A board-certified pediatrician and internist at Henry Ford Health’s Bloomfield Township medical center, Dr. Carrie Leff specializes in primary care for midlife women and is a certified menopause provider through the Menopause Society. She is committed to demystifying menopause and empowering women to prioritize their health during this stage of life.
Traditionally, women haven’t talked about menopause. Why do you think that is? And do you believe it’s changing?
It’s a stigma about women’s health that we’ve had for a long time but it’s 100% changing. That change, in my opinion, started with The New York Times article called “Women Have Been Misled About Menopause” in 2023. It was pivotal. The headline was impactful, it reviewed the history, they interviewed all the right people, and it was evidence-based. And it gained so much traction. That’s when I started to see the change. Social media and communities of women started to catch on and talk about menopause.
What are the biggest misconceptions about menopause that you see in your practice?
Five or six years ago, you could not convince a woman to go on hormones. And I always felt weird about that because I’m a doctor, not a salesperson. I would say, “I’m not here to convince you, but here’s what would benefit you the most.” They might start a prescription for hormones, and then they come back and say, “I didn’t continue because my mahjong group or my book club or the pharmacist told me I shouldn’t take them. I’m going to get cancer.” That is what we were up against.
Everybody starts at a different place. I always ask patients what they know about hormones and what they know about menopause because it’s important for me to understand where they’re getting their information and if it’s evidence-based.
Does menopause increase a woman’s risk for certain diseases or health conditions?
It can be confusing because menopause and aging happen alongside each other. It’s important to know that menopause is a hormonal shift that’s unique to women. No other hormones in our body just stop being produced one day. But aging is happening at the same time. And midlife is a time where chronic disease starts to emerge. If somebody comes in and says they’re super tired or having palpitations, we do our due diligence and check out their heart, as they could have heart failure or arrhythmia. My job as a menopause doctor is to sit here in the middle, be specific about the symptoms that we’re targeting, and make sure we’re not missing underlying medical issues.
When should someone seek medical support instead of waiting it out?
This is the hardest question for me to answer — and the one that I get the most. Women who are struggling with menopause should definitely seek out treatment, whether you can’t sleep, you’re having hot flashes, or your anxiety is piquing. Another good question is, “Does every perimenopausal 50-year-old, regardless of symptoms, need menopausal care?” I don’t believe that every woman needs to be treated for menopause — 25% to 30% of women sail through menopause without even knowing it’s a thing.
What are some symptoms outside of sleep issues and hot flashes that a woman should have a conversation with her doctor about?
In early menopause, the most common symptoms that we hear are vasomotor symptoms, which are hot flashes and night sweats. There are also mood changes, sleep disturbances, irritability, brain fog, and concentration problems. I’m super focused on sleep because I don’t believe a good life can be lived without it. If you’re having symptoms as you’re hormonally transitioning, you should seek out care.
We also have a subset of patients, [who] are the women who got skipped over — they’re around 70 now, and they’ve been having symptoms for a long time. These are the hardest conversations for me to have because they’ve been told they can’t have hormones or they don’t want to have hormones, and now the mantra is different and it’s hard for them. What gets worse at that age are vulvar and vaginal problems. They have pain with penetration and urinary issues. Those patients should be on vaginal estrogen. It’s important to note that local vaginal estrogen for vulvar or vaginal changes or urinary symptoms is safe and effective for anybody regardless of their age.
What are the benefits of a woman going to a certified menopause provider versus her primary care physician?
Most doctors have had little to no training in menopausal medicine. If they are certified through the Menopause Society (formerly North American Menopause Society) in menopausal care, that means they have invested their own time and their own resources to learn about menopause. In fact, the certification is just the beginning of your menopause journey if you’re a doctor. But it does mean that you’ve invested the time, you’ve passed an exam, and you’re committed to maintaining menopause-specific continuing medical education requirements.
Your practice is dedicated to caring for women of all ages, starting at 16 and up. Can you tell me more about that?
I put together a program for teens called Turning Teen, and I would do school-based education to teach parents and kids about what’s going to happen to their changing body. As I became more entrenched in my interest in menopause, I realized it was the same thing. Menopause is your second puberty. And women knew just as little about menopause as they did when they were kids about puberty.
In 2025, the Food and Drug Administration removed “black box” warning labels from many hormone therapy drugs used to treat symptoms of menopause and perimenopause. These warning labels were added in 2003 after a Women’s Health Initiative study was released that suggested that certain hormone therapies might increase the risk of breast cancer and other health conditions. What is the significance of the removal of the labels on hormone therapy drugs?
After the WHI, the FDA applied class labeling to all estrogen products. Every preparation carried the same warnings regardless of formulation, dose, or route of administration. For example, vaginal estrogen carried the same warnings as systemic estrogen, even though the risks are clearly different. The labeling did not reflect the evidence or the differences between therapies.
A black box warning is the strongest warning the FDA places on a medication. Having that warning on all hormone therapies created significant hesitation for both patients and physicians. Many of us spent years explaining to patients that the warning existed but did not accurately reflect the data for the therapy we were prescribing. Removing the black box warning acknowledges that the labeling was not aligned with the evidence and opens the door for labeling that better reflects the science.
Do you think this new phase will be a sort of reset on long-term health?
Yes. When you get messaging out like this, especially on this massive scale, there will now be more conversations about menopause for years to come, which is amazing.
To learn more about Dr. Carrie Leff, visit henryford.com/physician-directory/l/leff-carrie. Instagram: @drcarrieleff.
|
|
|
|
|
|
