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Menopause Symptoms | Foundational Concepts

Menopause: 40, Wine and Sex – Oh My!

I had dinner with my BFFs last night in honor of a 40th birthday (despite us all feeling a bit meh about 40). But you have to celebrate right? We are all happy with super husbands and hilarious children and really, 40 is the new 30!

Over dinner and wine, one friend shared her mother’s insight on turning 40: “Honey, don’t be sad about 40, your father and I had the best sex those years. Enjoy it because then it all dries up.” Insert about 2 solid minutes of laughter… and then, my friend asked me if we can even have good sex after menopause and how long before it hits? I love that my dear friends ask me these questions because they inspire blogs like this. If my friends are curious, many other women must wonder about menopause too.

When Will I Go Through Menopause?

The short answer to the second question – when will I go through menopause – is somewhere between 48 and 55. The average age is 51. The signs of menopause can be vastly different for different women due to the many tissues that estrogen affects throughout the body. Here are a few signs that menopause is approaching:

– Changes in your period: This can be irregularity, longer or shorter periods, or increased bleeding/less bleeding than usual
– Hot flashes: Sudden feeling of heat in your body with flushed face and neck and red, splotchy areas may appear. This can be followed by heavy sweating and then cold shivers. Fun, Right?
– Vaginal health: Your vagina may get drier (which we will discuss shortly) and can cause pain with sex, or may be a cause of frequent bladder or vaginal infections.
– Bladder control: Can become an issue with frequency increasing or leaking with strong urge or with cough/sneeze.
– Sleep changes: difficulty falling asleep, waking too early, or not able to fall back to sleep if you wake during the night
-Changes in sexual desire: For good or bad, you may be lookin’ for more or may have no interest at all. Hoping for the first of those, but there is help for the latter so don’t despair.
– Mood changes: Awesome, right? We give our children another reason to think we are crazier than they previously did! Exercise can be a huge help in this realm, even just a nice 10 minute walk can help alleviate a bad mood.

The Changes You’ll See

During perimenopause and menopause, shifting levels of hormones – especially estrogen – produce changes in a woman’s body. Both the vagina and the vulva (external genitals) are affected. Less estrogen may cause the tissues of the vulva and the lining of the vagina to become thinner, drier and less elastic, known as “vulvovaginal atrophy“. Vaginal secretions are reduced, causing decreased lubrication. Before menopause we are well supplied with estrogen and the vaginal lining is thicker with more folds allowing it to stretch and accommodate vaginal penetration and childbirth. After menopause, the thin lining has fewer folds and is less flexible.

This thin tissue is very fragile and tears easily even with use of lubricant. This can be very painful, limiting the attempt at intercourse. The pain also causes emotional concerns, and physical muscle guarding. When sex hurts, we have many alarms that go off in our bodies, protecting us from the pain. The muscles of the pelvis tighten up and often remain tight, causing more difficulty with intercourse and more emotional distress. This can lead to relationship issues, anxiety and depression. The North American Menopause Society states that continuing to have regular sex helps keep vaginal tissue moist and maintains length. Great advice, but if it hurts what then?!

The first thing to try is a daily moisturizer to the vulvo-vaginal tissues. We recommend any natural oil, such as coconut oil. Take a small amount on your finger tip and work the oil into the vulvar tissues (between your labia, clitoris and the tissues surrounding them), then work the oil into the vaginal opening, about an inch in. With your finger, make a sweeping motion in a “U” shape from left to right. This should be done daily to provide moisture to the tissues. If you are using a topical hormone cream you can still apply the coconut oil daily, or skip the days you use the hormone. This not only provides moisture, but the massage provides a desensitizing effect on the tissues and stretches the first layer of the pelvic musculature.

The second issue to consider are the pelvic muscles. They are often in spasm or guarding because of the pain. Our bodies are amazing, intuitive structures. If there is pain and we perceive it as a threat, we will try to avoid it the next time. This is where pelvic physical therapy is successful. We can assess the pelvic muscles and the neuro-muscular system. We can perform muscle release and teach you or your partner to do this to release the tense muscles. We can educate you on positions, stress management and exercise for optimal health after menopause. This in combination with addressing the tissue condition can calm this system and allow for pain-free sex.

If you’re entering menopause or perimenopause, don’t fret. While the symptoms may seem overwhelming, distressing, or just downright annoying – there is relief. Talk to your friends, talk to women who are experiencing it, talk to a pelvic floor physical therapist. We are all in this together!

–Sarah Dominguez, MSPT, CLT, WCS

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed, you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you. If you enjoyed this blog, check out our website at for more blog entries and to learn more about our specialty PT practice, Foundational Concepts. Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook/Foundational Concepts for updates.

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