per ACOG. During this time, it’s normal to occasionally have shorter or longer periods, or miss a period altogether some months. Once you’ve missed 12 consecutive periods, you’re officially “in menopause,” according to The North American Menopause Society.

This period irregularity may cause people to mistakenly think their childbearing years are behind them, and with it, their risk of accidental pregnancy. But it’s still possible to get pregnant during perimenopause, even if your periods are irregular, says Kelly Culwell, MD, an OB/GYN, women’s health expert, and former medical officer for the World Health Organization.

“One of the most common age groups for unintended pregnancies are women in their 40s, often because they are still ovulating, even if not every month,” she says.

That’s why, if you don’t wish to get pregnant, contraception should remain a priority during this time, says Taniqua Miller, MD, an OB/GYN, empowerment coach, and midlife and menopause expert in Atlanta, Georgia. “There will be times during the transition [to menopause] when ovulation does occur,” she says. “The average time to menopause is four years, so contraception is a must for those wanting to avoid pregnancy.”

You can still use hormonal birth control at this stage—including combined hormone options which have both estrogen and progestin, like the pill, patch, or ring, according to Dr. Miller. In fact, the Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria for Contraceptive Use clears the use of combined hormonal contraception up to age 55.

If you’re unsure about the type of birth control that’s best for you—hormonal or non-hormonal—reach out to your OB/GYN. They can help you make an informed decision about what’s best for your body and address any concerns you have.

The bottom line

Because menopause is still largely misunderstood, people going through it often feel embarrassed or disempowered to bring symptoms up to their doctor, or even talk about it with friends and loved ones. But menopause is a normal part of life, and there are treatments out there that provide relief.

One of the most important things you can do for yourself during this time is to find a supportive, caring, and knowledgeable OB/GYN or menopause specialist that you trust. Open up to them about your symptoms, even if they don’t seem serious, and ask for help with ones that are bothering you.

Ultimately, despite the misconceptions, life can still feel fun, healthy, and fulfilling during menopause.

—medically reviewed by Andrea Braden, MD, OB/GYN