Did you know September was national menopause month? No? Well, neither did I.  Actually, someone might have told me, and I just went ahead and forgot because I’ve got so much to do and too little estrogen to do it with. Anyway, I’ve been meaning to write about menopause for a long time on the blog because when I entered menopause, I was shocked that I knew little or nothing about it, and also how much of a taboo the issue was – and for a lot of women, it’s the same. 

Fake News 

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 symptoms, they said, “Fake news, mom!” No one tells you that estrogen, the hormone that makes women biologically so – a.k.a., “your mojo” – controls bone density, mental clarity, muscle mass, sleep cycle, and more. And oh, have you ever heard the phrase “losing your grip”? Well, to a great degree the phrase is rooted in the fact that estrogen partly 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, eventually, in your 50’s or 60’s, your period ends, and you can’t make babies anymore. 

Model Veronica Webb Webbonthefly.com at Caudalie spa NYC Madison Ave wearing a Maison De Papillion Caftan in yellow standing in front of a bookcase
The French Beauty Solution

Not worrying about birth control or having to deal with your period any longer may sound like a gift. At least, it seems so when you hear it during your peak fertility years; but my mother always said, “Don’t look a gift horse in the mouth.”  Our bodies are a gift for sure, but they’re also gift that requires a lot of care so every change that we go through as women needs to be examined and delt with the utmost care. Menopause can change a woman’s body by a lot, just as much as puberty changes our bodies. I wish someone would have had the menopause talk with me when I was a kid, it is every bit as important as the where do babies come from, birth control, STD prevention, and safe sex talk.

Can We Talk?

So, why don’t we have the menopause 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, to this day, as 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, no one, including me, dared bring it up. Until like most women, I hit a wall and started asking questions. 

Change is Going to Come 

My first symptoms of perimenopause occurred in my late 40’s. Out of the blue, the top of my ears would get hot like they were on fire and tingle for minutes. Sometimes, the same would happen to the back of my hands, and my grip would weaken. 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 it was 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. I wish I had been using an app like FLO the menstrual cycle and and fertility tracker that my teenage daughters have  grown up using.

Photo Courtesy of FLO

FLO is a handy calendar backed-up by rich a data base for learning about women’s reproductive health that contains real user information culled from over 100 million women world wide who use the app. 

Body Heat 

Honey, kiss your blow-dry bye-bye. Or shall we say climate change? Because, without warning, hot flashes would engulf my entire body raising my body heat 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 an ice cream or a piece of cake. Hot flashes are aggravated by caffeine, sugar and hot meals. Spicy food and sugar introduced into the ecosystem of a woman in the throes of menopause is like throwing gasoline onto a fire. Why am I saying all this? Basically, I was drenched after doing anything that was both fun and  necessary for daily activities – basically life. 

Menopause is like a series of unpredictable violent superstorms in your personal universe, ping-ponging between flood and drought. Drought! Let’s talk about that because once your period ends, its time to usher in vaginal atrophy. 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 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 equal decreased sexual desire. 

When the delicate skin of the vulva gets thinner, in some cases, micro-tears can occur in that area. You know, something as basic as taking a walk, can leave the vulva feeling like it’s covered in paper cuts. Have you passed out yet? No? 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. 

Your Sexual Wellness Routine  

For advanced perimenopausal and menopausal women, sexual intercourse brings its own set of challenges. For example, penetration can cause a burning sensation, which is often a sign of a weakened pelvic floor. Even if you hate to exercise, Kegel exercises can help, they are both effective and worth it. 

But how are Kegel exercises done? Well, here it is – now, pay attention! Start by contracting and drawing the pelvic floor upwards into a hammock position, then hold the contraction for a moment – release and contract the pelvic floor repeatedly to tone and strengthen both the vaginal canal and the pelvic floor.  Of course, some women prefer to speed the process by augmenting kegel exercises with a magnetic pulse kegel chair or using a kegel bar as part of their daily sexual wellness routine

Bye Bye Dry Down There

Then, there is vaginal dryness to worry about. Reduced, or, in some cases, near-total absence of lubrication fluids that should naturally 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 altogether. But like everything else, there are few ways to alleviate this sticky situation – use over-the-counter vaginal suppositories, which maintain a constant level of lubrication in the vaginal canal, and, by proxy soothe the external skin of the vulva. 

Replens, a mineral oil, and glycerine based product is the most basic way to handle this issue; but 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 its ilk contain parabens, which is contraindicated for women recovering from breast and ovarian cancers.

Photo Courtesy of Revaree

Revaree by Bonafide, although new to the market, makes next level vaginal lubrication suppositories, which are hyaluronic acid-based and paraben-free. When my OB-GYN told me about Revaree, a drug-free suppository made from hyaluronic acid (the most prized ingredient in high-end skincare products), as 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 and in 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, you know that 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-childbirth and during menopause for added comfort during any activity.

Photos Courtesy of Lady Suite

Lady Suite, an organic compound of natural oils is made expressly for this purpose, as many women find silicone-based lubricants, sticky and ultimately drying to the delicate skin of the vagina. 

Supple VS Tight 

Now, there’s a host of things that your doctor can prescribe 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 for a healthy pH and normal spontaneous lubrication. Women who have had c-sections, or have not experienced childbirth can often be subject to atrophy of the vaginal lining as well as painfully uncomfortable tightening of the vaginal canal. Women who have had vaginal deliveries often experience extreme dryness and weakened or loose feeling of the inner walls of the vagina. Vaginal resurfacing laser treatments like the highly popular Femilift or MonaLisa lasers can be used to restore elasticity to both the skin and the muscles forming the vaginal canal. This procedure needs to be done by a doctor with a lot of experience. You need your vagina, so don’t be shy about asking how many procedures your provider has performed.

Photo Courtesy of Netflix

Remember that 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, occasionally there is some minimal spotting, most women experience no symptoms afterwards, and nothing can be inserted in the vagina for 3 days after each course of treatment. For myself, and a lot of women who have had the procedure done by a board-certified OB-GYN, there has been 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.

Warm Days Hot Nights 

Since 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 what I speak of. If you haven’t had a baby or gone through menopause yet, here’s the deal: menopause jacks your sleep the f**k up. Here’s another thing, unlike the requisite 6 months, which most women experience after childbirth, this goes on to some degree for years with menopause. 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, all sopping. 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, buy way more eco-friendly beddings 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 one in the middle of the night as opposed to having to change entirely 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 (now, they occur to such an almost imperceptible degree and so infrequently that I really don’t notice them anymore) is to build up to taking ice-cold showers for 60 seconds or longer to lower your core body temperature. This is an easy fix, which is good for your general health because it increases circulation, which in turn reduces inflammation throughout the body. 

Hormone Replacement Therapy 

In addition to all these fixes, there’s the medical route, a combination of vaginal suppositories, daily application of topical estrogen based 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. Really, it’s just a matter of finding what works for you to restore mental clarity because estrogen is tied to cognition in women, reduced night sweats, and sexual function restoration. 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, using it for more than four years of use could have indications for causing breast cancer and or dementia.  What were the rewards? Reduced night sweats, less brain fog, BUT the side effects were substantial. Lightheadedness, hyperpigmentation on my face, and a 15-pound weight gain were acutely aggravated by taking the drug. I lasted 6 months on Angeliq, and then moved on bio-identical hormone replacement therapy (BHRT). I used two 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, but it wasn’t so great with treating vaginal atrophy.  The most effective method of BHRT I tried was the BioTe pellet, which combines estrogen with testosterone, but the weight gain was real – I gained nearly 25 pounds. After 6 months, there’s not a lot 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. 

Would your insurance cover all these? Not really. 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. You wonder why? They are being labeled as investigational

Sharing Breaks the Stigma 

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. Whatever the case, try to be a part of the movement to break the taboo of silence around menopause, and get the help you need.