Menopause marks the end of the woman’s reproductive ability.
Menopause it is a natural process of aging, and is defined as 12 consecutive months without a menstrual period. The average age of menopause is 51, but it can occur anywhere between the ages of 40 and 60.
Induced menopause: some women enter menopause because of surgery to remove their ovaries (surgical menopause), while others because of chemotherapy and/or medication for estrogen suppression to treat cancer (medical menopause).
What causes changes during menopause?
The hormonal changes associated with menopause send the woman’s body and mind into multiple changes. Although expected, these changes need to be understood, and well managed, to maintain quality of life as well as to alert the woman as to when to seek help.
What Changes Are Associated with Menopause?
Every woman will experience her own menopausal process and changes, some more severely than others, with the aging process taking its toll:
- Hot Flashes, night sweats – the most common, known sign of menopause;
- Osteoporosis: bones will become more weak and brittle, leading to increased risk of fractures, especially spine, hips, and wrists;
- Cardiovascular implications, including stiffer blood vessels, high blood pressure, heart disease, high cholesterol, dizziness, palpitations;
- Urinary urgency and frequency, urinary incontinence, frequent bladder infections;
- Vaginal dryness, vaginal infections, bleeding during sexual intercourse;
- Sexual breakdowns: painful intercourse, secondary vaginismus, low libido, disinterest in sexual intimacy;
- Appearance: weight gain, hair loss, skin changes;
- Mental health changes: insomnia, mood swings, anxiety, depression, memory loss;
Genitourinary Syndrome of Menopause (GSM)
The hormonal decline will make the vagina thinner, less elastic, drier, less acidic, thus more prone to chafing irritation, infection, and bleeding upon contact.
The urinary tract, which is embedded in the ceiling of the vagina, is also estrogen-dependent and becomes symptomatic by way of increased urinary urgency, frequency, burning, and incontinence.
Visual inspection of the menopausal genitals during a pelvic exam will typically feature atrophied, pale skin = genitourinary syndrome of menopause, or its old name – atrophic vaginitis.
Genital Functional Outcome
So what is it like to have menopausal genitals? Not a pleasant being…
- Feeling dry, pinchy, chafy;
- The genital lips may ‘stick together;’
- Insufficient natural lubrication;
- Insufficient sexual arousal lubrication;
- Intercourse is progressively uncomfortable and painful (dyspareunia);
- Intercourse and pelvic exams are progressively painful, or no longer possible (secondary vaginismus).
Secondary (Menopausal) Vaginismus
A few years ago, we had a patient who was a 60-year-old woman in a happy marriage for half of her life, and she shared the following story:
“It started 8 years ago with a burning sensation after vaginal intercourse, and got worse and worse over time. After 2 years it became so bad that penile penetration became impossible; now I can’t even insert an applicator with lubrication, and gynecologic examinations are horrible! What is going on?”
The condition of menopause-related painful intercourse is called “secondary vaginismus” or “menopausal vaginismus,” a condition that is one of our expertise.
At the Women’s Therapy Center, we built our reputation on supporting women on their journeys to healing. We take pride in finding and implementing a ‘wholistic’ approach to treatment, perfectly fit for every patient.
The course of treatment for secondary/menopausal vaginismus depends on many factors, including:
- The severity of the vaginal restriction,
- The duration of penetration difficulties,
- The pliability of the vaginal tissue, and
- Suitability for vaginal Estrogen replacement.
After about 4-9 sessions, the prognosis is typically excellent.
Suffering in silence or giving up on intimacy should never be an option for a woman in menopause. We believe in empowering women to have a happy healthy sex life, no matter the age.
Menopausal Management – A General Road Map
The good news is that menopausal changes have available solutions and the woman does not need to resign to living with the adverse effects.
- Maintain a healthy, balanced diet, and mind your daily caloric intake. The Mediterranean diet still ranks best!
- Move the body to keep it in best operational condition: find which activities ‘speak’ to you and adhere to them on a regular basis. tap into free programs on YouTube andTV channels, join a gym, or team up with an exercise buddy for inspiration and accountability. Whatever you decide to do, move lots as the body thrives on movement!
- No smoking;
- Minimize alcohol intake;
- Seek medical consultation for routine health checks and for any other ‘glitch’ just like you would take your aging car to the repair shop to keep it running safely and efficiently as possible;
- See your gynecologist on a regular basis, and discuss vaginal hormonal therapy, vaginal lubricants, and moisturizers.
- Seek a vaginismus specialist to restore vaginal penetrations;
- Seek psychological counseling for mental health;
- See a sex counselor for restoring libido and sexual interest.
With proper care, menopause can be a wonderful life cycle, with much to look forward to.