What is perimenopause?

By the age of 45 or so, there’s a good chance you already considered how perimenopause would affect you. There’s no accident that this period of hormonal disruption has been referring to for years as “the change.” You’ve most likely wondered: how will “the change” will change me? 

Perimenopause happens when the ovaries don’t function consistently and upset the normal hormonal rhythm.   This hormonal change usually happens within a couple years of menopause, but for some it can happen much earlier. The erratic and disruptive symptoms of perimenopause tend, however, to mark the beginning of menopause. Every decade brings about some emotional and physical change, but for women, the decade of one’s forties may pack the biggest punches of all. Between the typical 40-something anxieties of shifting relationships (divorce and dealings with hormonal or college-bound teens), self-esteem issues, job challenges and other midlife stresses, one’s 40s are challenging enough without the hormonal upheaval. In your forties, it’s not just life’s stresses that are affecting you emotionally and physically, it’s the beginning of “the change and it’s called Peri-menopause.

What age does perimenopause happen?

Perimenopause can happen up to 10 years before menopause which, on average occurs at age 51y.  The average age of perimenopause is 47year but many women notice significant changes during their 40’s. Peri- literarily means near. Perimenopause is the time of transitioning from having regular monthly periods to having irregular to no period at all. Once you do not have a period for one year, you are officially in menopause. In addition to period changes, many other physical and emotional symptoms occur during perimenopause.

 

What are the most common symptoms of perimenopause?

Between the typical 40-something anxieties from divorce, dealings with hormonal or college-bound teens, self-esteem issues, job challenges and other midlife stresses, one’s 40s are challenging enough without the hormonal upheaval. The most common symptoms of perimenopause include irregular periods, hot flashes, sweating, insomnia, depression, anxiety, feeling apprehensive, weight gain or loss, fatigue, bloating, poor concentration, memory loss, vaginal dryness and heart palpitations. These symptoms mimic the symptoms of menopause but tend to come and go unlike symptoms associated with menopause, where the symptoms just come. All of these disruptive symptoms can affect your quality of life.

 

How does perimenopause and menopause overlap?

Perimenopause refers to those years in the reproductive life cycle where the ovarian function becomes irregular. It occurs between 40-55years. Estrogen production from the ovaries is erratic and unpredictable causing menopausal symptoms.  Perimenopause are hormonal changes that occur before you are officially in menopause.  There may be months or years of overlapping symptoms. Menopause is a time when your ovaries completely stop producing estrogen and your female hormones are absolutely depleted.  Once you stop having your period for one year you are officially in menopause. The average age a woman enters menopause is 51yr but menopausal symptoms can start in your 40years as hormonal fluctuations begin.

 

How do I know I am in perimenopause versus menopause? 

It can be challenging to know the difference between these 2 normal hormonal cycles.  The conversation starts with knowing your period frequency, hormonal symptoms and adding in lab tests, including your FSH and Estradiol levels.  Since many of these symptoms overlap, the key differentiator is once your period stops for an entire year the diagnosis of menopause is at the top of the list. During perimenopause, your FSH will most likely be in a normal range, even though you are experiencing symptoms of menopause. This is why perimenopause is the most underdiscussed or diagnosed since your hormonal testing is normal.  Unfortunately, some healthcare providers may tell you “Everything is normal, so come back when you don’t have a period for one year”. The most important take home message, even though you are not in menopause, if you are having disruptive perimenopausal symptoms there are viable treatment options.

Sometimes what we need most is a thorough understanding of exactly what is happening physiologically, if only to realize that what you are going through is normal and, most importantly, that you are not crazy!

 

Who is most likely to experience perimenopause?

As long as you have ovaries you are fair game for premenopausal symptoms. Women who have breast cancer and are receiving chemotherapy may experience perimenopause symptoms earlier than the average woman.  Also, women who smoke cigarettes may also experience these symptoms sooner than women who do not smoke. Certain medications can make the ovaries not function properly bringing perimenopause and menopause on sooner than later. Thin women, genetic predisposition, chromosomal abnormalities such as Turner syndrome may also bring on premature ovarian failure.

 

How does perimenopause impact workouts and exercise routines?

Regular exercise 4-6 times a week for a minimum of 30minutes is helpful to reduce weight gain, fatigue, bloating and water retention.  Ideally, exercise should be part of your daily routine.  When you exercise there is a release mood boosting endorphins and serotonin which are the “feel good” hormones.  Exercise helps women emotionally and physically during perimenopause.

 

How can I treat irregular bleeding caused by perimenopause?

Heavy and irregular periods are best treated with hormone.  Since there is a hormonal disruption during perimenopause, these hormone treatments are perfect options for regaining control of your periods.

• Low dose oral contraception is at the top of list to control your periods best. There a many different pills available so if the side effects make you feel awful than keep switching until you find the right one. 
• Cyclic progesterone taken 10 days a month
• The IUD with progesterone (Mirena, Kyleena, Sklya, Liletta) 
• Hormone replacement therapy (HRT) 
• Non-hormonal alternatives include acupressure and herbal therapy.

 

How can I treat hot flashes caused by perimenopause?

 

Dressing in layers and staying in cool temperature are the first steps in dealing with hot flashes. Avoid hot beverages, spicy foods, red wine and hot climates bring that bring on hot flashes. Herbal remedies may include passion flower extract, ashwagandha, chasteberry for hot flashes and other symptoms of peri-menopause. 

Even though the studies are not conclusive, hot flashes may improve with acupuncture treatment. 

 

How can I treat mood swings caused by perimenopause?

Antidepressants are effective in controlling depression, anxiety and panic attacks. A therapist may also give added support. And, of course, exercise, the elixir to all. 

 

What lifestyle habits will help me manage symptoms caused by perimenopause?

A healthy lifestyle goes a long way at any time in your life, but especially in perimenopause. Inactivity, unhealthy diet (fast food!), smoking, obesity, excessive alcohol consumption…if you’re still waiting to remedy any of it, now is the time! All of these factors only make perimenopause worse than it needs to be. There are simple adjustments you can start to make as soon as you put this book down.

• A diet focused on fresh fruits, vegetables, whole grains and fish, with limited alcohol intake and little red meat (similar to the Mediterranean diet) not only benefits your heart, it improves cognitive function. The Mediterranean diet is associated with the highest life expectancy and lowest heart disease rate and is proven to help menopausal symptoms. No downside there.
• Ditch the fast food, fast! The saturated fats and excessive sodium in fast food gives you no “value” whatsoever, in fact, depression is more common in those who eat fast food regularly. Within weeks of removing this food, you will show a decrease in cholesterol levels and even a decrease in weight gain. 
• Removing or decreasing “sweets” in your diet will not only limit your calorie intake; it will often reduce your intake of fat. A reduction of sugary foods will immediately reduce blood sugar, which will help in decreasing the bloating and water retention so common in menopausal women.

 

Does exercise help with my symptoms of perimenopause?

Regular exercise improves metabolism, breathing, energy and emotional stability. Exercise makes you feel more confident and helps ease the stress of perimenopause symptoms. It strengthens your heart and improves your sleep patterns. Exercise abstinence not only puts you at risk for heart disease, high blood pressure and other chronic health problems, it leads to weight gain, obesity, fatigue, insomnia and depression, all of which worsen the transition into menopause. Exercising as little as 30 minutes, three days a week can show immediate health benefits. I’ve become obsessed with my Fitbit because I can be very sedentary some days. Keeping track of your steps, aiming for 7,500-10,000 a day, will make you more accountable and successful in monitoring your daily activity.

 

What bad habits make perimenopause worse?

Smoking.  Just stop, if not for the fact that smoking increases the risk of heart disease, stroke, lung cancer and death, but because it makes hot flashes more frequent and severe during perimenopause. A recent study showed women who stopped smoking at least five years before menopause had a significant decrease in the severity and frequency of hot flashes. 

Limit Alcohol Consumption. Alcohol increases your risk of heart disease, liver disease, high blood pressure, diabetes, colorectal and breast cancer, and, now we know (drum roll please), worsens hot flashes—and, by the way, one five-ounce glass of wine is equivalent to 1½ ounces of hard liquor, which may surprise and depress many of you. It’s recommended that you consume no more than three to four servings of alcohol a week. Removing alcohol, even one or two drinks a few times a week, has immediate effects on blood sugar levels, water retention, blood pressure, weight loss, energy level, emotional stability, sleep changes and pulse rate. 

How does sleep affect perimenopause?

Sleep is so important and necessary. As with eating and drinking, sleeping is a necessity in life. Getting a good night sleep is critical to good health, mentally, physically and hormonally.  The recommended hours an adult should sleep is 7 to 8 per night.  If there are several nights where you are losing 1 to 2 hours per night this can cause signs of sleep deprivation.  The hour’s loss during each night accumulates and is impossible to get back. 

If you are not getting enough quality sleep, you will not be able to function normally or feel rested during your waking hours.  Sleep deprivation can affect your ability to be efficient at work, school, and home.  Trouble focusing, thinking clearly, and reacting to everyday activities is compromised. Emotionally, you will feel frustrated, moody, irritable, and stressed.  Car accidents, leading to dangerous injuries and death, are also associated with sleep deprivation.  In the older population, there is an increased incidence of falls and broken bones.

Chronic sleep deprivation is associated with heart disease, high blood pressure, diabetes, stroke, obesity, and depression.

 

Why do sleep problems specifically occur for women as they enter perimenopause? 

It’s common for women to experience sleep disturbances as a result of the typical symptoms of perimenopause including hot flashes, night sweats, depression, anxiety and other mood disorders. When estrogen starts to become erratic by the ovaries hot flashes occur causing a quick and intense heat sensation all over the body accompanied by sweating. Up to 85% of women experience hot flashes occurring in the middle of the night causing insomnia.  Hot flashes can last 3 to 6 minutes making it difficult to go back to sleep, affecting the overall quality of sleep. The majority of perimenopausal and menopausal women experience insomnia, snoring and bouts of sleep apnea. Insomnia ultimate leads to daytime fatigue which is disruptive and a cause of concern.

During perimenopause, estrogen production from the ovaries is erratic and unpredictable causing disruptive symptoms.  Sleep problems can definitely begin in perimenopause.

 

Why do I gain weight during perimenopause?                  

Most women can handle the hot flashes, night sweats, insomnia, mood swings, anxiety, depression, fatigue, even low sex drive but it is the weight gain that takes women to the edge of the cliff. The average weight gain in perimenopause is around 5 pounds. 20% of women gain 10 pounds or more. 

There are many reasons women gain weight in perimenopause:

Decreased estrogen levels during perimenopause leads to an increase in total body fat which results in a decrease in lean body mass.  As we age, our muscle mass decreases while our fat increases. These changes also cause your metabolism to slow down. 

Weight gain is also accompanied by an increased tendency for central fat distribution -meaning abdomen, hips, thighs, and buttock–in women in midlife. The bottom line is if you continue to eat the same number of calories as you usual do, do not increase your physical activity and lose muscle mass with age… you are destined to gain weight. 

Lifestyle choices and changes also contribute to weight gain. As women age, they tend to be more sedentary and more stressed which also contributes to weight gain. The disruptive hormonal changes of peri-menopause and menopause including fatigue, insomnia, depression and other mood changes doesn’t set the stage for us to hit the gym on a daily basis. This decrease in energy contributes to unwanted weight gain.

Genetics always has a hand in weight gain which can be even more frustrating. 

Sadly, obesity or having a BMI>30 increases our risk of Diabetes, high blood pressure (Hypertension), and heart disease so combatting obesity should be our #1 priority.

How can you combat weight gain during perimenopause?

Weight gain in women over 45y is a common complaint at the doctor’s office. The best ways to help prevent unwanted weight gain is to do the following:

Exercise regularly and often-The best form of exercise is aerobic activity combined with strength training.  The more muscle you build up the better your body burns calories. If you are doing moderate aerobic activity such as brisk walking, 150 minutes a week is optimal.  For more strenuous aerobic activity such as jogging, 75 minutes a week is recommended.

Eat 200-300 calories less a day to maintain your current weight.  Be mindful of eating a colorful, healthy and well-balanced diet including fresh fruits, vegetables, whole grains and fish.  If you have to cut calories chose those with less nutritional value, such as fats and alcohol.  Eating a healthy diet will also have other health benefits such as reducing the risk of heart disease, stroke, diabetes, high blood pressure, high cholesterol and improve cognitive function.

Create an over 50yr support team-I am sure your close friends are going through the same frustrating challenges regarding unwanted weight gain.  Use your friends and family as a support team to make permanent healthy lifestyle and dietary choices that will promote healthy aging and defeat the battle of the budge.

 

What foods can I eat to help my perimenopausal symptoms?

There are many dietary and lifestyle choices that can be made to help avoid bloating, diarrhea, constipation, and intestinal symptoms associated with perimenopause and menopause. 

 

1. Avoid foods that are classic causes of bloating including beans, broccoli, Brussels sprouts, cabbage and cauliflower. Other dietary culprits include rich and fatty foods, whole grains, apples, peaches, pears, lettuce, onions,
2. Avoid foods high in sodium that contribute to bloating and weight gain such as salty ethnic foods.
3. Drink as much water as possible, 2-3 liters a day is ideal to help minimize water retention and bloating. Other water-based foods that help with hydration include berries (strawberries, blueberries) celery, cucumber, lettuce and watermelon. Adding ginger to hot water is another useful remedy.
4. Vitamins such as calcium, vitamin’s E, D, thiamine, magnesium and omega 3-fish oil may also be helpful in relieving the period bloat and swelling.
5. Eat healthy foods including fresh fruits and veggies, proteins-fish, chicken- and complex carbohydrates such as whole grains and brown rice prevent bloating.
6. Eat foods that are natural diuretics to reduce the bloating and swelling such as celery, cucumbers, watermelon, tomatoes, asparagus, lemon juice, garlic, melon & lettuce.
7. Green tea is a great natural diuretic and can serve as a comforting beverage. 
8. Regular exercise 4-6 times a week for a minimum of 30minutes is helpful to reduce bloating and helps with water retention. 
9. Limit your alcohol consumption during this sensitive time during your menstrual cycle since it makes bloating symptoms worse.
10. Calcium rich foods and supplements reduce muscles from cramping.  Ideally 1,000mg/day of dietary calcium works best.  Dairy products (cheese, yogurt, milk), sunflower seeds, spinach, soybeans, kale, figs, almonds, sesame seeds and tofu are excellent sources of calcium.
11. Drinking water, warm or hot, helps relax the uterine muscles.

 

What are some treatment options to help my libido?

Perimenopause is brutal for the sexual wellness for the millions of people dealing with this normal hormonal cycle. Using vaginal estrogen, vaginal dilators, a great lube helps with some of these disruptive symptoms caused by perimenopause. Testosterone is not FDA approved but can help with sexual desire and arousal for some women. One of the FDA approved medications, Addyi, can also be used to help increase sexual desire for peri-menopausal women. 

Getting control of your irregular bleeding and emotional distress is also helpful in regaining your sexual interests in the bedroom.

All women, especially those in perimenopause need a vibrator and here’s why.

It can be harder to have an orgasm after 45year, has anyone noticed?

During perimenopause there is less blood flow to the vulva and clitoris. Orgasms can take longer to happen and may not feel as intense. Keeping the vulva and vagina moisturized is a step in the right direction. There is some truth to “if you don’t use it, you’ll lose it”. The more stimulation the vagina gets the more natural lubrication will occur which is helpful to maintaining a healthy vagina. A vibrator is a great way to improve sexual function, satisfaction, sexually related distress, and genital sensation…it’s a win-win in my opinion!

 

Aren’t vibrators for a sex fiend?

The vibrator was not originally intended to be a sex toy. Vibration therapy was originally used to treat sexual problems for women and men. In the late 1800’s, vibration therapy was used to treat erectile and ejaculation dysfunction, low desire and inability to have an orgasm. You may be surprised to learn that up to 20% of women have never had an orgasm. Vibrations delivered to the vulva, vagina, testicles, scrotum, perineum and anus significantly and positively improves sexual desire, sexual arousal and orgasm. Vibration increases blood flow and stimulates the complex nerve fiber pathways-superficially on the skin and deeper in the erectile tissue. 

Clitoral and erectile tissue sensation fades as women grow older due to less blood flow to sensitive and fragile genital tissue. As a result, it can take longer to become aroused, along with longer stimulation and the need for lubrication, to have an orgasm. This is where vibrators can help. They can provide the needed stimulation in order for you to orgasm. 

Vibrators have long been a taboo and the best kept secret.  Vibrators are not typically regarded as a medical device by mainstream society but can be classified by the FDA as therapeutic devices to treat sexual dysfunction/sexual problems—because vibrators have been shown to provide sexual health benefits for people!!…The time is now to bring the vibrator out of the closet. Genital vibrator use is associated with increased openness in people’s thoughts and attitudes about sexual activities generally and about themselves as sexual beings

It’s time to embrace our sexuality and enjoy using whatever type of sex toy turns you on. 

Reassuring statistics are vibrator use.

The new results are based on two studies, one surveying more than 2,000 women and the other more than 1,000 men (ages 18 to 60), both of which are published this week in the Journal of Sexual Medicine. 

• More than 50 percent of women participants had used a vibrator, with nearly one in four having done so in the past month.
• More than 70 percent of women reported having never experienced any side effects associated with vibrator use. (Those side effects that were reported were typically rare and of a short duration, including mild genital numbness, irritation, or inflammation.)
• About 45 percent of men, both gay and heterosexual, reported incorporating a vibrator into sexual activities.
• Of men who have used vibrators, 10 percent had done so in the past month, about 14 percent in the past year and about 21 percent more than one year ago.
• Men who reported having used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam.
• Men who had used vibrators recently also scored themselves higher on four of the five factors used to measure sexual function (erectile function, intercourse satisfaction, orgasmic function and sexual desire).

“The study about women’s vibrator use affirms what many doctors and therapists have known for decades — that vibrator use is common, it’s linked to positive sexual function such as desire and ease of orgasm, and it’s rarely associated with any side effects,” said study researcher Debby Herbenick, associate director of Indiana University’s Center for Sexual Health Promotion.

Why does vaginal dryness happen during perimenopause? 

Hormonal changes over the decades also influence the integrity and elasticity of the vagina. Vaginal dryness is a common consequence of the hormonal collateral damage to the vagina. Estrogen fluctuations during peri-menopause can cause vaginal dryness. As you age and lose your subcutaneous fat in your body, the fat in the vagina also decreases making the lips looks thinner and the tissue more prone to dryness.

With peri-menopause and menopause there is the loss of estrogen nourishing and hydrating the vagina, the tissue becomes dry, pale and dehydrated.  The labia of the vagina can become fused and the vagina and clitoris shrink.  The labia become less full, losing its fatty pads and the skin loses its collagen. The end result is lighter or darker appearing labia that ultimately sag. Bladder changes happen as well creating symptoms of urinary frequency, urgency and urinary tract infections. The medical term for this is genitourinary syndrome of menopause (GSM), formerly known as atrophic vaginitis.

Treatment includes starting vaginal estrogen or DHEA early in the menopause transition to prevent worsening symptoms of genitourinary syndrome of menopause (GSM).

 

What’s the best advice to keep the vulva and vagina hydrated and moisturized before perimenopause causes worsening genital dryness?

Creating your personal daily hygiene routine with specific products used is important to create. A healthy vagina needs the same hygienic attention as any other part of the body, similar to the way we care for our face.  The skin of the vulva and tissue inside of the vagina is susceptible to dryness if not taken care of properly.  When your body is adequately hydrated the vulva. including the labia majora and minora, is less prone to dryness and the inside of the vagina will be moist and well lubricated.

There are known offenders, such as childbirth, hormonal changes including postpartum, perimenopause and menopause, which lead to chronic symptoms such burning, itching, vaginal infections, urinary tract infections and painful sex.

Skin dryness involving any part of the body is uncomfortable and annoying, especially when it comes to the sensitive skin of the vagina.  Persistent vaginal dryness causes itching, irritation, burning and pain that leads to emotional and physical disruptions in daily life activities. Bladder symptoms including urgency, frequency and urinary tract infections can become more noticeable as well. Discomfort, avoidance and pain with sexual activity also becomes a common problem.

Keeping the skin hydrated, clean, and cared for will help prevent dryness. Other helpful daily hygiene rituals include using a gentle, non-fragranced soap and natural skin moisturizer daily, especially ones made specifically for the vagina.  Taking a 20-minute warm bath with a handful of extra virgin coconut oil 3 to 4 times a week will also rehydrate the skin of the body and vulva. Using internal vaginal moisturizing suppositories every 2-3 nights will help nourish and soothe the delicate skin inside the vagina. Adding oral or vaginal pro-biotics to your daily regimen will also keep the vagina hydrated and in complete balance and harmony.

 

Keeping the body hydrated helps keep the vagina hydrated too. The amount of water needed each day will depend on how active you are, if you have any medical problems and the climate you live in. In general, you need to drink at least 8-8 ounces glasses or about 2 liters of water a day. Water is vital for every system in our body, making up 60% of body weight, so constant replenishing is essential.  Alcohol and caffeine should be consumed in moderation since both cause dehydration of the skin and cause dryness of the vagina. Finding your favorite sexual lubricants are great additions to vaginal dryness during intimacy.  

Dryness can also worsen in menopausal women who are not taking oral or vaginal estrogen or DHEA which results in burning, dryness and pain inside the vagina, especially with intimacy and penetration.  Start vaginal estrogen or DHEA early in the menopause transition to prevent worsening symptoms of genitourinary syndrome of menopause (GSM).

 

If you are experiencing on going vaginal dryness, irritation, recurrent vaginal and urinary tract infections, it’s important to see your health care provider to help you strategize with helpful treatment options. You should never suffer in silence!

 

What are some hygiene routines and lifestyle habits that may contribute to genital dryness before it gets worse during perimenopause?  

Erratic production of estrogen during perimenopause makes vulva and vagina dryness that much worse. The years leading up to perimenopause can be used to prevent vulva and vagina dryness by knowing what commonly used feminine products promote harmful changes of this delicate area of the body.

Dryness occurs on the vulva and inside of the vagina. Every day unsuspecting feminine rituals can disrupt the pH balance and irritate all areas of the vulva and vagina causing vaginal dryness.  The list is long and some of the common offenders may surprise you.

Common irritants you may or may not realize are problematic:

• Fragrant soaps, bubble bath liquids, bath salts, talcum powder
• Detergents, fabric softeners and dryer sheets
• Sanitary wipes and pads
• Warming gels and scented lubricants
• Nylon underwear or bathing suits
• Rubber products such as diaphragms and condoms
• Latex allergy
• Saliva or semen 
• Spermicides such as foams, creams and jellies
• Feminine hygiene sprays, tampons or deodorant pads
• Creams or ointments applied to the vulva
• Shaving and waxing the hair around the vagina
• Medications including the Birth Control Pill, Accutane, allergy and cold medications and certain antidepressants are common contributors to vaginal dryness. 

Persistent vulva and vaginal dryness cause itching, burning, infection and pain could create emotional and physical disruptions in your daily life activities.

Make the changes in your daily feminine care now, to minimize the drying effects that the normal hormonal cycle of perimenopause and menopause create.

How can I enjoy sex while in perimenopause? 

The bottom line is that quality of life, especially in the bedroom, is incredibly important and should be a priority.  Expect the unexpected as your body transitions into perimenopauses. Perimenopause is a natural process and everyone goes through it differently.  Irregular bleeding, hot flashes, trouble sleeping, bloating, fatigue, low sex drive, trouble having an orgasm, vaginal dryness, moodiness…none of this bodes well for romance, passion and sex. 

1. Communicate with your partner: Communicate openly with your partner so they know what you are going through is directly related to the erratic production of estrogen, which goes hand in hand with perimenopause. Involving your partner is the first step to improving your intimacy and sexual experience.
   
   2. Self-care: Prioritize self-care activities like exercise, eating a balanced diet, and getting enough sleep. These can help improve your overall well-being and potentially boost your mood, energy and sex drive.
   
   3. Lubrication: Reduced estrogen levels during perimenopause can lead to vaginal dryness. Using a favorite lubricant, especially water-based, can increase comfort and pleasure during intimacy and sexual activity.
   
   4. Explore different types of stimulation: Experiment with different types of sexual stimulation such as oral sex, solo play, or using sex toys. Vibrators are always worthwhile to bring into the bedroom for yourself and with a partner. Vibrating erectile tissue helps reach orgasm more easily and quickly, and will give you a novel intensity when having an orgasm.  

5. 
   Address physical changes: Perimenopause can bring changes like decreased vaginal elasticity. Regularly performing Kegel exercises can help strengthen pelvic muscles and improve sexual pleasure.
   
   6. Educate yourself: Learn more about the effects of perimenopause on sexual health. Understanding the physical and emotional changes can help you navigate this normal hormonal cycle more comfortably and confidently.
   
   7. Seek professional help: If perimenopause is significantly impacting your sexual enjoyment, consider talking to a healthcare provider or a sexual health specialist. They can offer personal guidance and potentially suggest treatment options, such as hormone therapy.
   
   Remember, everyone’s experience is different, so it’s important to explore what works best for you and communicate with your partner openly.

 

What can I do for my shrinking and collapsing vagina-in perimenopause? 

Shrinking and collapsing vaginas need a voice too! Many women suffering from vaginal shrinkage or atrophy usually do not have regular vaginal penetration. Lack of penetration, combined with GSM, can result in a shrinking of the vaginal opening which I have coined the Collapsed V. A survey found that 45% of women have never actually had an honest conversation about their vaginal dryness with their health care provider. They may have resigned themselves to sexual intercourse only once or twice a month or on “special occasions,” giving the term “birthday sex” a whole, new despairing meaning. 

The good news is these disruptive vagina changes can be reversed. To begin the process of opening up again, literally (and perhaps figuratively), vaginal dilators may be employed to stretch the vaginal opening. Usually, the process involves use of a dilator for 20-30 minutes, three to five times weekly, gradually increasing the size, with the goal of making vaginal penetration easier on the tissue. I created the first and only award-winning vaginal dilators that you can wear (compared to traditional dilators where you need to be lying down to use them) which has improved comfort, compliance and faster results at keeping the entrance of the vagina more accommodating and less painful during vaginal penetration. Used in combination with weekly estrogen cream therapy, symptoms related to vaginal atrophy may be reversed, allowing painless (and, with luck, enjoyable) intercourse. As long as you’re at it you might try soaking in an Extra virgin coconut oil bath for 20-30 minutes a day as a pampering addendum to treating dry skin, not only in the vaginal area, over your entire body. Using my silky serum vulva skin moisturizer also keeps this delicate area moisturized since menopause causes thinning of this area as well.

Alternatives to conventional dilators can be found not only at a local sex toy store in the form of dildos or vaginal vibrators, I don’t care if you use a cucumber or zucchini (of course covered by a condom) but traditional vaginal dilators are recommended.  If you do however choose a ubiquitous form of produce, make sure you use a condom on it to avoid unwelcome bacteria. A pea-size dollop of topical lidocaine applied to the entrance of the vagina also helps in avoiding pain when introducing anything into a sensitive vagina, be it vegetable or mechanical.  Because some of my shyer and less adventurous patients don’t know where to begin, I have gone online in my office with them in order to scroll through dildos on goodvibrations.com, a great, accommodating online sex store that caters to women. While we’re perusing the endless array of toys, I ask these shyer patients of mine to try and approximate their husband or partner’s “size.” I tell them to decide on a favorite color, choose a special lube and pick a vibrator. 

I’m glad to say that most of these patients report back with promising results after conventional vaginal estrogen therapy combined with a little fun (perhaps in the form of a classic purple dildo). Realize that when you enter menopause it’s not just the vaginal pain and dryness that can ruin a perfect date night, it’s the worry of vaginal collapse from infrequent intercourse. If you are having problems not only with dryness, but vaginal shrinkage and pain, please talk to your health care provider. Many doctors are not comfortable talking about sexual issues and if that is the case, find one who is comfortable doing so. Keep in mind that creative strategies are not only fun, but may be a necessity. The perimenopausal women deserve sexual enjoyment in the bedroom but you have to be an active participate in this area.

 

Why does peri-menopause affect me sexually, especially my sexual desire?

When you enter the next chapter of life, your estrogen and testosterone levels both come erratic, affecting your sexual functioning and desire to be sexually and intimate.  Estrogen plays a key role in women’s sexual functioning. It helps maintain the genital tissue sensitivity, elasticity, secretions, pH and microbiome flora, urinary continence, pelvic muscle tone and joint mobility. When you enter menopause and lose your estrogen, physical and mental changes occur, some symptoms faster than others.

 

50% of women have vaginal and bladder problems caused by low levels of estrogen beginning in peri-menopause, and worsening in menopause. Pain with vaginal penetration, trouble having orgasms and inadequate vaginal lubrication are reasons women’s sexual desire is decreased.

 

Over 60% of women will report losing their libido.  Women are being bombarded with physical and emotional symptoms that directly affect their mood in the bedroom. Many women rather be doing the laundry than having sex with their partner.  This can create a lot of disruption in a relationship since over 30% of women stop having sex all together.  Perimenopause and menopause are brutal on sexual wellness and the vulva and vagina. Using vaginal estrogen, vaginal dilators, a great lube helps with some of these disruptive symptoms caused by perimenopause and menopause. Using testosterone can also help with sexual desire and arousal for some women. One of the FDA approved medications, Addyi, can also be used to help increase sexual desire. 

 

Give your vagina a voice so you can continue to have a healthy sexual relationship with yourself or a partner during perimenopause and menopause.

Why does noticeable vaginal dryness begin in a women’s 40’s?  

Hormonal changes over the decades also influence the integrity and elasticity of the vulva and vagina. Dryness of these areas is a common consequence of the hormonal collateral damage of the decline in estrogen production. Estrogen fluctuations during peri-menopause can cause vaginal dryness and becomes worse, when estrogen is completely gone, during menopause. As you age and lose your subcutaneous fat in your body, the fat in the vulva also decreases making the lips looks thinner and the tissue more prone to dryness.

With peri-menopause and menopause there is the loss of estrogen nourishing and hydrating the vulva and vagina causing the tissue to become dry, pale and dehydrated.  The labia of the vulva can become fused and the clitoris and vagina shrink.  The labia become less full, losing its fatty pads and the skin loses its collagen.  The end result is lighter or darker appearing labia that ultimately sag. The medical term for this is genitourinary syndrome of menopause (GSM), formerly known as atrophic vaginitis.

How to navigate depression, brain fog, and fatigue — this is the first time I have experienced this in my life?

We always hear about hot flashes, night sweats, irregular periods and insomnia classically linked to perimenopause but there are other symptoms equally annoying but less talked about.  Perimenopausal symptoms occur as a result of low estrogen levels which can also cause a drop in serotonin and dopamine levels leading to cognitive changes including memory loss, poor concentration, brain fog and depression. Normal aging also contributes to memory and brain fog issues so the overlap makes these symptoms seem more pronounced.

 

Vyvanse and other ADHD medications can be helpful with perimenopausal symptoms related to staying focus, organized, managing time, improving concentration, forgetfulness, and memory, also known as “foggy brain”.  Even if you have not been officially diagnosed with ADHD in the past, perimenopause can throw you into an ADHD-like state. 

A woman’s natural estrogen supply is protective against developing depression.  Hormone replacement therapy can be helpful with some of these symptoms, especially if it is a new onset of depression. Perimenopause can worsen a woman’s depression or can bring out a depression a woman did not know she had. Talking to your healthcare provider or therapist can help you navigate these symptoms and consider starting a new antidepressant or increasing the dose of one that a woman is currently taking.

How do antidepressants help with perimenopausal symptoms? 

Some antidepressants have been found to lessen perimenopausal symptoms including hot flashes, night sweats, mood swings, depression, and anxiety. Unfortunately, some of the side effects of antidepressants, such as low libido and weight gain, can discourage their use.  As long as the benefits outweigh the risks, it’s a viable treatment option worth exploring.

What are other non-hormonal alternatives in treating perimenopausal symptoms?

There are medications including Gabapentin and Clonidine which are not FDA approved for perimenopausal symptoms but can help minimize hot flashes. Side effects of both include dizziness, headaches which drowsiness may feel more disruptive than hot flashes. 

Acupuncture and relaxation techniques including mindfulness, biofeedback, hypnosis, cognitive behavior therapy, yoga and Tai Chi may be helpful in controlling mood swings, depression, anxiety, hot flashes, and other mild symptoms of menopause.

There are many safe alternatives and supplements to use to treat common symptoms of perimenopause. You may be surprised to know that there are many scientific studies showing certain herbs to be helpful in managing the symptoms of menopause. Rubarb extract, Passionflower extract, L-Theanine, Chasteberry, Royal Jelly, Ashwagandha, Rhodiola, phytoestrogens, Ginseng, Black Cohosh, Evening Primrose oil, Hops, Lemon balm, Red Clover, Shatavari, Tribulus, Valerian, Wild Yam, Dong Quai root, St. John’s wort, Chromium, Fenugreek, Ginkgo Biloba Leaf Extract, Chamomile, Maca Root and CoQ10 are some of the better researched herbs shown to combat symptoms and improve your life. Although herbs are not FDA approved like pharmaceutical medications, well-regulated supplements can be as effective as, if not safer than, prescription medication.

Can Cannabis/THC help with perimenopausal symptoms?

Despite up to 80% of peri-menopausal and menopausal women using medical marijuana to help alleviate common symptoms including hot flashes, mood swings and insomnia, there are no long-term medical studies to support benefits versus potential risks. Medical research often lags behind new treatment options for disruptive hormonal symptoms, yet use with caution until science can prove its safety.

 

Why you need to advocate for yourself in perimenopause?

I am here to empower women to have courageous conversations about their bodies as you age and transition in perimenopause. You must come to your healthcare provider with your personal questions on how “the change, is changing you”. You deserve answers, guidance and treatment options that fit your personal needs. Many healthcare providers will dismiss your symptoms if you ovarian hormonal testing-including your FSH and Estradiol-are normal and you are still getting periods, even if they are irregular or erratic. 

I love encouraging women to take control of their health and well-being.  I am challenging women and others to change the narrative on improving women’s healthcare needs, especially as we age. 

 

Why am I experiencing hair loss during perimenopause? 

Hair loss during perimenopause and menopause can be attributed to hormonal changes. Estrogen, a hormone that plays a role in maintaining hair thickness and growth, decreases during these normal hormonal cycles. The androgen hormone levels, including testosterone, may remain constant or slightly increase, leading to hair thinning or hair loss patterns more commonly associated with male-pattern baldness.

These hormonal shifts can upset the natural hair growth cycle. Hair follicles may enter a resting phase (telogen phase) more frequently, leading to increased shedding. Additionally, the new hair that grows during the growth phase (anagen phase) may become thinner and less pigmented.

The good news is not all women will experience noticeable hair loss during perimenopause or menopause, and the extent of hair loss may vary. If you’re concerned about excessive hair loss, consulting with a healthcare professional or a dermatologist can be helpful to provide personal guidance and treatment options.