Menopause Q&A with Wendy, NP - Insights, Support and empowerment for the midlife journey

This article was created in partnership with sanoLiving clinicians for trusted, accurate information.

This chapter can be filled with surprises—physically, emotionally, and hormonally. But with the right tools and knowledge, it doesn’t have to be overwhelming. Today, I’m answering some of the most common questions I hear about menopause. Let’s dive in!

Question 1: How do you define menopause, and when does it officially start? 

Menopause is defined as the point when a woman has gone 12 consecutive months without a period. That one-day mark officially marks the end of reproductive years—and the beginning of post menopause. Before that? That rollercoaster is called perimenopause, and it can last up to 10 years. You might experience irregular periods, heavy flow, or spotting. When your cycles stretch beyond 60 days apart, you’re likely in late perimenopause, and your final period is probably within 1–3 years.

Question 2: What are the most common symptoms of menopause?

The list is long—and no, you’re not imagining it! Hot flashes, night sweats, joint pain, and genitourinary syndrome of menopause (GSM)—which can cause vaginal dryness, painful sex, and frequent UTIs—are very common.
But that’s just the start. Some women experience over 40 different symptoms, from brain fog, heart palpitations, and dry skin to tingling fingers and digestive issues. Frozen shoulder, burning tongue, and bloating can also show up. It’s a lot—and it can take a toll on your self-esteem, relationships, and career, especially during a time when many women are juggling more than ever.

Question 3: What’s actually happening in the body during this time?

Your ovaries, once full of millions of oocytes, are nearing the end of their reproductive function. As estrogen and progesterone decline, we begin to feel the effects everywhere—from brain fog and mood swings to joint pain and dry skin. These hormones affect every system in the body, so when they dip, the ripple effects are wide.

Question 4: Why is perimenopause so challenging to diagnose or treat? 

Because it’s so unpredictable! Hormone levels swing wildly—your estrogen might be 20 one day and 500 the next. Progesterone steadily declines. That’s why lab work isn’t always helpful—it just gives us a snapshot of a single moment.
This volatility can deeply affect mental health, which is why it’s so important to raise awareness. Rates of depression and even suicide are highest in women aged 45–55. Understanding this transition and seeking help early is crucial.

Question 5: What does hormone treatment look like during perimenopause? 

One strategy I love is “hormone stacking.” We start with progesterone (especially if sleep and mood are the big issues), then layer in estrogen later if needed. Starting one at a time helps us pinpoint what’s helping and minimizes side effects.
Progesterone often helps with anxiety and sleep—and estrogen, when added, helps with hot flashes, vaginal dryness, and more.

Question 6: What is GSM, and why is it so important to treat?

Genitourinary Syndrome of Menopause is a fancy term for what happens when estrogen declines and affects the vulva, vagina, and urinary tract. Think dryness, pain with intercourse, chronic UTIs, urgency, and even discomfort from wearing jeans.
Here’s the key thing to remember: GSM doesn’t get better on its own. Topical vaginal estrogen is the gold standard for treatment. It’s safe for most women and brings hydration, blood flow, and elasticity back to those sensitive tissues. It’s about reclaiming your comfort—and your confidence. 

Question 7: What lifestyle changes make the biggest impact during menopause?

You’ve probably heard it all—protein, strength training, sleep, hydration, fiber, vitamins, you name it. And yes, all of that matters. But my advice? Start simple.

• Move your body in a way that feels joyful.
• Eat enough protein and fiber.
• Focus on Vitamin D, magnesium, and calcium for bones.
• Prioritize heart health (did you know cardiovascular disease is the #1 cause of death in women?).
• And yes, please—if you smoke, now’s the time to quit. It makes symptoms worse, and menopause come sooner.

Question 8: Will hormone therapy make me gain weight?

Great news: it won’t.
The Women’s Health Initiative (WHI) study—one of the largest studies ever—showed no weight gain associated with hormone therapy. Some people do feel bloated on certain types of progesterone, but we can tweak that if needed.

Question 9: What’s happening with my skin, hair, and nails? 

Estrogen loss leads to drier skin, more wrinkles, thinner hair, and weaker nails. Collagen decreases, pigmentation changes, and some women even notice acne due to increased androgen activity.
Genetics and nutrition also play a role—so we look at iron, biotin, and zinc levels too. And of course: sunscreen, hydration, and gentle skincare are your best friends. 

Question 10: How does hormone therapy really help?

Hormone therapy gives your body the estrogen it no longer produces—and if you have a uterus, we pair it with progesterone to protect the lining.
It’s the most effective treatment for hot flashes, night sweats, and GSM. In fact, up to 80% of hot flashes improve with HT—compared to just 55–65% with antidepressants or gabapentin.
It also supports bone, brain, and heart health—especially when started before age 60 or within 10 years of menopause. For many, it can be life-changing. And yes, it’s safe for most women.

Final Thoughts

Thanks so much for joining me in this Q&A. I hope it’s helped bring clarity, confidence, and maybe even a little excitement to this powerful phase of life.
If you’d like to explore your own menopause journey, know that we at sanoMidLife are here for you. 
Whether it’s with a Nurse Practitioner, Naturopath, or Health Coach, we’d be honoured to support you.
Let’s walk this path together—with knowledge, care, and empowerment every step of the way.

Warmly,
Wendy Hildebrand, NP
Nurse Practitioner, sanoMidLife
 

Article written by: 

Wendy Hildebrand, Nurse Practitioner

Wendy Hildebrand is a Nurse Practitioner based in Victoria, BC, with over two decades of diverse nursing experience spanning medical-surgical, palliative, maternal-child health, and public health. Her passion lies in supporting and empowering women through the complex transitions of midlife with evidence-based education and compassionate care. Wendy brings a warm, collaborative approach to her work with sanoMidLife, where she is proud to partner with women on their journey toward renewed health, confidence, and well-being.