The focus of Dr. Susan Hardwick-Smith's OB/GYN residency at University of Texas-Houston was on delivering babies. “I think the amount of education that I had in menopausal treatment was probably about a day or a chapter in a book or something like that,” she says.
Now, Hardwick-Smith is shifting that paradigm with her new clinic, Complete Midlife Wellness Center, which is dedicated exclusively to women’s midlife sexual, relational, and spiritual health and opened July 1, and her new book, Sexually Woke, which focuses on midlife intimacy and comes out in September.
Hardwick-Smith graduated from Baylor College of Medicine in 1995, and at that time, there wasn’t a huge focus on women’s health over 45. Throughout her early career, when menopausal women approached her with their symptoms, including a decreased sex drive, she passed it off, like many other doctors. “I might say something like, ‘Well that’s normal to have no sex drive, most people don’t. Take up tennis or something.’”
Then she herself went through menopause, and a divorce around the same time, and realized there was an information gap for both patients and doctors. She began to do more research on menopause and treatments. “I felt like the second half of my life should be as vibrant, and exciting, and enjoyable as the first half, if not more so,” she says.
Her research led Hardwick-Smith to launch a study with 1,000 middle-aged women about their sex lives in 2017. By the end of 2019, she had turned the results of that study into Sexually Woke. In March 2020, as COVID-19 was beginning to hit Houston, Hardwick-Smith was talking with a patient, who suggested she open a clinic for older women. And open a clinic she did. Although Hardwick-Smith doesn’t recommend starting a business in the middle of a pandemic, she says she’s glad to dedicate her time and her practice to women going through menopause. It’s “a place just for mature women that focuses on what mature women want to focus on.”
We sat down with Hardwick to talk about menopause misconceptions, her clinic, and her book.
What usually happens when a woman goes to the doctor for menopause?
Typically when a woman who’s, say, 49 or 50, goes to her doctor and says, “I feel terrible; I gained 10 pounds for no reason; I’m having hot flashes; I can’t sleep; I’ve got vaginal dryness; I don’t want to have sex with my husband,” they might hear something like, “Well, you’re going through menopause. Just wait it out, you’ll get used to it." Or, 'This is just what the rest of your life is going to be like now. Welcome to the rest of your life.” I’m not joking, that’s something that many doctors say.
Besides the typical menopausal symptoms like hot flashes, what other symptoms do women have?
Insomnia was my biggest problem, to the point where I could only sleep about two hours a night. So, it’s really serious problems: forgetfulness, memory loss. We have estrogen receptors literally from our heads to our toes, and so it affects every part of our body—joint pain, tiredness, chronic fatigue-like symptoms, so many things.
Are there any other side effects?
There’re psychological aspects that go along with it too. All of a sudden now, you’re seen as just old, and that sort of puts you into a different part of the cultural spectrum. Like, you’re not fertile anymore, so you’re not relevant anymore—just old—and it can be a very challenging. You see a lot of depression along with long relationships ending. It’s a real whirlwind of things that come together in all different directions. It's right at the time that your kids are going to college, and your parents might be getting sick, and your job might be coming to an end. All these things happen at once. It’s a very delicate moment that I can say, without question, most doctors just breeze right over and then leave the patient feeling not only invalidated, but also kind of crazy.
At your clinic, Complete Midlife Wellness Center, you spend an hour with your patients during exams. What goes during that time?
Our annual exam we call an "annual wellness experience." We take the whole hour, and we do the same things. We’ll do your breast exam and the pap smear and your blood work, but we’ll also talk to you for as long as it takes, going through all of those other subjects—your relational wellness, your sexual wellness, your spiritual wellness, your exercise routine. We do your body composition; I do recommendations on how to optimize your muscle mass, for example. Check your hormones, and see if hormone replacement might be an option for you. We just get into much more detail than you are normally able to get into with an annual exam.
Your clinic also focuses on sexual wellness and you bring in a weight loss specialist and sex therapist. What else do you do?
Some of our services are not strictly medicine. One of my other skills is that I’m a professionally trained life and leadership coach. In the same vein of having someone really listen to you, if the problem isn’t really so much a medical issue anymore—that you’re struggling with a career change, or relationship change, or trying to create a plan for your life, cash, and/or purpose, we can do that to, without any gynecology involved. That’s more general life improvement. So I do coaching. I collaborate with and bring in several other wonderful female physicians who provide extra services that I don’t offer, including cosmetic surgery.
Let’s talk about your book, Sexually Woke. Your own experience of rediscovering your sex drive after your divorce served as its inspiration. Can you talk more on that?
Leaving that relationship, and starting a new relationship, and discovering that my sex drive actually hadn’t gone—it was just asleep. It was the wrong partnership, it was the wrong type of communication; there was nothing wrong with me. It was just a conglomeration of things that didn’t work, so I got really interested in whether other women felt this way too. So, I did a big study over a period of about 18 months, interviewing hundreds of women, and isolated a group of women who felt the same way—who felt that their sex drive had become even fuller and richer with time, rather than going away.
What message were you wanting to present in the book?
Mostly, I would say, to present a different, more optimistic, and hopeful picture of what life and menopause can be like. Particularly, in regard to sexual life. I talk more about life than just sex. We talk about relationships, spirituality, and some other things, but it is a book primarily about sexual relationships.
You say our current culture doesn’t do older women justice, especially when it comes to intimacy. Why do you want change that?
The cultural perception of what life is like after menopause is just wrong, and in a way, that really invalidates the amazing, wonderful, beautiful life that women my age can have and do have. And that should be inspired, and honored, and we should be excited about it.
Complete Midlife Wellness Center is located at 1200 Binz St. Sexually Woke is available for pre-order for $22 on Amazon.
This interview has been edited for length and clarity.