Menopause. Suddenly, the topic is everywhere in the headlines, in our news feeds, on podcasts. Until recently, this normal life stage marking the end of a woman's reproductive years was only discussed in certain circles - limiting knowledge and research. Occurring in middle-aged women, the transition can cause more than four out of five to suffer debilitating symptoms that can significantly impact their lives.
For decades, millions took hormone replacement therapy (HRT) to cope with hot flashes, night sweats, thinning bones and other changes triggered by lower estrogen levels. They also used the medication long-term as a preventive postmenopausal treatment for such conditions as osteoporosis and heart disease. But popularity of the medication plummeted when a landmark women's health study in 2002 was halted over concerns about stroke, blood clots, breast cancer.
Those risks were actually limited to certain older, postmenopausal women, but the dangers were viewed broadly and usage radically dropped.
In recent months, federal guidance changed on hormone therapy. "Black box" warnings were removed, and timing recommendations were updated, with the goal of reducing fear that led to underuse. The changes, however, left many with questions.
Sondos Al Sad , MD, a UCSF primary care clinician who founded The Menopause Connection at the Women's Health Primary Care Clinic and launched the Menopause Educational and Professional Interest Collaborative across the University of California, explains what to know about menopause and who should take HRT and when.
What are the stages and common symptoms of menopause?
Menopause is a transition, not a single moment. It includes perimenopause (when cycles become irregular and symptoms begin), menopause (defined as 12 months without a period), and post-menopause. These stages are a helpful framework, but they are a simplified model and don't fully capture women with underlying endocrine conditions or complex health histories.
Common symptoms vary widely and can include hot flashes, sleep disruption, mood changes, brain fog, joint aches, and vaginal dryness. There is no single "menopause experience" - symptoms differ in type, timing, and intensity.
What can women do to strengthen their bones?
Bone health requires consistent, proactive habits. The most effective strategies include strength training at least twice weekly with progressive resistance, maintaining adequate vitamin D (through sunlight or supplements), and ensuring sufficient calcium intake through diet. Avoid smoking and limit alcohol. Nutrition patterns that emphasize whole, plant-forward foods (e.g. green leafy vegetables) may further support bone health.
What benefits do women get from hormone replacement therapy (HRT)?
When started at the right time with precision for each individual, hormone therapy can significantly reduce hot flashes, improve sleep, and help preserve bone density. It may also support pelvic and genitourinary health. The benefits are most meaningful when therapy is tailored to symptoms and individual risk profiles.
When should women start HRT? How long should they take it?
For symptomatic women, hormone therapy is generally most effective and safest when started within 10 years of the final menstrual period or before age 60. Duration should be individualized - there is no fixed "stop" date. Many women can continue therapy as long as benefits outweigh risks, with regular reassessment.
What does the research say about women stopping HRT?
After early 2000s studies raised concerns, many women abruptly stopped hormone therapy. This led to untreated symptoms and likely contributed to increases in conditions like osteoporosis. It also created lasting fear and confusion about menopause care that we are still working to correct today.
What has changed in the last year? Why are women now more willing to take HRT?
We're seeing a shift driven by better science, clearer guidelines, and more women in medicine leading this conversation. Patients are also more informed and are actively seeking care that improves quality of life. It's a combination of evidence and advocacy.
Why are people more willing today to discuss menopause when it used to be in the shadows?
This is a cultural shift. Social media has opened space for shared experiences, and women are speaking more openly about the impact of menopause on their health, work, and daily lives. At the same time, the cumulative demands on women - professionally and personally - are making these symptoms harder to ignore.
What should we know about UCSF's work on menopause?
We're focused on building integrated models of menopause care that combine clinical services, education, and research. This includes improving access to evidence-based treatments, developing provider training programs, utilizing large language modules (LLM -AI) to explore patients' lived experiences, and studying how menopause affects long-term health outcomes such as cardiovascular disease, bone health, and cognitive function.
Can you tell us about your research on menopause and joint disorders?
My research examines the relationship between menopause and musculoskeletal symptoms, including joint pain. I review global data on how women experience these symptoms during the menopause transition and use that evidence to better understand how this "musculoskeletal syndrome of menopause" presents in our local population. The goal is to improve recognition and guide more targeted care.
