Dr. Leah Millheiser is the Director of the Female Sexual Medicine Program in the Department of Obstetrics and Gynecology at Stanford University Medical Center and the Senior Vice President of Medical Affairs at Hims & Hers, a consumer telehealth company. She is a NAMS-certified menopause practitioner and her clinical focus is on the treatment of female sexual dysfunction and the care of women in midlife and beyond.
What are the main symptoms of menopause?
The most common symptoms of menopause are the vasomotor symptoms. These include hot flushes and night sweats. However, the severity with which a woman experiences these symptoms can vary (i.e., mild vs. severe). Other symptoms that can occur during and after the menopause transition include insomnia, mood changes, mild cognitive changes, lowered libido, and vaginal dryness/painful intercourse related to vulvovaginal atrophy.
Can menopause cause hair loss?
Female pattern hair loss (FPHL) is the most common cause of hair loss during and after menopause. In FPHL, it is the change in the balance of estrogen and androgens that leads to the thinning of a midlife woman’s hair. This is characterized by thinning at the crown with a widening of the part. The frontal hairline remains intact. It is extremely rare for FPHL to lead to total baldness. Frontal fibrosing alopecia (FFA), a much less common form of postmenopausal hair loss, affects the front and sides of the scalp. It is an inflammatory condition believed to be caused by an autoimmune reaction. Other causes of hair loss in menopausal women include major life stressors, chronic disease, certain medications, and untreated thyroid disease.
When should you choose to go with hormone therapy?
There isn’t a requirement to start hormone therapy (HT) when experiencing symptoms of menopause. This is a decision made between a woman and her medical provider which is influenced by several factors (i.e., severity of symptoms, quality of life, risk vs. benefits, potential contraindications, other medical conditions, etc.). A woman who has severe symptoms is more likely to seek HT vs. a woman with mild symptoms who may not require any treatment at all. Menopausal hormone therapy is the most effective treatment for vasomotor symptoms (e.g., hot flushes and night sweats). However, it is not appropriate for everyone. For women whose biggest concern is the symptoms of Genitourinary Syndrome of Menopause (e.g., vulvovaginal atrophy, frequent UTIs, painful intercourse), a local vaginal hormone therapy is the treatment of choice. There are few contraindications to this type of therapy and women who may not be candidates for systemic hormone therapy can typically use this type of therapy. Examples of treatment include low-dose vaginal estrogen and intravaginal DHEA.
What are some natural ways to reduce menopause symptoms?
There isn’t a lot of research supporting recommendations in this area. However, anecdotally, we know that the following changes in behavior may help reduce some vasomotor symptoms:
- Decreased alcohol intake
- Avoidance of spicy foods
- Avoidance of stressful situations / better stress management
- Increased exercise
How to lose weight during menopause?
Many women struggle with weight gain in menopause as lean body mass decreases with age and there is more of an adoption of a sedentary lifestyle. Sleep disturbance (i.e., insomnia or middle of the night awakenings due to vasomotor symptoms) in menopause also contributes to weight gain as it may interfere with weight-management behaviors. It can also increase stress levels which can make it more difficult to lose weight. The distribution of fat also changes in midlife women, who tend to notice weight gain in the abdominal area. Being overweight in midlife increases the risk of diseases like type 2 diabetes and metabolic syndrome. The best way to lose weight in midlife is through calorie reduction (a reduction of 500 – 750 calories per day is estimated to lead to weight loss of 1-1.5 pounds per week). For most midlife women, this typically translates to a daily intake goal of 1,200-1,500 calories per day. As stated above, the Mediterranean diet is considered one of the best diets for overall health. Daily exercise is also recommended for both weight loss and bone health.
What supplements/ Vitamins are recommended?
Women should get their nutrients through a diet of healthy foods. However, postmenopausal women may want to consider calcium and vitamin D supplementation for bone health. Although It is recommended that the majority of daily recommended calcium come from the diet, sometimes this is not possible and supplements are necessary. The Institute of Medicine recommends 600 IU per day of vitamin D for all healthy people up to 70 years old and 800 IU per day for healthy people aged 71 and older. Foods that are a good source of vitamin D include wild-caught oily fish (salmon, mackerel) and eggs. The daily recommended intake of calcium is 1,000 mg for women 50 or younger and 1,200 mg for women older than 50. Again, the majority of this should come through the diet. Multivitamins, in general, don’t have enough scientific evidence to support their use in the prevention of diseases like cancer and cardiovascular disease.
Would you recommend a diet change for menopause?
In general, I recommend the Mediterranean diet as it has the best research evidence for its health benefits. The Mediterranean diet is based on the traditional foods consumed in Italy and Greece, such as vegetables, fruits, nuts, grains, healthy fats, reduced red and white meat intake, and moderate intake of fish and dairy. It has been shown to lower the risk of coronary heart disease, improve cognitive health, and may prevent metabolic syndrome. It is also associated with the lowered risk for breast and colorectal cancers.
About Dr. Leah Millheiser
Leah S. Millheiser, MD, FACOG, NCMP
Dr. Millheiser has devoted her career to researching and treating all aspects of female sexual health. She has a particular interest in the sexual wellness of cancer survivors. In her gynecology practice, she takes care of women across the lifespan, from adolescence to menopause and beyond. She has served as the principal investigator for many clinical trials in the area of women’s sexual health and has authored numerous publications on female sexual dysfunction for peer-reviewed journals and textbooks. At Stanford, she has been a mentor for medical students, residents, and PhD students interested in women’s sexual health. She has served as the Education Chair for the International Society for the Study of Women’s Sexual Health (ISSWSH) and was a past member of the ISSWSH Board of Directors. Dr. Millheiser is frequently invited to lecture, both nationally and internationally and serves as a women’s health expert for various television, online, and print media outlets.
In addition to her current role at Hims & Hers, Dr. Millheiser has also worked with several medical device and pharmaceutical companies in varying capacities. She has served as the Chief Scientific Officer of Nuelle and Aytu Bioscience and was the Chief Medical Officer of Sprout Pharmaceuticals. Dr. Millheiser was the co-creator of the Legalize V campaign, which received national media attention, including a segment on CBS’s The Doctors. The purpose of the campaign was to bring awareness to the issue of censorship in the media, specifically as it relates to the use of proper terminology for female genital anatomy. The campaign highlighted the wide-ranging negative effects that this type of censorship has on women’s overall health.
Dr. Millheiser holds a B.A. from Columbia University and an M.D. from Northwestern University. After completing her residency in Obstetrics and Gynecology at Stanford University, she became the recipient of the prestigious Women’s Reproductive Health Research Scholarship (K12 award) from the NIH. This provided her with the opportunity to do novel research on the specific patterns of brain activation and sexual response among women with Hypoactive Sexual Desire Disorder. Her groundbreaking findings were published in the journal, Neuroscience.