The Most Common Menopause Myths, Debunked with Dr. Mary Jane Minkin

When it comes to women’s health, there’s a lot of noise. And, we may be biased, but it feels like there’s more BS out there surrounding menopause than anything else. 

That’s a big part of what we’re here for. One of the best things about working at Alloy is that in addition to offering products to help you feel good, we have webinars and support groups with experts who help us cut through that noise and tell you what’s what. Our community manager Rachel Hughes recently had the opportunity to interview Dr. Mary Jane Minkin about some of the myths we hear most often. 

We’re sharing some of the highlights below, or you can watch the whole interview here on our YouTube. 

The transcript has been edited for length and clarity.

Rachel Hughes: 

Let’s get started. Welcome everyone, I’m Rachel Hughes. For those of you who don’t know, I’m the new community manager at Alloy Women’s Health and I’m joined today by Dr. Mary Jane Minkin. Dr. Minkin is a clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale University School of Medicine, and has been in private practice in New Haven, Connecticut for more than 40 years. Dr. Minkin is a fellow of the American Congress of Obstetricians and Gynecologists (ACOG) and has been certified by the Menopause Society (formerly the North American Menopause Society) since 2002. Welcome, and thank you so much for joining us here, Dr. Minkin.

Dr. Mary Jane Minkin:

Rachel, thank you so much for the very kind introduction.

Rachel Hughes: 

Let's dive right in. Today we are focusing on the myths of menopause. There are certain myths that are persistent. They’re loud and they need to be debunked. The first is about breast cancer. Lots of people think estrogen is dangerous and leads to breast cancer. Could you speak about that?

Dr. Mary Jane Minkin:

Sure. Let’s start with the Women’s Health Initiative study which was published about 21 years ago on July 9th, 2002. I remember the day because I’ve never gotten more phone calls. I got 50 phone calls before noon. 

Basically, there was a large study that was being done. It was what we call a prospective randomized double blind control trial. They gave women estrogen therapy, and, if they had a uterus, progestin as well. The study was designed to look at whether estrogen helps prevent heart disease, but as they were studying it appeared that the women who were getting estrogen and progestin had a very slight increased risk of breast cancer, and so they stopped the study. The risk of breast cancer was announced everywhere, and everyone immediately got rid of all of their estrogen products.

In the end, the risk was actually not statistically significant. And, in the women who were getting estrogen only, the study actually showed a decreased risk of breast cancer. But that wasn’t the headline. And doctors stopped offering menopausal hormone treatment, and that is something that’s still being seen today, even though the study was 21 years ago, and the hormones that are available now are very safe. So what happened is residents who were trained in the United States after the year 2002 had very little exposure to menopause education.

Rachel Hughes:

Thank you. And it’s not just systemic estrogen people are afraid of, which brings us to myth number two: Vaginal estrogen is contraindicated for breast cancer survivors and increases the risk of breast cancer. And while we’re discussing this, can we talk about the black box warning?

Dr. Mary Jane Minkin:

Basically, all FDA-approved products available for sale through pharmacies in this country come with a package insert that says things about the product. If the warnings are really serious, they put it in a sort of black border box. After the WHI published those results, the FDA put a black box warning on estrogen. The problem is, they also put the same black box warning on vaginal estrogen, which was not even studied in the WHI. 

Then, people get vaginal estrogen and see the warning and think “I’m going to die!” when the truth is, the absorption from vaginal estrogen is so miniscule. Almost every woman can safely use vaginal estrogen.

Rachel Hughes:

Next up: Libido always declines in menopause, and there is no therapy for this. Could you speak to that myth?

Dr. Mary Jane Minkin:

Well, libido does not always decline in menopause. I do know there are many women who notice a decline in libido, but it’s not everyone. And, there are solutions. We can help. Plus, being postmenopausal can also be really liberating. Fibroids shrink, endometriosis shrinks, and there’s no longer the risk of unplanned pregnancy.

Rachel Hughes:

Freedom!

Moving right along. Next up: Hormone therapy makes you gain weight. 

Dr. Mary Jane Minkin:

Women do tend to gain weight during menopause. Weight gain is typically about five to eight pounds from the beginning of the menopausal transition through perimenopause and to that one magic year without the period. But that has nothing to do with hormone therapy, and if you look at women who do take estrogen, their average weight gain is actually about four to seven pounds. 

Rachel Hughes:

This is not about me, but I'm going to make it about me for just one second. I found that menopause hormonal treatment helped me get my arms around weight gain. I felt like before treatment, I was in a perpetual state of PMS and I was very, very crazy and sort of bloated and uncomfortable and all of that. And for me, it took a little while, but not that long, and things just kind of settled down and evened out. 

Next up, perimenopause. This one is really interesting. There’s a myth that you cannot begin MHT during perimenopause. Can you speak to that?

Dr. Mary Jane Minkin:

People are pretty symptomatic during perimenopause. But, doctors used to wait until that magic 1 year without a period to prescribe MHT, because if you had abnormal bleeding, you’d know that it was pathological, vs. just being part of perimenopause. But, it’s safe to start estrogen during perimenopause under supervision.

Perimenopause is tough to treat, because it’s not a straight curve down. But a low-dose birth control OR MHT can help.

Rachel Hughes: 

Finally, and this is by no means the last of the myths, but there’s a myth that you can’t take antidepressants and estrogen. 

Dr. Mary Jane Minkin:

This is important. And there’s some interesting data out there that shows if you give women who are on SSRIs or SNRIs some estrogen, it actually sort of primes the pump and they respond much better to the antidepressants.

It’s impossible to condense the interview into one blog post, and we highly recommend you watch the whole webinar! There was a lot more detail, and Dr. Minkin took audience questions. 

HUGE thanks to Rachel Hughes and Dr. Mary Jane Minkin for a great afternoon!

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