Things No One Tells You About Menopause

Hair in weird places, “menopause brain” and other wonders of the female body. 

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By Rose Hayes

“The change of life,” “The Big M,” “Just a phase”… menopause is too often shrouded in mystery and euphemisms. Your gal pals—not to mention, women of generations past—might have left out key details from their experiences, but we’ve got you covered.

Afua Mintah, MD, an OBGYN at St. Mary Medical Center in Langhorne, Pennsylvania, weighs in on some lesser-known facts about menopause and offers tips to help ease the transition.

“I wish more women knew that what they’re feeling is normal,” says Dr. Mintah. “Many women just need validation that these experiences aren’t in their head and they’re not being imagined.”

Here are 10 things no one tells you about menopause.

The shape of your vagina may change

2 / 10 The shape of your vagina may change

During menopause, estrogen levels drop. Estrogen contributes to the development of female sex traits like breasts and uterine lining, along with a number of bodily functions like menstruation, sleep and more.  

“Without estrogen, the walls of the vagina become thin and dry,” says Dr. Mintah. This can cause pain during sex by making the vagina more prone to irritation and tiny tears.

You may also experience vaginal:

  • Itching
  • Burning
  • Dryness
  • Light bleeding after sex

“Additionally, decreased collagen reduces the elasticity of vaginal tissues and can make the entire vagina shorter and narrower,” adds Mintah. Prior to menopause, the vagina has more folds, allowing it to stretch easily during intercourse. When the vagina shortens and loses some of those folds, it becomes more difficult for it to accommodate penetration. How can you ease vaginal symptoms?

Lube is your new best friend

3 / 10 Lube is your new best friend

If you experience discomfort during sex, fear not—there are more solutions and treatment options than you might think. “Lubricants, for one thing, are inexpensive and readily available,” says Mintah.

“Applied to the vagina or vulva, lubricants aren’t absorbed into the skin, but rather act on the surface to decrease friction. Use them liberally if dryness is interfering with your ability to stay sexually active,” she says. Not sure which is right for you?

  • Choose oil-based lubricants like baby oil and Vaseline for masturbation and massage only. Never use them with condoms because they can wear down latex, causing condoms to break. They also leave behind a residue in which germs can easily grow.
  • Use water-based lubricants like KY Jelly for sex with condoms or masturbation. If you’re prone to vaginal yeast infections, choose a brand like Play that’s glycerin-free.
  • Silicone-based lubricants like Eros may be used with both condoms and latex sex toys (not silicone sex toys since they can ruin the material). However, they’re tough to rinse off, may cause vaginal irritation for some and can taste strange.
Vagina moisturizer helps, too

4 / 10 Vagina moisturizer helps, too

 “I also wish more women knew about vaginal moisturizers, which are different than lubricants,” says Mintah. “Moisturizers are applied the same way, but they do get absorbed into the vaginal and vulvar tissues. They’re meant to be used regularly, not just during sex, and are effective at reducing itching and irritation.”

Vaginal moisturizers can be found in the pharmacy and include brands like Replens and Vagisil. Use these products about every two to three days and consider wearing a pad or panty liner since your vagina will release any product it doesn’t absorb.

Other methods to relieve dryness include:

  • Estrogen-based vaginal creams: Available by prescription only, these products can help thicken the vaginal wall and promote natural lubrication.  
  • Estrogen-based vaginal rings: Vaginal rings typically last for three months. Some may help ease hot flashes, in addition to vaginal irritation.
  • Vaginal estrogen suppository: An alternative to creams and rings, you insert an estrogen pill or tablet into the vagina, typically with an applicator that works similar to a tampon (you’re just inserting medication, instead of cotton).  
  • Hormone replacement therapy.

And our favorite tip? Have more sex. It increases healthy blood flow to your lady parts, encouraging natural plumping and lubrication.

The world can feel topsy turvy

5 / 10 The world can feel topsy turvy

Menopause can make your head spin. From newfound clumsiness, to confusing mood swings, to literally feeling light-headed, here’s what you need to know about your brain on menopause.

  • The dizziness: Dizziness is a common menopause symptom, but the two aren’t always related. Ask your OBGYN about other possibilities like dehydration, low blood sugar, low blood pressure or a heart condition if you experience this symptom often.    
  • The highs and lows (also the rage): Let’s be honest—the mood swings can get real. One moment you’re ordering a cupcake at the local bakery, and the next, you’d like to smash it in a stranger’s face. You’re not insane, you’re hormonal: During the transition to menopause, or perimenopause, your ovaries make a daily attempt to produce estrogen. Sometimes they fall short, and sometimes they overcompensate. Since estrogen helps to regulate brain chemicals like serotonin, which controls mood, your emotions can have a hard time keeping up. Your emotions should eventually level out after you’ve reached menopause.
“Menopause brain” can affect memory, too

6 / 10 “Menopause brain” can affect memory, too

Don’t panic if you find yourself wandering into rooms for no apparent reason or forgetting your thought mid-sentence. Brain fog is a common side effect of menopause.

“Many women describe problems with mild memory loss and difficulty concentrating,” says Mintah. “Estrogen is thought to be important to cognitive function and the decrease in estrogen may be associated with these symptoms,” she explains. Tasks involving working memory, or the ability to take in new information, process it and use it to make decisions, may feel especially challenging.

Sound familiar? If so, try this: Repeat new information like names, numbers or instructions out loud as soon as you hear them. Writing the information down may also help it stick in your mind. (A full night’s rest is a proven brain booster, too.) 

Your depression risk goes up

7 / 10 Your depression risk goes up

“There’s an increased risk of depression in women during the menopausal transition, compared to their younger years,” says Mintah. “But this risk is generally thought to decrease in the early post-menopausal years,” she adds.

In general, women have double the lifetime risk of depression, compared to men. (Although mental health problems are likely underreported among men.) This is due, in part, to dramatic hormone changes that come with life stages like puberty, pregnancy and menopause. When estrogen drops during menopause, specifically, it can interfere with your brain’s ability to regulate mood chemicals like serotonin.  

Social pressures, family responsibilities and gender inequalities also influence depression risk for women. Middle-aged females, for example, often must juggle careers, childcare, eldercare, financial and household responsibilities, making them prone to caregiver burnout and depression. If you experience the warning signs of depression, reach out to a counselor for help. 

Hair may appear in unexpected places

8 / 10 Hair may appear in unexpected places

During menopause, hair can pop up where it’s not supposed to, like your face and back, and fade from areas where it belongs. Unlike men who tend to go bald in patches during midlife, women often experience an overall thinning of hair related to decreasing estrogen and progesterone levels.

At the same time, certain types of androgen—the hormone responsible for male sex traits—might rise during perimenopause. This spike may not be dramatic, but since your estrogens are lower at this point any way, it can be enough to encourage male-pattern hair growth.

Hormone changes might also result in:

  • Thin, brittle nails
  • Acne
  • Decreased skin elasticity

“Collagen is what gives your tissues elasticity and keeps the skin and hair young looking,” explains Mintah. “The collagen content in your skin decreases when estrogens are low, leading to wrinkles and an aged appearance.” Learn how to keep your hair healthy and get quick, dermatologist-approved tips for better skin care.

“Menstrual flooding” can happen

9 / 10 “Menstrual flooding” can happen

Are you sure you’ve officially reached menopause (more than one year without your period)? While some women transition gradually, noticing longer stretches of time between periods until they stop all together, others can be pretty irregular.

In fact, it’s possible to go months without menstruating—making you think you’ve crossed the finish line—then boom! Surprise period happens out of nowhere.

Though less common, it’s possible for this type of period to be extremely heavy. Some women may lose up to 80 ml of blood in one cycle (pad soaked through every one to two hours), bleed for over seven days at once or experience symptoms related to blood loss like weakness that interfere with their life. Women who are obese or have uterine fibroids are more likely to experience menstrual flooding.

If it happens to you, make an appointment with your OBGYN to confirm the bleeding’s related to perimenopause and to check for anemia, or a low red blood cell count. Your HCP may recommend you take an iron supplement to treat the anemia or hormone therapy to reduce the bleeding. They may also have you undergo additional tests to rule out other conditions like uterine fibroids, depending on your blood work, symptoms and medical history. 

Ask about your heart health

10 / 10 Ask about your heart health

“Long term, estrogen deficiency can lead to an increased risk of heart disease,” says Mintah. “This is thought to be due, in part, to changes in cardiovascular risk factors, such as cholesterol levels, which begin to change during perimenopause.”

While menopause doesn’t cause heart disease, blood pressure and cholesterol levels tend to increase during this time (even if you’re following the same healthy diet you always have and are getting regular exercise). These factors raise your risk—not to mention, heart disease the number one killer of women in the US—so it’s important to start a conversation about screenings and prevention with your HCP.  

For example, ask how often you should get blood pressure and cholesterol checks and find out where to go for free blood pressure readings in your neighborhood. 

Read more from Dr. Mintah.

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