The menopausal transition is tough. We’re here with some info to make it a little easier
Since we at KCM first started writing about menopause, we’ve been flooded with questions from women about how to deal with the often uncomfortable side effects of the transition. So we teamed up with Kindra, a female-led company that makes estrogen-free menopause essentials, to help us demystify the life change that every woman will eventually experience. Using questions that you’ve written to us, we spoke with Dr. Suzanne Gilberg-Lenz, a nationally renowned doctor and advocate for integrative women’s health, about how to make the menopausal transition a little less stressful.
WUC Reader: I’m experiencing painful sex after menopause. My doctor said it was a lack of moisture, but I believe it’s more than that. Sex feels like shards of glass. I feel defective and don’t even know how to begin to fix this. I’ve been happily married for 25 years, and I really want this issue resolved.
Dr. Suzanne: This woman is right— it is not just a moisture issue. Of course moisture is part of it, but why is there less natural lubrication? Because of hormonal changes that have an impact on the tissue. As women enter the menopausal transition, estrogen levels fluctuate in a pattern that we’re not used to during our reproductive years. This can have a negative impact not just the vaginal tissue, but the urogenital tissue, so the urinary tract as well. This results in less blood flow, changes in vaginal pH, and changes in your body’s microbiome.
As all of these things change, tissue becomes more fragile. When you have less blood flow, you have less engorgement, and you have less production of natural lubrication. We have glands in the genital area that will become full and release liquid when we are aroused. When your estrogen levels decrease, the tissue will thin and become less elastic. And microbiome changes can cause a shift in bacteria, so you may have more inflammation and irritation. All of these things are going to produce discomfort and pain. So it’s not a matter of just putting lube in during sex.
That “shards of glass” feeling— I hear that description of feeling cut all the time, which is exactly the opposite of what you want to feel! The right kind of moisturizing products in the vaginal area can be really helpful. You can’t just reach for petroleum jelly. Oil based estrogen products, or hormonal products, are really effective and really safe for a lot of women. I’m not talking about systemic therapy— I’m talking about something applied directly to the vagina. But like thousands of women, I’m a breast cancer survivor, and I treat a lot of breast cancer survivors who have either been through chemo or are on anti-estrogen therapies. There’s a lot of fear and misinformation about what you can use to deal with vaginal dryness, specifically after breast cancer. Some of us can use a local estrogen therapy, but for those who can’t, or don’t want to, or it’s not available, then a vaginal lotion can be a lifesaver. The one made by Kindra is for frequent daily use, not necessarily just for sex. It will help keep the area moist and protected, which will not only make you just much more comfortable as you live your everyday life, but hopefully it will stop further tissue damage resulting in that “shards of glass” feeling.
The truth is that during the menopausal transition, vaginal dryness is a problem in general, and then sex just highlightings it. During sex, you need something that’s going to stay slick, that’s not going to pull fluid out, but that’s also not going to put fluid in because that can increase friction and actually make sex more painful over time. So you can definitely use an everyday lotion, but you may also want to add a lubricant during sex. I would suggest something silicone based. Water-based products don’t generally stay slick as long, and a silicone lubricant isn’t absorbed, which is great— it just acts as a barrier.
I am 44 and going through menopause. I have anxiety so bad that I sometimes get panic attacks. Antidepressants and anti-anxiety meds haven’t helped. Is there anything I can do?
Mood disorders are much higher in women, especially in women in this age group. But many women who either have never had a mood disorder before or have had a mild controlled mood disorder may feel a real change in perimenopause and menopause. The reasons for this are multifactorial. There’s definitely a relationship between the fluctuations in our hormones and a lack of sleep or changes in sleep habits. That’s why sleep depravation is used as a torture device— because people start to lose touch with reality.
Sleep can be disrupted during menopause for a lot of reasons. If women are having night sweats and they’re waking up, or getting up because they have to pee more frequently during the night, that can have a major impact on sleep, and then your mood. Some of it is also societal, cultural, and personal. A lot of major life changes also happen to coincide with the timing of menopause. Maybe you’ve been in a career for a really long time and you’re bored and you’re questioning your career goals, or maybe your kids have grown up and are leaving the house, and you’re dealing with that stress. I think pointing the finger only at hormonal fluctuations when it comes to changes in mood is really unfair.
A lot of women will go on antidepressants during this time, and don’t get me wrong, I think antidepressants are great for many people. I’m not against them, but they’re also not the answer for everybody.
In terms of sleep remedies, Kindra makes a product for sleep which I think is awesome— it’s a supplement that helps to manage the impact of hormonal shifts. There’s melatonin in it, which works really well for a lot of people.
I’m a huge fan of CBD too. The data is non-existent, I’m not going to lie, but for sleep, I use it a lot. Most of my patients don’t have trouble falling asleep, they have trouble staying asleep. This is why the Kindra products or other edible products like CBD work really well, because you have to swallow it, digest it, and it’s going to hit you three or four hours later when you would be waking up. If you use a tincture which is absorbed under your tongue, the effect is immediate, and that’s not going to help you when you’re waking up in the middle of the night.
Finally, I would also suggest trying to make some lifestyle changes. Whether it’s incorporating meditation into your day, or adding more exercise. Exercise is hugely important for mood. Seeing a therapist will help immensely as well. Just know that so many women are going through this, and you’re not going crazy.
I’m 57 and have been in menopause for the past 3 years. My hot flashes put me into a full tomato-face dripping sweat for a few minutes every hour on a daily basis. I live in Minnesota, where we’re having temperatures in the 20’s…but I still have to sleep in our guest bedroom with the window open because of my night sweats. What can I do?
Unless there is a reason why you can’t, like you’ve got a serious heart condition or have had cancer, you sound like someone who needs hormone therapy. I don’t generally recommend hormone replacement therapy (HRT) as a first line of treatment, but if there was ever someone who could benefit from it, it’s this woman. How can she function? This type of extreme hot flashes only occur in a small subset of women. Now if she for some reason this woman isn’t able to do HRT, there are actually some antidepressants, notably paroxetine, effexor, and paxil, which work very well for hot flashes. The issue with effexor is that it’s very difficult to wean yourself off of, so make sure to do that under the supervision of a physician who knows what she’s doing.
Clonidine, which is a really old school antihypertensive blood pressure medication, has been used in the past. A lot of breast cancer patients end up using Gabapentin. So there are definitely options. No woman should have to deal with hot flashes like that.
During the menopausal transition, I developed stubborn belly fat that just won’t budge. Do I just have to accept that this is my body now, or can I do something about it?
I’m right there with you! It’s really frustrating. It’s stress, it’s changes in habits, it’s sleep issues, and it is definitely the hormonal shift. People also really need to look at the way they’re eating. I think intermittent fasting has been a bit overhyped, but it can be great for the right person. And then here’s a big one: as we age, we lose lean body mass, and we start losing bone mass. That really accelerates in your forties. When you lose lean body mass, your muscles decrease, and you don’t metabolize and burn calories as efficiently. That’s why weightlifting is so important. You have got to lift heavy things! If you can build up large muscle groups like your quads, your back, and your core, you will burn calories more efficiently. The stronger and more balanced we are, the more flexible we are.
Then there’s cardio: cardiac health is so important. It’s the number one killer of women. Plus, anytime you’re exercising, blood flows everywhere in your body. It’s going to your genitals. It’s going to your brain. Exercise will help with so many of the issues we’ve discussed.