Dealing With Menopause, With Dr. Donnica Moore

World Menopause Day was observed on Oct. 18, and what that means for lesbians in a couple is double duty, as both will eventually face the symptoms of menopause. Luckily, Dr. Donnica Moore has some tips to help you deal with it.

"The most important thing women need to understand about menopause is it's a natural part of lifecycle, not a disease," said Moore. "It is very sensationalized in the media reports about terrible symptoms like mood swings and hot flashes, and it sounds very scary. But all it really means is the end of menstruation, which for a lot of women is a cause for celebration."

Menopause happens in your 50s. It is marked by a change in your periods; either lighter and farther apart, or heavier and closer together. The time approaching menopause is perimenopause -- like "adolescence in reverse," said Moore. But the common reason a woman's periods stop is that her ovaries are producing far less estrogen. But it's not a gradual decline; they go up and down several times a day like the stock market, and are responsible for hot flashes and irritability.

"The good news is that not all women have terrible symptoms. About 30 percent have very mild symptoms," said Moore. "The bad news is that 70 percent of women have moderate to severe symptoms. These can include night sweats so bad that you have to get up and change the sheets. There is also vaginal dryness, a result of vulvar vaginal atrophy. In the same way the skin ages on your face, the tissue of our vagina gets thinner, sags, and becomes friable and dry. That can lead to painful sex after menopause."

For 80 percent of women, most menopausal symptoms will resolve in five years: All except vaginal dryness, which if untreated will continue to get worse. This is a significant problem for half of these women.

"And the implications for lesbian women is that if you're in a couple, you face double jeopardy, because if you're around the same age, you're both going through this at the same time, around 51 years old," said Moore.

There are also artificial or medical causes for earlier menopause, including chemotherapy, radiation, hysterectomy, having your ovaries removed or other diseases. Women who go through surgical menopause make this journey in just one day. And in many cases, hormonal supplements are not needed.

Does Every Woman Need Estrogen?

About 20 years ago, most doctors thought that any woman going through menopause should be on estrogen. Now, they believe that those who have moderate to severe symptoms should consider estrogen therapy. That includes a whole classes of drugs, from Premarin, made from synthesized urine of pregnant mares, to 50 other preparations and medications available to treat the symptoms of menopause.

"For many women who are having vaginal dryness due to menopause, I like to break it into either bedroom vaginal dryness or dryness walking around during the day," said Moore. "Quite honestly, you shouldn't be aware of your vagina during the day; it shouldn't be bothering you. But some women are affected so badly that walking around or sitting is uncomfortable."

Moore said in those cases, women should see their doctor immediately, because something is wrong. But most women are only aware of vaginal dryness when they are having sex. They're not lubricated in response to any sexual stimulation, they don't feel like they're responding the way they used to, they think that something is wrong with them or the relationship, or they aren't in the mood anymore. This becomes very stressful. Painful sex can be treated with the prescription Osphena, a non-estrogen oral treatment.

Another solution people use are lubricants, a temporary solution that can help in the moment but won't solve the problem. Without a doctor's help, the underlying problem will get worse.

Some good news is that menopause does not come with depression. This is a myth, one that Margaret Mead tried to debunk decades ago. Moore said that although some women may be blue over the 'empty nest' syndrome, most women love their children as much as they love their independence.

"Studies show no correlation between menopause and depression except among women who have had moderate to severe depression in the past, such as PMDD (pre-menstrual dysphoric disorder), or post-partum depression," said Moore. "The rest of us are not at increased risk of depression. Mood swings and irritability are fairly classic in women going through moderate to severe menopause."

The best way to combat the symptoms of menopause is through knowledge. Talk to your girlfriends, partners and doctors about your symptoms. Perimenopause can begin in your 40s, and last up to 10 years, and it can happen while you are still getting your period.

Make a list of symptoms and bring it with you to your next GYN appointment. Ask your doctor questions, and take notes. A good relationship with your doctor can help you differentiate between normal menopausal symptoms and real problems, like urinary tract infections.

And as you get older, the best way to stay healthy is to be healthy. Regular exercise and healthy nutrition will help. Cut back on sweets and caffeine. And remember that, as you get older, your metabolism slows down. If you continue to eat the same number of calories and do the same amount of exercise, you'll still gain weight each year.

Finally, don't neglect a good night's sleep. Women may benefit from melatonin or sleep meds, and from strict sleep hygiene such as practicing good sleep habits, maintaining a specific bedtime and winding down with no screen time.

Understanding how to deal with menopause can help you live a happier, more fulfilled life. And that's something we can all get behind!