Normalizing Menopause and Vaginal Dryness with Your Patients: Q&A with Shirley Weir

Normalizing Menopause and Vaginal Dryness with Your Patients: Q&A with Shirley Weir

Shirley Weir is on a mission to empower women to navigate menopause with confidence and ease. Read our interview with Weir on the most common menopause myths, the best options for symptom relief, and what she believes is the most important research on vaginal health in the last five years.

Weir is the founder of the Menopause Chicks community, a popular online platform where women come to access quality health information, health professionals who can support their journey, and to “crack open” the conversation on all-thing women’s health. Weir is also the author of Mokita: How to Navigate Perimenopause With Confidence & Ease, an Amazon women’s health best-seller.  

SHWI: What was your own personal experience with menopause and what motivated you to start your organization, Menopause Chicks?

Q&A with Shirley Weir

Menopause Chicks was born out of my own experience. In my early to mid-40s, I went to my doctor, and I also did what every other smart, savvy woman does when she has questions about her health, I went to Google! Both experiences left me feeling confused and frustrated. There is such a huge gap in quality women’s health information. At the time, everyone was starting a blog so I decided I needed to crack open this important conversation for other women like me. Now I spend most of my days inside a private online community that has over 31,000 members and received 2+ million visits last year. I was right—women have a lot of questions about their midlife health.

SHWI: You’re actively trying to change the conversation and educate women about menopause. What are common misconceptions that you feel women need to be informed about?

Originally I thought my role would be to “crack open the conversation” because menopause is severely under-discussed. But what I quickly realized was we also need to change the conversation around menopause because there are so many myths and misconceptions. Gloria Steinem has an excellent quote: “Our first challenge is not to learn, but to un-learn.”

It’s common for women to arrive in midlife relatively uninformed and unprepared. Yet, all of us have picked up assumptions about menopause along the way. Mine were that my period would magically stop like turning off a light switch, and I would somehow be blessed and “sail through” relatively unscathed. The list of myths and assumptions about menopause can be quite long.

Here are the most common misconceptions:

Menopause Means Hot Flashes and Irregular Periods

Hot flashes and night sweats get a lot of airplay from media and marketers as “the” defining sign of menopause that every woman will experience. The truth is: all of our journeys through perimenopause-to-menopause and beyond are unique. About 25% of women experience hot flashes when their cycles are still regular in perimenopause; about 10% of women continue to experience hot flashes for more than 5 years; and 2% continue for more than 10 years—if they don’t decide to treat the root cause (hormone imbalance) before that. What does not get a lot of airplay and can be a serious source of distress for women is irregular bleeding and heavy bleeding. This is probably the most common perimenopause experience (and least commonly discussed!), and according to the International Menopause Society, accounts for 70% of all gynecological visits.

Perimenopause and Menopause Are Conditions

Puberty, perimenopause, and menopause are life phases that a woman goes through. And what’s “natural” is when our bodies thrive in hormone balance, which they are designed to do, up to around age 50. Just a century ago, women only lived to be 50. Now we expect to live to be 85—or even 100, but evolution has yet to catch up. Without optimal hormonal health in our 50s and beyond, we continue to ask our bodies to do the same jobs for another three-to-five decades, but often they are unable to do so because they lack the same levels of estrogen and progesterone they had in their 20s, 30s and 40s. Thus, we find ourselves in a society where women have staggering rates of heart disease and stroke, dementia, osteoporosis, incontinence and vaginal dryness.

Perimenopause and Menopause Are Synonymous with Suffering

Perimenopause and menopause are life phases. They are not ailments, conditions, or diseases—therefore, they do not have symptoms. What has symptoms is: hormone imbalance, burnout, iron deficiency, thyroid imbalance, and more. This is a really important distinction because the longer we continue to tell women that perimenopause is “just part of being a woman” or we group “menopause + symptoms” in the same sentence, the longer we are going to have women putting their own health on the back burner, somehow believing they are supposed to suffer.

Women in Menopause Are Hot, Old, Tired, and Overweight

We have decades of media interpretations to thank for this assumption. Ask anyone today what they think of when they think of menopause and I guarantee you will see a thought bubble rise about their head that includes these negative connotations. Or Google “perimenopause” and I guarantee the images will be of gray-haired women holding fans. We have a long way to go before we convince the media, marketers, and even the medical community that while the average age of menopause (12 months without a period) is 51.2, perimenopause can start in your late 30s or early 40s. And that with these midlife phases comes wisdom, beauty and confidence! This is not to say that women do not have challenges or even suffer, but we are smart and savvy, and we can learn to overcome those challenges. Especially if we have access to quality health information, experienced health professionals to support our journey, and a community that has our back.

There’s No Sex After Menopause

I was asked this question at a conference a few years ago. My answer: Yes, there is plenty of sex after menopause—sometimes even with a partner!

My Doctor Will Know What to Do

Hormone health is complex. When a woman is dealing with mood changes, heavy bleeding, sleep deprivation, vaginal dryness, and joint pain—and that conversation really requires more than 10 minutes. If your doctor is experienced in women’s midlife hormone health, it is because he or she invested in additional training. We, as patients, have to learn how to interview and ask our health providers about their education, experience, and expertise, rather than assuming they will know what to do. We do this with tradespeople who come to work on our house; we have to do that same when we are building our midlife health team.

SHWI: You believe that vaginal dryness and atrophy is preventing women from getting the healthcare they need. Why is this important?

I do believe the way we talk/don’t talk about vaginal dryness is preventing women from getting the healthcare they need. A few years ago, I read that the #1 reason women don’t talk about vaginal dryness with their physicians is because their physicians don’t bring it up. And the #1 reason physicians don’t bring up vaginal dryness with their patients is because their patients don’t mention it. So this tells me that we have a long way to go to bridge the gap in conversation, for starters.

I rarely hear of a woman booking an appointment to address vaginal dryness. I often hear that if mentioned at all, it is brought up at the tail end of another appointment for another health concern. This doesn’t allow for much time for validation, education or treatment. The result: currently, only 7% of women with vaginal dryness/atrophy are receiving treatment.

We need to normalize vaginal dryness as a common occurrence when estrogen and hyaluronic acid decline post-menopause. Even incontinence pads are advertised in the media, but we have yet to normalize vaginal dryness.

I believe one of the reasons health professionals shy away from conversations about vaginal health is that they don’t want to talk about sexual health. I’m not sure how many generations it will take for us to get over that. But what if we could campaign to ensure all women of all ages understood the health benefits of vaginal health? From sitting comfortably to moving comfortably to dancing and yoga, to warding off UTIs (urinary tract infections), they would understand how essential a healthy vagina is to preventing incontinence and prolapse. And what if we made women of all ages aware of all the underlying reasons for vaginal dryness? From birth control to over-use of absorbent pantiliners, from postpartum to cancer treatments and other medications.

Then there is brain health. What’s the first thing a woman does when she is experiencing uncomfortable vaginal dryness/atrophy? She stops moving. And that sets us on a path toward brain health decline. So I imagine billboards that read: “Moisturize your vagina to protect your brain!”

And finally, language matters. In 2013, the North American Menopause Society (NAMS) coined the term “genitourinary syndrome of menopause” or GSM—of which symptomatic vulvovaginal atrophy (VVA) is a component. Before that, physicians were trained to use the terms vaginal dryness or vaginal atrophy. I have yet to meet a woman who knows what GSM or VVA mean. Simply put, her vagina is dry, she is uncomfortable, and it is affecting her quality of life. The language we use is important for women to comfortably discuss their symptoms and get access to the healthcare they deserve.

SHWI: What do healthcare providers and postmenopausal women need to know about moisturizers and lubricants to improve their vaginal health and sexual function?

This question shines a light on yet another women’s health question, which is ensuring women understand the difference between a moisturizer and a lubricant.

A moisturizer is an investment in current and long-term vaginal health. We want women to include moisturizing their vaginas into their regular routines, the same way we moisturize our face, hands, and elbows. And to use it away from sex as a way of restoring the natural moisture back into the cells of the vulva and vaginal wall. Why? So they can sit continue to sit, move, and enjoy sex comfortably.

We also encourage women to read the label! Often I hear from women whose doctors recommended a certain brand of moisturizer—yet when you flip the box around and read the ingredient list it includes things like glycerin (derivative of sugar which can lead to yeast) and other additives and derivatives that I assume are included to extend the shelf life of the product.

Separately, we recommend lubricants for pleasure and fun. A lubricant offers a friction-free barrier, but it is temporary. So, we encourage women to use a moisturizer as part of their routine away from sex, and then use a lubricant adjacent to sexual activity.

Last but not least, choose a lubricant that is pH balanced for your vagina! One of my more shocking learnings was how some lubricants (warming lubricants are amongst the worst culprits!) can alter the pH balance of the vagina. Manufacturers are not required to post the pH balance (ideally 3.0  to 5.0) of their lubricant on the packaging, so women who have the awareness to inquire have to dig around websites and figure it out on their own.

SHWI: What do you believe is some important research that has been done in the last five years in support of vaginal health?

I don’t believe there are nearly enough resources invested in women’s health research. However, I was encouraged a couple of years ago when women in the Menopause Chicks community kept asking about solutions for vaginal dryness. Some were aware of localized estrogen therapy as a viable option, but many were also aware of some of its limitations. These therapies may take 3-4 months to show results, they require a prescription, and doctors won’t prescribe for preventative purposes. Some women choose not to use hormone therapy or have decided to stop using hormone therapy.

So thanks to research on hyaluronic acid demonstrating it is equally as effective as localized estrogen therapy for the treatment of vaginal dryness, many of our members are now realizing the benefits of hyaluronic acid as a vaginal moisturizer.


1. Dr. Jerilynn Prior, The Centre for Menstrual Cycle and Ovulation Research
2. Dr. Marla Shapiro
3. Stute, Petra. (2013). Is vaginal hyaluronic acid as effective as vaginal estriol for vaginal dryness relief?. Archives of gynecology and obstetrics. 288. 10.1007/s00404-013-3068-5. 

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