What No One Tells You About Menopause That You Need to Know

Women in menopause naked showing real bodies of aging women


Menopause is a significant phase in a woman's life, marking the end of her reproductive years and often arriving in her late 40s or early 50s. Beyond the physical symptoms and changes that come with it, menopause can substantially affect a woman's sexual health and desire, introducing challenges that require understanding and adaptation. 

This crucial period calls for not only physiological adjustments but also a profound embrace of evolving notions of sensuality and intimacy. This embrace, in turn, cultivates a comprehensive approach to women's health during this transformative journey. 

In episodes 7 and 8 (Season 1) of the Great Sex Podcast, we focus on the challenges many women face during menopause, such as dryness, pain, and reduced sexual desire considering that there is a lack of clear information about menopause. We aim to provide valuable insights as we are joined by Sharon Depcinski, a licensed clinical social worker and certified sex therapist with 25 years of experience.



Menopause symptoms and hormone fluctuations.

Identifying the onset of menopause can be particularly challenging for women who are using certain birth control methods, such as intrauterine devices (IUDs) or hormonal implants, which can suppress menstrual periods. For women relying on these birth control options, the absence of a menstrual period might not be a reliable indicator of menopause, making it difficult to pinpoint when they've reached the 12 consecutive months without a period, which officially marks menopause.

The preceding period, perimenopause, involves hormonal fluctuations and noticeable symptoms, potentially lasting up to 10 years. It is a transitional period leading up to menopause characterized by erratic hormonal changes. Hormonal fluctuations during perimenopause further compound this challenge as estrogen levels can vary significantly.

These fluctuations can trigger a wide range of symptoms, including hot flashes, mood swings, sleep disturbances, and changes in sexual desire. It's crucial for women to be aware that perimenopausal symptoms can start in their 30s, underscoring the need for broader awareness and understanding. 

Due to this hormonal rollercoaster, relying solely on hormone testing can be inadequate for accurately determining menopausal status. Hormone tests provide a snapshot of hormone levels at a specific moment, but they may not reflect the overall hormonal pattern during perimenopause, which is characterized by unpredictability and variability. Estrogen levels can surge even amidst this transition, leading to a misconception about menopausal status if relying solely on these tests.

Relying on symptom monitoring proves essential in gaining a comprehensive understanding of an individual's menopausal stage, as symptoms – irregular periods, changes in mood, sleep disturbances, and other typical perimenopausal signs – are a more accurate and direct reflection of the hormonal shifts during this transitional period compared to isolated hormone tests.


Menopause symptoms and their impact on quality of life.

It is important that your doctor is listening to your concerns and is genuinely caring about symptoms during the menopausal transition because the sad reality is that there are clinics prioritizing profit over understanding women's experiences, particularly regarding hormonal testing. 

Perimenopause, the transitional phase leading to menopause, presents a spectrum of symptoms that fall into distinct categories: physical, cognitive, mood-related, and genital-urinary. Each of these categories highlights the diverse ways in which the body responds to hormonal fluctuations during this life stage. In fact, 50% of women experience sleep disturbances during menopause. And as we know, sleep disruptions have a far-reaching impact on overall well-being. There are also cognitive changes, such as brain fog and word-finding difficulties, common during perimenopause. 

In addressing these symptoms, it becomes evident that maintaining a healthy lifestyle and prioritizing bone health are crucial strategies to lessen the overall impact of these changes. By focusing on a balanced diet, regular exercise—particularly weight-bearing exercises—and proper bone health practices, individuals can positively influence their experience during perimenopause. Building a strong foundation of health not only aids in alleviating physical discomfort but also contributes to an improved overall well-being throughout this transformative phase of life.


Menopause symptoms and their impact on sexual health and sexual desire.

Menopause brings forth a spectrum of symptoms that profoundly influence sexual health and desire. We must take note, however, that not every challenge is directly tied to this phase. Navigating depression during menopause can be a complex journey, and one common approach is using SSRIs (Selective Serotonin Reuptake Inhibitors) as an antidepressant solution. However, what adds another layer of complexity is that these medications can inadvertently exacerbate the decrease in sexual desire. SSRIs, widely known for their efficacy in treating depression, can unfortunately bring about sexual side effects. 

These may manifest as decreased sex drive, difficulty reaching orgasm, or even anorgasmia, making it a multifaceted challenge for individuals already grappling with the natural decrease in sexual desire that often accompanies menopause. It's essential for those managing depression during this phase to be aware of these potential effects and work closely with healthcare professionals to strike a balance between managing their mental health and maintaining their sexual well-being. 

Nearly 1 in 3 women in the US experiences a decrease in libido during menopause, affecting their intimate relationships. And shockingly, a significant percentage of postmenopausal women, ranging from 50% to a staggering 84%, grapple with symptoms related to genital urinary syndrome of menopause. 

Painful intercourse, or dyspareunia, affects over 25% of women after menopause, making it clear that these issues are pervasive and demand attention. It's essential for women to understand that these changes are common and can be addressed to enhance their overall well-being and sexual experiences.

That is why it’s disheartening to know that less than 25% of these women seek help. The lack of awareness and understanding plays a role here. Many women may not even realize that these issues are connected. Medical practitioners, too, often feel uncomfortable discussing matters related to sexuality and women's bodies, contributing to this lack of awareness. It's a significant challenge, as medical professionals may not receive comprehensive education on sexual health, resulting in an avoidant approach to discussing these vital topics. 


Vaginal estrogen for menopause symptoms and affordability.

Vaginal dryness, a prominent menopausal symptom, can cause discomfort during intercourse, leading to painful sex and overall sexual dysfunction. This, in turn, can contribute to a decline in sex drive and sexual interest, culminating in low sexual desire and sexual function. The changes in vaginal tissues and reduced blood flow to the pelvic region can further exacerbate sexual difficulties, impacting the sexual response cycle.

These intricate connections underline the emergence of conditions like hypoactive sexual desire disorder, underscoring the multifaceted challenges that menopausal individuals may face in sustaining a satisfying sex life. Addressing these issues with appropriate care and support is crucial to ensure a positive transition into this phase of life, especially since symptoms in the vulvar area during menopause can worsen over time.

Recent recommendations suggest that from age 45 onwards, if you're facing any of these symptoms, using vaginal estrogen—whether in cream, annular, or ring form—can be highly beneficial. It's likened to preventive measures like sunscreen or wearing a seatbelt. Applying estrogen directly to the vaginal tissue helps maintain its health and suppleness, acting similar to a moisturizer for the skin.

Physiological changes occur in the vulvar region during menopause, including increased fragility and shrinkage in various areas. Vaginal estrogen can help counteract these changes effectively. Interestingly, the latest recommendations emphasize that vaginal estrogen is often safer than systemic medical hormonal therapy because it's locally delivered.

There are more positive aspects of using vaginal estrogen as compared to the potential negatives. Even in terms of cost, a tube of vaginal estrogen is relatively affordable, making it a viable option for many women. However, pharmaceutical costs can be excessively high, making it challenging for some individuals to afford these essential treatments.


References for menopause, body image, and acceptance.

Dr. Jen Gunter, an OB-GYN and author, known for her insightful works like "The Menopause Manifesto" and "The Vagina Bible" shares a wealth of knowledge and maintains an informative blog called the Vagenda, which you can check through this link:

Another notable book is "What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities" which offers a more inclusive perspective, particularly for non-binary or transgender individuals. This resource can be immensely comforting and informative on the journey through menopause. For those navigating menopause at work or just in general, "Let’s Talk Menopause" is a fantastic online resource. It provides clear information about menopause and its symptoms, offering a handy one-page symptom checklist that can be filled out and taken to your physician for a comprehensive discussion. 

One symptom worth mentioning, which is often a concern, is weight gain around the midsection or thighs. While societal pressures can be challenging to deal with, it's essential to remember that our worth isn't defined by our appearances. It's vital to embrace acceptance and love for ourselves as we age, and movies like "Good Luck to You, Leo Grande" offer a heartwarming exploration of body acceptance and self-discovery.


Aging, sexuality, and redefining expectations.

Welcoming the aging journey empowers us to redefine how we perceive beauty and sexuality. Society often enforces conventional standards that link youthful looks with desirability, unfairly stigmatizing the natural signs of growing older. One prime illustration of this is the stereotype associating gray hair with a decrease in allure. Nonetheless, this perspective is evolving, with many individuals challenging these conventional ideas. 

By accepting our changing appearance, including the graying of our hair, we can liberate ourselves from these ingrained beliefs. Gray hair can symbolize wisdom, life experience, and the passage of time, representing the insights acquired over the years. When we resist conforming to societal expectations and allow our hair to transition to its natural hue, we are affirming our self-acceptance and embracing our genuine selves.

Additionally, going against these beauty norms is an act of empowerment. Our value isn't determined by external appearances or adhering to unrealistic standards. Embracing the natural process of aging enables us to redefine what it means to exude sexiness, attractiveness, and confidence at every phase of life. It becomes a commemoration of our individual journey, encouraging others to do the same, ultimately nurturing an environment of inclusiveness and acceptance.

We should also challenge the conventional idea that sex equals intercourse and explore what truly ignites pleasure and fosters meaningful connections, going beyond the boundaries of penetration. It's about redefining our expectations and preconceived notions and having an open-hearted acceptance of our authentic selves at this particular juncture of life. 


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