Understanding Menopause with Dr. Naomi Busch

Written By Lauren Lozano

SHE Guest Speaker – March 19, 2025

On March 19, The SHE hosted Dr. Naomi Busch of Seattle Menopause Medicine for a powerful and eye-opening discussion on perimenopause and menopause—two stages of life that every woman will go through, yet ones that are often shrouded in misunderstanding, misinformation, and stigma.

What is Perimenopause?

Perimenopause is the transition phase leading up to menopause, marked by fluctuating estrogen and progesterone levels. This hormonal shift can start as early as your 40s and last up to 10 years. One of the earliest indicators is a cycle change of more than 7 days from your normal pattern.

Dr. Busch explained that this stage can bring symptoms such as:

  • Mood swings, irritability, and even “existential rage”

  • Anxiety and disrupted sleep

  • Brain fog and memory lapses

  • Irregular or heavier cycles

  • Hot flashes and night sweats

Importantly, perimenopause is diagnosed by symptoms and cycle changes, not hormone blood tests—which are often unreliable due to daily fluctuations.

What is Menopause?

Menopause itself is a single moment in time—defined as 12 consecutive months without a period. After that, a woman is in postmenopause. The average age in the U.S. is 51, but it can happen anywhere between ages 45 and 55.

Once estrogen levels drop significantly, women may experience:

  • Vaginal dryness

  • Sleep disturbances

  • More frequent hot flashes

  • Higher risk for osteoporosis and heart disease

Dr. Busch emphasized that menopause is not a disease—it’s a natural life stage. But many women suffer unnecessarily because most healthcare providers receive very little menopause-specific education, and outdated beliefs about hormone therapy still persist.

Hormone Therapy & Treatment Options

Hormone Therapy (HRT) can be life-changing for many women. It has been shown to:

  • Reduce hot flashes and night sweats

  • Improve sleep and mood

  • Protect bone density

  • Support cardiovascular health

Myth-busting moment: Estrogen does not cause breast cancer. Large studies show no increased risk with estrogen-only therapy and only a minimal increase with combined estrogen/progestin therapy (about 7 in 10,000 women).

For women who cannot take HRT—such as those undergoing active breast cancer treatment—non-hormonal options like SSRIs, gabapentin, rhubarb extract, and black cohosh may help. Cognitive Behavioral Therapy for Menopause (CBT-Meno) is also gaining recognition for its ability to reduce symptom impact.

Beyond Symptoms: Long-Term Health Implications

Without estrogen, bone loss accelerates, increasing the risk of osteoporosis and hip fractures—conditions that claim 60,000 women’s lives each year. Heart disease, the leading cause of death in women, claims 300,000 lives annually. If started within 10 years of menopause, estrogen can lower heart attack risk.

Dr. Busch also touched on skin health, noting that while estrogen can help with collagen, proven anti-aging tools like retinol, hyaluronic acid, and sunscreen should remain staples.

Forms of HRT

Transdermal estrogen (patch, gel, or cream) is often the safest choice, carrying a lower risk of blood clots than oral estrogen. Women with a uterus should pair estrogen with progesterone—either orally or via IUD—to protect against uterine cancer.

Dr. Busch’s Key Takeaways

  • Menopause education in medical school is lacking—advocate for yourself.

  • You don’t need a blood test to confirm perimenopause—your symptoms tell the story.

  • There’s no one-size-fits-all solution—treatment should be personalized.

  • Misinformation is rampant—find a provider who understands menopause care.

This session was more than an educational talk—it was a call to action for women to embrace knowledge, advocate for their health, and approach menopause as an empowered, informed chapter of life.

Seattle Menopause Medicine – 6800 E. Green Lake Way N, #200, Seattle, WA 98115, 206-552-8553

Lauren Lozano