Are You In A Postmenopausal Desert?


“I’m itchy down under,” I told the gynecological nurse practitioner during my last visit. I was going to purchase an over-the-counter medication for what I thought was a simple vaginal infection. Glad I didn’t self-medicate. It’s not a good idea.

“You have postmenopausal dryness,” said the nurse practitioner. “Your vaginal walls are thinning and irritated due to your lack of Estrogen. It’s simple to fix.” She prescribed an estrogen cream. Just a few small dabs worked wonders and now I’m pleasantly hydrated again.

Who says sex has to stop after you hit menopause?

Well, according to an international survey of 4,100 women, up to 50% said that sex was painful (1) Ouch! 50%?! That’s a whole lotta deprived vaginas.

Top 5 symptoms you might complain of in your golden years:

  • A vagina dryer than the Sahara desert
  • Getting “hot” and not it a good way
  • Waking up to a pool of sweat in your bed sheets
  • Insomnia
  • That annoying belly fat that won’t go away no matter what diet or exercise fad you try

Not Alone With My Postmenopausal Woes

I’m not alone with my postmenopausal woes (psst, psst, it can impact your sexual health after 50), and soon there will be many more women joining me in the vaginal desert. According to statistics, nearly one out of two (45.25%) American women will be menopausal or approaching menopause next year. While most women are aware of hot flashes and night sweats as annoying menopausal symptoms, fewer know about vaginal atrophy, a condition that effects one-third of women.

“Let’s Talk About Change”

I learned more about postmenopausal vaginal atrophy after talking with actress Brenda Strong, who is spokesperson for Pfizer’s “Let’s Talk About Change” campaign, which addresses the need for increased public awareness of this condition, including thinking and talking differently about postmenopause and sexual health after 50.

“The Other Talk”

The campaign kicked off this week with a light-hearted video called “The Other Talk,” featuring Brenda. An important event in a young woman’s life is when a mother talks with her teenage daughter about sex. (Can’t remember what my mom said when I was an adolescent. I think she just slapped me when I got my period.

What about you?) “The Other Talk” expands this coming-of-age to the next generation with a dialogue between mother and daughter about postmenopause. (I didn’t talk to my mom about postmenopause, except to complain about all the hair that is now popping up on my face instead of on my head.)

I enjoyed talking with Brenda, who in addition to being an actress (known for roles in Desperate Housewivesand Dallas), is an accomplished yoga instructor. “I’ve been teaching yoga for the last 20 years. I used yoga when I was going through infertility years ago and now I teach yoga for women, for fertility, and for partners,” said Brenda. As a fellow yogi, I was interested in what Brenda had to say about women and wellness. “Gentle and restorative yoga practices help cultivate energy,” said Brenda.

We agreed that some of the best times of a woman’s life are during her years after 50. “Now that my children are grown, I have more energy and more time to focus on maintaining my own health and wellness,” said Brenda. Her tips for women post 50:

  • Start exercising it’s never too late.
  • Make better choices about what you put in your body.
  • Maintain balance in your life.
  • Get lots of rest.
  • Tune in to your own needs.
  • Educate yourself about what your body is going through during menopause and postmenopause so you can make wise choices to increase your longevity.

“This campaign is a call to take action for yourself,” said Brenda. “It’s not about surviving menopause. It’s about thriving through menopause.”

Speak With Your Doctor

Also on yesterday’s call was Michelle Warren, MD, a nationally certified menopause practitioner and founder and medical director of the Center for Menopause, Hormonal Disorders and Woman’s Health in New York City.

Dr. Warren said women should not suffer in silence. She empowers women to talk openly and in detail about their menopausal and postmenopausal symptoms and not feel embarrassed about these topics.

“I urge every woman experiencing these changes to bring up their symptoms to their health care professional at the start of their visit, not when they are walking out the door,” she said.

Are you taking care of your health? Have you seen your gynaecologist this year for your annual checkup? Don’t get stuck in the vaginal desert without hydration. It’s not fun.

So What Gives?

I’m not gonna bore you with the medical jargon so let’s keep it simple eh? Basically, after you hit 30yo your hormones gradually start to drop. Dr. Irwin Goldstein ,sexual medicine doc, recently stated at this year’s International Pelvic Pain Society conference in Chicago that during menopause “biologically your tissue will become like the pre-pubescent days.” Remember those days? Bald vagina and small “lips”?

Your vaginal tissue health is dependent on a nice balance of testosterone and estrogen among other reproductive and stress hormones. Believe it or not the amount of estrogen you have is dependent on testosterone. Yup, it’s not only dudes that have to worry about low T. You’re heart, brain, skin, and “privates” need it too!

Your Bladder on Menopause

Your bladder, urethra (tube that empties the bladder), vaginal tissue, pelvic ligaments, pelvic floor muscles and connective tissue all depend on estrogen to keep things running smoothly. During menopause, it’s been reported that 50% of women complain of urinary symptoms that worsen over time and 9-39% over 60yo report urinary leakage (2,3).

Vaginal dryness and pelvic floor muscle degeneration is common in menopause.

Besides leaking everytime you a-choo! you’re also at risk for POP. No, I’m talking about a carbonated beverage here. I’m talking about pelvic organ prolapse, POP for short.

POP is a condition where the pelvic organs start to creep down towards the vaginal opening. Some women complain of lower abdominal and pelvic pressure or feelings of something “falling out” of the vagina. Don’t get me wrong, menopause isn’t the only thing that can put you at risk for POP. Other risk factors include “hulking it” to poop, childbirth, previous abdominal or pelvic surgeries, chronic coughing, and lifting heavy weights just to name a few.

The plumbing “down below” relies on hormones to function properly and since testosterone and estrogen both decline in menopause, it’s no wonder why symptoms like leakage, low libido, vaginal dryness, and pain with intercourse just spring up outta nowhere.

Menopause Doesn’t Have to Suck

Ok, by now you’re probably thinking that a life after menopause looks depressing. It doesn’t have to be! There’s lots of options out there to help keep your hoo-ha vibrant. I’m sure you’ve heard about bioidentical hormone replacement therapy and maybe even about laser vaginal therapy.

Although there’s conflicting research about these hot topics there seems to be benefits to both. Whoa! Hold on. I’m not promoting any of those treatment methods but I’d like you to be aware of your options, especially about the most important option which is pelvic floor muscle training! We will talk about it in a second blog post.

Perimenopause & Bio-Identical Hormones

As young women, we grow up hearing horror stories about “going through the change” when hormone fluctuations create often unbearable symptoms like hot flashes, crazy brain, and mood swings. And we know that when this time comes, we will have to make choices for ourselves.

In my early thirties, I learned about hormone replacement therapy (HRT) and that the primary drug used is Premarin. I also learned that Premarin stands for Pregnant Mare urine when I met Bella, a beautiful Friesian mare who was rescued from a Premarin manufacturing plant. As a lifetime equestrian, I came to dread and fear my choices as I knew them: deal with being a crazed, middle-aged woman or support this practice.

At 40, I sensed an early shift and began searching for natural options like diet and exercise. It was upon my move to the Desert that I discovered two life-changing revelations: perimenopause (the ‘early’ change) and bio-identical hormone replacement therapy (BHRT), a plant-based option.

For those scratching their heads at these new terms, and those interested in truly understanding the hormonal changes your body goes through as it ages, I strongly recommend Suzanne Somers’ new book,

Targeting women 35-50, the book describes in great detail why we may experience unexplained symptoms like weight gain, irritability, insomnia, and decreased sex drive at this age, and provides natural options for hormonal balance through diet, supplementation, healthy practices like getting adequate sleep and exercise, and BHRT.

Somers jocosely refers to the most common symptoms as the “Seven Dwarfs of Menopause”: Itchy, Bitchy, Sweaty, Sleepy, Bloated, Forgetful, and All-Dried-Up. But the news for many is that these symptoms may begin as early as the thirties and is referred to as perimenopause.

She explains that perimenopause is the most dangerous phase for women because of the significant fluctuation of their hormones. “You go through puberty and the blissful days of your 20s, and then things start to change. The mood in the house starts to change, and one day you wake up and you and your husband don’t recognize the person you’ve become.” She adds that the symptoms you experience are your body screaming, “All is not well!”

Somers struggled through three years with very bad symptoms including uncontrollable weeping, flying off the handle for no reason, bloating, and weight gain. “One day my husband came to me and said, ‘Suzanne, a marriage can only take so much’ and I just died inside. I hadn’t realized how bad it was and that I was taking it out on him.”

She went from doctor to doctor and was offered a variety of drugs aimed at treating her symptoms including anti-depressants, anti-anxieties, diuretics, and sleep medication, to name a few. “And then I heard about this endocrinologist who introduced me to bio-identical hormones and I never looked back.”

In an effort to help other women through this phase, Somers dedicated herself to thousands of hours of research, interviews and case studies to compile information for her many books. “When I starting writing about menopause for women my age, I realized that women under 50 weren’t interested. They would tell me, ‘I’m having trouble sleeping’ and I would say, ‘It may be your hormones’ and they would say, ‘No. I’m too young for this.’

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