BY JYOTHSNA HEGDE
Atlanta, GA, June 23, 2025: At the Perimenopause & Menopause Symposium hosted by Aspire Medical Group on June 14 at the Celebrations Banquet in Cumming, the long-muted conversation about menopause erupted into the spotlight with clarity, compassion, and conviction. Organized by Dr. Nandini Sunkireddy, a double board-certified physician in Family and Obesity Medicine and a North American Menopause Society Certified practitioner, the event was designed to challenge stigma, correct misinformation, and empower women with the tools they were never given.
“A healthy woman who’s been doing well suddenly starts seeing her health shift in her 40s. That’s the beginning of spiritual and physical transformation — but no one ever prepared us for it,” Dr. Sunkireddy said. “We were never given the tools, or even the language.” She spoke with urgency about hormonal changes, slower metabolism, insulin resistance, sleep disruptions, and stress. She also addressed Hormone Replacement Therapy (HRT), explaining that while it isn’t suitable for everyone—such as women with active breast cancer, recent blood clots, or myocardial infarction—for many, it can be not only safe but protective. She broke HRT into categories of low, intermediate, and high risk, and emphasized the importance of personal assessment and support from medical providers. “You don’t want to suffer in silence. How many of you believe that?” she asked, prompting a spontaneous and affirming response from the audience.
What followed was a powerful and wide-ranging panel discussion among experts across medical disciplines, each illuminating a vital aspect of the menopausal journey. Dr. Stephen Tugbiyele, a urogynecologist and reconstructive pelvic surgeon, addressed Genitourinary Syndrome of Menopause (GSM), a condition affecting more than half of postmenopausal women. “This isn’t just about dryness,” he explained. “It involves the labia, clitoris, urethra, bladder—and it can cause burning, itching, urgency, recurrent UTIs, and painful intercourse.” With warmth and candor, he described how declining estrogen levels compromise the protective balance of bacteria in the vagina, leading to discomfort and infection. “They throw a party,” he quipped, drawing laughter from the audience. He laid out treatment options ranging from hyaluronic acid and natural oils to vaginal estrogen, testosterone, DHEA suppositories, and even laser therapy—many of which are insurance-covered. “Don’t wait for your gynecologist to bring it up. You bring it up,” he urged.
Adding a physical therapy perspective, Kristina Poole, Doctor of Physical Therapy and pelvic health specialist, tackled one of the most misunderstood issues: urinary incontinence. “It’s common, but it’s not normal,” she said, underscoring how pelvic floor dysfunction can affect not just urination, but intimacy, posture, bowel health, and self-esteem. Her approach is comprehensive, assessing breathing patterns, pelvic floor strength, and motor control. “Even something as simple as how you breathe can affect pelvic function,” she said. She also championed resistance training as essential for combating sarcopenia and bone loss. “This is about more than muscle—it’s about quality of life and independence,” she added. Her message was loud and clear: women deserve better care, and they deserve to feel better.
Cardiologist Dr. Pavani Kolakalapudi spoke about a lesser-known but critical consequence of menopause: its impact on heart health. “Many women don’t realize that estrogen is cardioprotective,” she explained. With its decline, blood pressure tends to rise, cholesterol worsens, and visceral fat increases. She emphasized that menopausal heart risks must be viewed through the lens of each woman’s history—including early menopause, PCOS, gestational diabetes, and family cardiac history. She advocated for using the Coronary Artery Calcium (CAC) score, a scan that detects plaque in arteries and helps guide individualized prevention strategies. “Risk calculators can’t always see you. This test can,” she said. She also clarified misconceptions around HRT, noting that for many women, cardiovascular risk alone does not rule out hormone therapy. With careful evaluation, she said, it can even be part of the solution.
Dr. Peahen Gandhi, an OB-GYN, addressed a topic many women are hesitant to discuss: low libido. “It’s not all in your head—but desire begins in the brain,” she said, explaining how the hypothalamus governs sexual desire and is influenced by hormones, stress, trauma, and mental health. She noted that about 30% of women experience low sexual desire, especially in early adulthood and again after 60. Dr. Gandhi stressed that the causes are often multifactorial, ranging from chronic illness to relationship issues, and that female sexual response is often misunderstood. “We need to stop pathologizing female pleasure,” she said. Penetrative sex alone isn’t enough for most women to orgasm, and that’s normal. Her treatment toolkit includes bloodwork, hormone balancing, psychotherapy, lifestyle shifts, and FDA-approved drugs like Addyi and Vyleesi. She also highlighted promising off-label options like testosterone and DHEA. “We’re behind countries like Australia, which already approves testosterone for women,” she noted. “But supervised bioidentical therapy can make a real difference.”
Psychiatrist Dr. Neha Khurana explored the emotional dimension of menopause in a talk titled “Flames and Feelings.” Drawing parallels between depression and chronic illnesses like diabetes, she noted, “If you’ve had depression before, you’re more likely to experience it again during menopause. But even women with no prior history can develop new mental health challenges at this time.” She highlighted the convergence of psychological, biological, and life-stage pressures during midlife—empty nests, aging parents, marital strain, and career plateaus—all of which make this a vulnerable time. “This isn’t just about estrogen. It’s about identity,” she said. She encouraged women to pay attention to mood changes and seek support without shame. “Mental health symptoms aren’t weakness. They’re signals,” she reminded attendees.
The symposium was as interactive as it was informative. A lively Q&A session between attendees and doctors allowed for personal stories, pointed questions, and clarifying dialogue. Women asked about everything from choosing the right type of HRT to managing libido in long-term relationships, and how to talk to primary care doctors about menopause-related changes. The panelists responded with warmth, depth, and practicality, emphasizing that no question was too small, no symptom too trivial.
What began as a medical symposium quickly evolved into a collective awakening — a shared space where science met empathy, and silence gave way to solidarity. As Dr. Sunkireddy concluded, “Let’s not wait for the system to catch up. Let’s be vocal. Let’s be informed. Let’s be each other’s support.” And she urged, “Don’t suffer in silence.”
Because menopause is not the end — it’s a new beginning. One that deserves celebration, education, and above all, visibility.
