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What is menopause?

Menopause is a biological process that is a natural part of aging. It marks the end of your menstrual cycle and reproductive years and is defined as the point in time when you have not had a period for a full 12 months. According to Johns Hopkins, women tend to hit menopause naturally at about the same age as their mothers, which on average is at 51 years old.

But, there's more to the story. There's a transitional phase leading up to 'The Change' called perimenopause when many women will experience symptoms. While it typically starts in our mid-40s, perimenopause can begin as early as 35 for some women and can last between 4 to 10 years.

How does it start, exactly? Perimenopause is triggered when your ovaries start producing less estrogen, which affects your body in many ways. Dr. Brittany Klooster, an OB-GYN at LAC+USC explains, 'Estrogen affects many parts of your body (skin, joints, blood vessels, glands, other hormone levels, etc.), and as a result, women experience different symptoms as their estrogen level drops. While the hallmark symptom of perimenopause and menopause is the hot flash, women face a range of symptoms throughout this life change.'

According to The Mayo Clinic, perimenopause and menopause symptoms include:

Irregular periods

Vaginal dryness

Hot flashes

Changes in mood

Anxiety and depression

Memory and concentration problems

Chills

Trouble sleeping

Night sweats

Weight gain

Thinning hair and drying skin

Loss of breast fullness

Dr. Barb DePree says that the mental and emotional effects of menopause can be some of the most prominent. 'One of the major target organs of estrogen is your brain. Some of the consequences will be hot flashes and night sweats, but also brain fog and short term memory problems. It will also impact mood. Many women will experience issues with irritability, anxiety, and just feeling more emotion overall.'

It's worth noting that menopause may not be the result of aging in some cases. Women who have had their ovaries removed (for example, some breast cancer patients) will immediately begin menopause after surgery. Women who've experienced chemotherapy or radiation can also go through menopausal symptoms.

How does menopause affect my sexual health?

Overwhelmingly, we ignore the sexual health side effects of menopause which has serious physical and emotional consequences. While sex is an important part of overall health at any age, the benefits can get even better as we get older (more on this below). But, we're not going to pretend it's a walk in the park.

'Genitals have the most concentrated areas of estrogen receptors, so the impact of menopause is likely to have its biggest effect on the vulva, vagina, and lower urinary tract,' explains Dr. DePree. These are not necessarily the first symptoms of menopause, but many women experience a progressive course of dryness and pain that worsens over time.'

What's happening exactly? 'The lack of estrogen in the bloodstream leads to a decrease in blood flow to the vagina and vulva causing decreased vaginal lubrication,' explains Dr. Klooster. 'These changes can also cause the vagina to shorten and narrow, all of which can result in painful intercourse along with a host of other vaginal and urinary symptoms.' This mix of vaginal and urinary symptoms is often referred to as the Genitourinary Syndrome of Menopause or GSM.

According to The Mayo Clinic, the signs and symptoms of GSM include:

Vaginal dryness

Vaginal burning

Vaginal discharge

Genital itching

Burning with urination

Urgency with urination

Frequent urination

Recurrent urinary tract infections

Urinary incontinence

Light bleeding after intercourse

Discomfort with intercourse

Decreased vaginal lubrication during sexual activity

Shortening and tightening of the vaginal canal

If this sounds familiar, you're not alone. A recent study found that GSM can be clinically detected in up to 90% of post-menopausal women, although only about one-third of women report symptoms. This could suggest that many women still feel too ashamed or embarrassed to discuss these issues openly with providers. Overwhelmingly, experts believe GSM symptoms are under-recognized and under-treated.