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Navigating Menopause: Expert insights from Dr. David Archer on World Menopause Day

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A floral graphic illustration of the word menopause

World Menopause Day, observed annually on Oct. 18, is a global initiative aimed at raising awareness of menopause and the health challenges it presents. Spearheaded by the International Menopause Society, the day encourages open discussions about this natural life transition that affects millions of women worldwide as well as the importance of managing menopause proactively. 

Menopause marks the end of a woman’s reproductive years, typically occurring between the ages of 45 and 55, and is characterized by hormonal changes that can lead to physical, emotional and psychological symptoms — including hot flashes, sleep disturbances, mood swings and long-term risks such as osteoporosis and cardiovascular disease.

Despite being a universal experience, menopause remains underdiscussed, often surrounded by stigma or misinformation. Here, David Archer, MD, professor of Obstetrics and Gynecology, shares insights on menopause misconceptions, preparing for this life stage, thoughts on hormone replacement therapy — and also some positive aspects of menopause.

What is a common misconception about menopause?
A common misconception is that every woman will experience hot flushes. About 80% of women have moderate to severe hot flushes, and some women do not experience them at all. 

How can women best prepare themselves physically and mentally for the transition into menopause?
All women should expect to have a loss of fertility beginning at age 35 and accelerating over the next 15 years and be unable to become pregnant when they reach menopause. Menopause is the cessation of menstruation, but ovarian function such as synthesizing and producing estrogen declines before the actual menopause. The decision to start hormone replacement therapy can be considered during this time. Weight gain can be rapid after menopause and changing your diet and increasing exercise are positive activities to promote healthy aging without the need for hormonal intervention. 

What are some of the less-discussed symptoms of menopause that women should be aware of?
There are a variety of symptoms associated with menopause, but many are not related to the decrease of estrogen. Some common symptoms are rapid heart rate, joint and muscle aching that move from shoulder to knee or other muscles and joints in the body, and dryness of the skin.

How do hormonal and non-hormonal treatments differ in managing menopause symptoms, and what should women consider when choosing a treatment option?
Hormonal methods use estrogen and in women with an intact uterus an added progestin as treatment for the estrogen loss. This approach guarantees that the woman’s hormone receptors are activated and functioning normally. Non-hormonal methods do not work through hormone receptors. Therefore, they do not have the same degree of efficacy as the hormone, but they offer relief of symptoms that are equivalent in some instances — or the symptom is relieved, but the atrophic process due to estrogen loss continues.

Another misconception is that hormone replacement therapy increases a woman’s risk of breast cancer. This statement is only partially true. Use of both an estrogen plus a progestin has been found to increase a woman's risk of breast cancer. Although the risk estimate is a 25% increase compared to non-hormone users, the actual number of women who are diagnosed with breast cancer is 6.0 new cases per 10,000 women per year who use hormone therapy. Conjugated equine estrogens (Premarin) alone in the Women’s Health Initiative had a reduction of 5.0 new cases per 10,000 women per year of use — a 30% reduction in the relative risk. Other estrogens used for hormone replacement have not been as extensively studied and are usually considered to have the same risk as any estrogen.

Are there any positive aspects of menopause that you feel are underappreciated or overlooked?
Relief of the hot flush — the principal symptom of menopause — has other benefits. These are improved sleep architecture with no night sweats waking the woman. This results in less daytime fatigue and improvement in sense of wellbeing. There is also improvement in bone density delaying osteoporosis, restoration of the vaginal epithelium (a multilayered tissue that lines the vaginal walls) back to premenopausal state, and relief of vaginal dryness and reduced discomfort with intercourse.

Learn more about women's healthcare through EVMS Medical Group Obstetrics and Gynecology.


David Archer, MD, Professor of Obstetrics and Gynecology, develops combination products for contraception and HIV prevention. His research interests focus on menopause, oral contraception and hormone replacement therapy. He has published extensively on hormone replacement therapy and endometrial bleeding. Dr. Archer is the editor of Menopausal Medicine, a publication of the American Society for Reproductive Medicine, and is on the editorial board of Menopause, the journal of the North American Menopause Society. He has been an active member of multiple national and international societies related to women's health, including the Board of the American Society of Reproductive Medicine, the North American Menopause Society, International Menopause Society, European Society for Contraception and Reproductive Health and the Egon and Ann Diczfalusy Foundation.