Menopause symptoms you shouldn’t be embarrassed to discuss

Every woman of a certain age will experience menopause, says Dr. Amy French, a board-certified OBGYN with Sharp Community Medical Group and affiliated with Sharp Grossmont Hospital. However, not every woman feels comfortable talking about it with their doctor.

Menopause, a natural, biological process that marks the end of a woman’s menstrual cycles occurs, on average, when a woman is around 51 years old. However, menopausal symptoms can start earlier and may include:

• Bleeding irregularities

• Hot flashes and night sweats

• Brain fog and forgetfulness

• Anxiety, irritability and depression

• Dry skin and eyes

• Hair changes

• Poor sleep

• Weight gain

• Vaginal atrophy, in which vaginal wall tissue becomes thin, dry and inflamed

• Painful sex

• Increased urinary tract infections (UTIs)

• Loss of libido and change in orgasm

• Painful joints

• Osteopenia and osteoporosis

While this generation of women going through menopause does seem more open to broaching the topic, Dr. French says some women may still have difficulty discussing a few of their menopause symptoms. From vaginal dryness to a loss of libido and painful sex, a number of women decide to simply “grin and bear it” rather than working with their doctor to find solutions.

Topics that shouldn’t be taboo

“Vaginal atrophy from loss of estrogen typically becomes noticeable three to five years from the onset of menopause, but it varies greatly from person to person,” Dr. French says. “Symptoms include an itchy, dry feeling; painful sex; more frequent UTIs; and urinary symptoms, like incontinence. Unlike hot flashes that will likely go away eventually, vaginal dryness will — unfortunately — continue to worsen as you get older.”

According to Dr. French, vaginal estrogen can be highly effective at addressing these symptoms. Vaginal estrogen comes in a vaginal cream, tablet, capsule with coconut oil mixed with estrogen, or a ring you insert for three months at a time. There’s also a suppository of the hormone DHEA and an oral medication, Osphena, that can help, though Osphena may worsen hot flashes.

“These estrogen treatments are considered safe for women that have had breast cancer,” Dr. French says. “Although, this has admittedly been controversial, and you should discuss your individual risk with your doctor before trying it.”

Additionally, over the counter moisturizers containing hyaluronic acid can help dryness and make sex more comfortable, though they are unlikely to improve urinary symptoms. Dr. French encourages her patients to “get creative” with personal lubricants, including over-the-counter products made to address vaginal dryness and reduce friction during intimacy or kitchen staples like olive oil or coconut oil, which can also be effective.

Low libido? You’re not alone

“Lower libido is very common in middle age, even before menopause,” says Dr. French. “It’s rare that I have a patient in her 50s or 60s who doesn’t have some issues here.”

It’s first essential to consider all the other factors that might be contributing to your low libido and see if they can be addressed. This can include:

• Relationship issues

• Lack of privacy, sometimes due to older children returning home

• Life stress, such as aging parents or feeling worried about retirement

• Partner’s erectile dysfunction (ED) issues

• Low self-image due to changes related to aging

• Medications, including anti-depressants, blood pressure medications and pain medications

• Pain with sex

“Of course, we know that, sometimes, none of these factors apply, and a woman’s low libido seems to be related to changes in hormones,” Dr. French says. “Unfortunately, menopause hormone therapy doesn’t help most. However, talking to a sex therapist may be beneficial.”

Dr. French reports that some doctors prescribe testosterone to help a woman’s libido, though it is not approved by the Food and Drug Administration (FDA) for that use. What’s more, not all women notice improvement in their libido with the use of testosterone.

“Sex will almost certainly change for you in this time of life, and can still be satisfying, even if it’s not the same as it used to be,” Dr. French says. “But if you still have the libido you did in your 30s, congratulations!”

Additional ways to improve your symptoms

Talk with your doctor if you are experiencing signs of menopause — even those you may be embarrassed to discuss. You certainly won’t be the first, Dr. French says.

Along with hormone therapy, there are additional effective menopause treatments. These include antidepressants, nerve medications and a nonhormonal medicine for hot flashes that is safe for women with breast cancer. There is no one way to approach the symptoms of menopause, Dr. French says, and your doctor can help you decide what may be the best treatment for you.

“It’s possible to thrive in menopause and beyond,” Dr. French says. “Regardless of your age or stage of life, staying physically active, maintaining a well-balanced diet that is primarily plant-based, engaging in hobbies, continuing to learn new things, and staying social and connected to loved ones are all essential.”

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