Menopause is simply the end of menstruation, but there is absolutely nothing simple about menopause. I’ve been fortunate to care for many women going through this hormonal transition during my 20+ years of medical practice. I believe I’ve learned far more from them about managing menopause than they from me. That doesn’t mean I’m ready for the inevitable, but at least I’m heading in that direction armed with knowledge. While there are loads of books and websites discussing the subject, many women still enter it blindly. The symptoms can vary considerably in intensity from woman to woman, but the standard array of symptoms are, to some extent, shared by all.
Why am I gaining weight there? Why am I so emotional? Where did my sex drive go? Can I control when a hot flash hits? What the hell is going on with my vagina?
It has been so long since puberty, we’ve forgotten the roller coaster feeling of not being in control of our mind and body. While hormone therapy and some supplements help, the hormonal fluctuations of perimenopause often can only be tempered and endured. Once you are solidly in menopause, hormone therapy can be fine-tuned to control many of the symptoms. But, for those that do not want, or cannot take hormone therapy, the roller coaster ride can go on and on.
Weight gain is absolutely a problem at this time in our life. Doing the same level of exercise and eating the same diet that has always maintained your weight is suddenly not enough. To add insult to injury, not only do you have this onslaught of symptoms to contend with, but you have to cut calories out of your diet to avoid weight gain. And, even with doing that, the weight can still distribute in less flattering places on your body. Our bodies carry a higher percentage of midsection body fat as we age.
There are a percentage of women who enter menopause with minimal symptoms, so they are often the most surprised by the vaginal symptoms which will inevitably arise. Vaginal dryness and irritation are a result of losing the superficial cell layer lining the vagina, a rising pH which changes our bacterial flora, a loss of blood flow, plus the insult we experience from head to toe – a loss of collagen and elastin.
When you are gaining weight in places you do not want, your vagina hurts and the hormones that used to drive our sexual response are completely out of whack – is it any wonder that sex drive drops? Plus, due to the hormonal roller coaster we are now on, we expend far more mental energy trying to maintain our daily cool, both literally and figuratively. Many of my past patients describe it as a loss of the tolerance cushion we need to get through the day without punching someone. That emotional cushion which once allowed us to smile and say “it’s okay” when responding to perceived or real infractions is now gone. We are lucky if we can count to 1 before lashing out. So, watch out.
What to do? Some women choose to grin and bear it. Others opt to use hormones moving from low dose pills to hormone therapy. Some women may need a low dose mood stabilizer, a low dose appetite suppressant and possibly even a dose of testosterone or a visit to a sex therapist. I try to use symptoms and hormone tests to guide women to the therapies that best meet their needs. For the pockets of fat you suddenly see and don’t like, I recommend the 5-day fast mimicking diet Prolon. And, add in a little CoolSculpting for the midsection. Yes, there is also help for the vagina. Vaginal rejuvenation with C02 treatments to stimulate collagen, improve blood flow, lower the pH and make everything far more comfortable.
Whatever approach you choose, arm yourself with the tools you need to successfully manage your menopause. It is a battle from within and it is not an easy fight.