Healthy Transitioning Through Mid-life

Perimenopause occurs when your body makes less of the hormones that control your period -- estrogen and progesterone. Many factors play a role in whether or not your provider will recommend hormone replacement therapy such as estrogen and progesterone. Once you've missed your period 12 months in a row, you are officially in menopause and no longer can get pregnant. But how do you know when you're in perimenopause?

They may be light or very heavy, long or short. You may skip some altogether. If you go more than 60 days between periods, you may be near the end of perimenopause. Low-dose birth control pills can keep you more regular and may help with other symptoms well. 

If your periods are heavier, it may be because the lining of your uterus is thicker before it's shed. This is caused by a drop in the hormone progesterone. It also may make other issues, such as fibroids (growths in the wall of your uterus), worse.

You suddenly get flushed and sweat for 5 to 10 minutes. Some women get slightly warm while others are drenched in sweat. When they wake you in the early hours of the morning, they're called night sweats. Deep-breathing exercises may help. You also can try to avoid triggers -- warm temperatures, hot drinks, spicy food. You can try black cohash or add soy to your diet, as a natural source of estrogen. Talk to your health care provider about medications for moderate-severe symptoms.

Because you have less estrogen, your tissue may become thinner and drier. This can cause itching, soreness, and pain during sex -- all of which can make you less frisky. Regular sex can help keep that tissue toned and healthy. Talk to your doctor about other conventional medication options.

Changes in your hormones and night sweats can wreak havoc with your rest. Good habits, such as a regular schedule and giving yourself time to fall asleep, can help. Talk to your health care provider for options for more severe symptoms. 

Some women swing from high highs to low lows during perimenopause thanks, at least in part, to their changing hormones. And it can be worse if you have trouble sleeping. Women who have had severe PMS symptoms may have more serious mood changes during this time as well. Some suggestions: Set priorities, and get out and do things you enjoy.

Changes in your hormones, along with other symptoms of perimenopause (mood swings and sleep problems), may make it a little harder to remember things. You might lose your keys more often, forget some appointments, or have trouble focusing. It probably will get better once you’re past menopause.

Vaginal Changes:

Just like the rest of your body, your vagina ages. Once you get close to menopause, its parts don't look or function the same as they did when you were younger. Dryness, drooping, and a lack of lubrication are all issues at this stage of life. These changes are natural, though their effects on your bathroom habits and sex life may not be welcome. 

The hormone estrogen keeps the tissues of your vagina healthily plump and moist. When estrogen levels drop around the time of menopause, those sensitive tissues are dry. Dryness is one of the more distressing symptoms of menopause. It can make sex uncomfortable or even painful. Use a lubricant to reduce friction. And have sex regularly to keep the moisture you still have. 

Changes in pubic hair:

Your hair goes through natural cycles where it grows for a period of time and then falls out. As your hair gets older, its growth cycle shortens. At the same time, a drop in estrogen makes testosterone your body's dominant hormone. Testosterone fuels hair loss. When more hair falls out than your body can replace, you'll start to see areas of thinning. It happens on your scalp, and it happens down there, too.

Skin tone gets worse because of the age-related loss of elastin and collagen -- proteins that once kept it taught. That's true for the skin on your face as well as your labia -- the folds on either side of your vagina. Sagging is less obvious when it's inside your pants, but if it bothers you, there are surgical procedures to plump and firm up your labia.

The muscles of your pelvic floor act like a sling that supports your uterus, bladder, rectum, and the top of your vagina. Childbirth and menopause weaken these muscles, which can make the organs in your pelvis droop. This is called Prolapse. An organ may fall into the vagina and creates a bulge. Devices and medical procedures can give your pelvic organs a lift and treat prolapse.

You might expect the hair on your head to go gray as the years pass, but finding your first gray hair down there can come as a big shock. Your pubic hair turns gray for the same reason that the hair on your head does. As you age, the pigment cells inside each hair follicle die and stop producing the chemical melanin that gives your hair its color. As melanin production slows, your pubic hair turns gray or white.

The loss of estrogen around the time of menopause makes the once-stretchy tissues of your vagina thinner and less elastic. This is definitely a case of "use it or lose it." If you don't have sex often enough, your vagina can get shorter and narrower. So when you do have sex, it will hurt. Maintaining a healthy sex life (with a partner or a vibrator) will keep your vagina loose and limber.

You'll feel the loss of estrogen when you try to make love. Dryness plus thinning of tissues in the vagina add up to painful penetration. Over time, the delicate tissues can tear and bleed. Don't let fear of pain keep you from a healthy sex life. When you avoid sex, it can make the problem worse. Use a lubricant. If that doesn't help, ask your health care provider about estrogen therapy or other treatments.

You may not be well-acquainted with your vulva -- the opening and outer lips of your vagina. But if you've held a mirror down there recently, you may have noticed some changes. For one thing, it's probably paler than it used to be. The lighter color is due to reduced blood flow from lower estrogen levels. The inner lips have shrunk for the same reason, and they may be drier than they were before.

Sudden urges to use the bathroom or pain when you pee could be signs of a Urinary Tract Infection (UTI). Your vagina is home to lots of bacteria -- some good, some bad. The loss of estrogen around menopause changes the climate down there, leaving more bad bacteria than good. Women have more UTIs as they age because of the loss of protective tissue barrier due to thinning and atrophy. Vaginal estrogen therapy can increase helpful bacteria and reduce the number of infections you get.