Did you know September is National Menopause Month? Well, neither did I.
Well, maybe someone told me, and I just forgot because I’ve got so much to do and too little estrogen to do it with. I’ve been meaning to write about menopause for a long time on the blog because when I entered menopause, it was so shocking that I knew little or nothing about it, and also how much taboo the issue was. And this is how it has been for a lot of women in our society.
When I told my teenage daughters, (who have attended some of the most comprehensive and advanced health curriculums in the U.S. school system), about perimenopausal menopausal symptoms, you know what they said: Fake news mom!”
No one tells you that estrogen, the hormone that makes a woman biologically a woman - aka your mojo - controls bone density, mental clarity, muscle mass, sleep cycle… have you ever heard the phrase “losing your grip”? Well, estrogen, to a great degree controls your ability to grip objects with your hand.
My well-educated girls told me little to nothing had been covered in their health or AP bio classes, other than that, eventually, in your 50’s or 60’s your period ends and you can’t make babies anymore.
Not worrying about birth control or not having to deal with your period any longer may sound like a gift. At least, it sounds so when hear it during the peak fertility years when your period is just a way to keep track of the days, but my mother always said: “Don’t look a gift horse in the mouth.”
But we all know everything in this life comes with a price, which I would say, isn’t necessarily a bad thing - if you’re prepared for the cost of whatever change that comes, whether good or bad.
Menopause can change a woman’s body a lot, as much as puberty changes our bodies. I wish someone would have had the menopause talk with me when I was a kid.
The menopause talk is every bit as important as the where do babies come from, birth control, std prevention, and safe sex talks. So why don’t we have that talk on the regular?
One, we don’t value age and wisdom in our culture as much as we value sex, youth and money. Women are most valued, up to this day, as sexually reproductive pleasure-giving beings, and menopause is like kryptonite to the culturally coveted image of the super sexualized Western woman. It is shocking that most of the time, menopause isn’t even discussed between grown women in private because, no one including me dared bring it up, until, like most women hit a wall, and THEN I started asking questions.
My first symptoms of perimenopause occurred in my late 40’s. Out of the blue, the tops of my ears would get hot like they were on fire and tingle for five minutes. Sometimes, the same would happen to the backs of my hands, and then, my grip would feel weaker. I’m a marathon runner, so I’m no stranger to pain and discomfort, but with the arrival of these symptoms, post-workout recovery began to take longer.
Looking back now, I realize this is because my periods would sometimes last for as many as 14 days at a time. Bad cramps were never an issue for me during my lifetime of menstrual cycles, but somehow with these mega-long periods, I felt like someone was throwing gravel at my legs and lower back non-stop. After a few years of the deluge, my cycle stopped entirely: Can you say climate change?
Without warning hot flashes would engulf my entire body. Kiss your blow-dry bye-bye honey, because my body heat would arise so fast and furiously, I would sweat my hair out in a matter of minutes. This would usually happen after eating a meal or drinking a cup of coffee, or a glass of wine or when enjoying ice cream or a piece of cake. Hot flashes are aggravated by caffeine, sugar and eating hot foods. Spicy food and sugar introduced in the ecosystem of a woman in the throes of menopause is like throwing gasoline onto a fire. I say all this to say that basically, I was drenched after doing anything that was both fun and necessary for me to do on the daily. Seriously? Yes. Seriously!
Menopause is like a series of unpredictable violent superstorms in your personal universe, ping-ponging between flood and drought.
Let’s talk about drought. Ok, so once your period ends - vaginal atrophy begins. Wait what? Yes, that’s a thing, reduced estrogen causes the lining of the uterus and vagina to thin significantly, as well as the skin of the vulva and labia. Many women, during this season in life, report experiencing pain during sexual intercourse along with decreased libido.
Here’s where the chicken and the egg question is clear cut: discomfort and pain = decreased sexual desire. When the delicate skin of the vulva gets thinner, in some cases micro-tares can occur in that area. Tarring can be triggered by something as basic as taking a walk, which afterward can leave the vulva feeling like it’s covered in paper cuts.
Have you passed out yet? Ok if you’re still here, take comfort in the fact that simple topical medications such as Estradiol, a hormone replacement cream prescribed by a doctor can help to ease and, in many cases, significantly remedy the situation. Sexual intercourse basically brings with it, its own set of challenges for advanced perimenopausal and menopausal women. Penetration can cause a burning sensation, which often is a sign of a weakened pelvic floor.
Even if you hate to exercise, it’s both effective and worth it to make Kegel exercises, done by contracting then drawing the pelvic floor upwards into a hammock position then holding the contraction for a moment - then releasing and contracting the pelvic floor repeatedly to tone and strengthen both the vaginal canal and the pelvic floor.
Some women prefer to speed the process by using augmenting kegel exercises with a magnetic pulse kegel chair or using manual equipment like a kegel bar as part of their daily sexual wellness routine. Move it or lose it, ladies.
Reduced, or, in some cases, near-total absence of lubrication fluids, that naturally would occur upon arousal, can cause the vaginal canal to become so aggravated that it feels as though you’ve skinned your knees, and can sometimes result in minor bleeding after sexual intercourse. Vaginal dryness can even become both physically and psychologically detrimental to intimacy causing women to become depressed or avoid intimacy with thief partners all together, but there are few ways to alleviate this sticky situation.
Over the counter vaginal suppositories, which are meant to maintain a constant level of lubrication in the vaginal canal, and, by proxy soothe the external skin of the vulva like Replens, a mineral oil and glycerine based product is the most basic way to handle this issue.
Glycerine based products can have a heavy waxy feel, and in some women the ingredient has been known to cause yeast infections. A lot of over the counter personal lubricants like Replens and others of the ilk contain parabens which also have counter indications for women recovering from breast and ovarian cancers. Revree by Bonafide is new to the market, and it makes next level vaginal lubrication suppositories, which are hyaluronic acid-based and paraben-free.
When my OB-GYN told me about Reveree, a drug-free suppository made from hyaluronic acid, the most prized ingredient in expensive skincare products, and as I’m a beauty junkie, I was instantly game. Both products mentioned here are designed to be used daily to keep the vagina at a correct Ph level, as well as a constant and healthy state of lubrication, which makes both daily activities like walking, exercising and sexual intercourse a much more comfortable and relaxed experience.
While we’re on the subject of care for down there, for thousands of years women have used extra virgin olive oil topically on the perineum and vulva to lubricate and make the skin more supple pre and post child birth and during menopause for added comfort during any activity. Lady Suite, an organic compound of natural oils is made expressly for this purpose and as many women find that silicone based lubricants can become sticky and ultimately drying to the delicate skin of the vagina.
Now, there’s a host of things that your doctor can prescribe to you for relief from vaginal atrophy. The point is not to have a “tight” vaginal canal, but rather to tone the muscles and stimulate collagen production in aid of achieving a healthy pH and normal spontaneous lubrication. Vaginal resurfacing laser treatments like the highly popular Femilift or MonaLisa lasers used to restore elasticity to both the skin and the muscles forming the vaginal canal. Laser resurfacing of the vaginal canal is also prescribed for the treatment of stress incontinence of the bladder, also post-hysterectomy. This procedure needs to be done by a doctor who has had a lot of experience.
You need your vagina, so don’t be shy about asking how many procedures your provider has performed, medical devices in the US and their use on patients can be fast and loose; watch the Nextflix documentary The Bleeding Edge to educate yourself on what to know before interacting with any medical device.
With that said, my experience with the Femilift was extremely positive. It’s no more uncomfortable than a pap smear and takes about the same amount of time - 8 minutes to be exact — three treatments in total and spaced 4 weeks apart. Honestly, it’s a little unsettling to have a Star Wars situation happening down there, the laser wand sounds like a lightsaber during the process. Post-procedure expect some minimal spotting and nothing can be inserted in the vagina for 3 days after each time.
Results? For myself, and a lot of women who have had the procedure done by a board-certified OB-GYN, there has been a significantly increased comfort during intercourse. Be advised that laser vaginal rejuvenation is still new to the market and considered “off-label use” by the FDA.
While we’re talking about remedies, let’s go back to the subject of personal climate change, night sweats are a whole other level of hormone powered superstorm. If you’ve had a baby, you know of what I speak. If you haven’t had a baby or gone through menopause yet, here’s the deal: menopause jacks your sleep t*%k up. This goes on to some degree for years - not for the requisite 6 months, which most women experience after childbirth.
Falling asleep is difficult, and once you manage to slip off into slumber it’s not unusual to wake up suddenly in a puddle of sweat sheets hair pajamas sopping wet.
There’s a couple of ways to go on this one. Tough it out and use herbal teas and supplements, exercise and restrict your diet from foods that stimulate a hormonal response. Stick to sheets and pj’s made from natural fibers like cotton or those equally as good as cotton, but way more eco-friendly bedding and nightclothes made from bamboo.
I found it really helpful to sleep on a towel to combat night sweats because a sweat-dampened towel can easily be replaced by a dry towel in the middle of the night as opposed to having to completely change or sleep on soggy sheets.
Another secret that saw me through those early years of night sweats, which lasted for about 3 years for me, and now occur to such an almost imperceptible degree and so infrequently that I really don’t notice them anymore. An easy fix, which is good for your general health because of increased circulation, which in turn reduces inflammation throughout the body is to build up to taking ice-cold showers for 60 seconds or longer to lower your core body temperature.
Then, there’s the medical route with a combination of vaginal suppositories, daily application of topical estrogen cream to the fattiest part of the inner thigh, oral estrogen therapies or hormonal pellets with a combination of estrogen and testosterone implanted in the buttocks.
It’s just a matter of finding what works for you to restore mental clarity - estrogen is tied to cognition in women, reduced night sweats and restoring sexual function. My experience with oral estrogen combined with progesterone was a trade-off.
First of all, it came with a warning, my doctor cautioned that while Angeliq, the form of hormone replacement therapy (HRT) she prescribed, was safe for a short period of time to see me through the initial phases of menopause; more than four years of use could have indications for causing breast cancer and or dementia. What were the rewards vs. the risks? Reduced night sweats, less brain fog, BUT the side effects were substantial. I had a 15-pound weight gain lightheadedness and the hyperpigmentation on my face was acutely aggravated by taking the drug. I lasted 6 months on Angelique, and then moved on bio-identical hormone replacement therapy ( BHRT). I used 2 forms of BHRT, which is a cream formula made in a compounding pharmacy, that you self-administer by rubbing it on the fattiest part of your thigh once a day.
Kinda messy, but not bad and pretty effective in reducing hot flashes and stimulating libido, not so great on treating vaginal atrophy though. The most effective method of BHRT I tried was the BioTe pellet, which combines estrogen with testosterone, but the weight gain was real - nearly 25 pounds. After the pellet lasts for 6 months there’s not a lot of you can do about titrating the dose other than returning to your doctor to have the pellet, which is inserted through a small incision removed the same way.
For me, I had increased energy in every area of my life, and I felt more strength in my hands, which seem like a godsend experience for me. Low testosterone in women is an issue when it comes to fatigue if you’re literally ready to hibernate around 4 o’clock every day you know what I mean. Most of the above treatments are not covered by insurance since women’s sexual well-being is not treated with the same urgency as men’s sexual well-being.
Viagra is covered by every major medical plan, where only a limited range of HRT or BHRT options are covered by insurance carriers, as they are being labeled as investigational. Knowing what works for you to improve cognition, mood disorders, sexual function, sleep hygiene bone density and muscular strength is a matter that takes a lot of personal research.
Talk to your doctor and open up to other women, in all try to be a part of the movement to break the taboo of silence around menopause, and get the help you need.