The Talk Part II: Thriving Through Menopause

Menopause expert, Dr. Amy Heeringa, wishes it were common practice to have a second version of “The Talk” when women hit their forties. We all know “The Talk” we get around fifth grade: blood, body hair, and birth control. But what about those changes later in life? Ideally all women would have a second “Talk” around the age of forty, says Heeringa. A candid seminar, if you will, on lube, libido, and love in later life. 

So, what is menopause? According to the North American Menopause Society, “Menopause is defined as the final menstrual period and is usually confirmed when a woman has missed her period for 12 consecutive months (with no other obvious causes). Menopause results in lower levels of estrogen and other hormones.” The average age of natural menopause (not surgically or medically facilitated) is fifty-one, but normal onset of menopause can range anywhere from forty to fifty-eight. Just as each woman’s experience with menstruation and fertility is unique, so is their experience with menopause. No longer producing estrogen means not having periods (it’s OK to celebrate!) and, depending on the person, it might also mean weight, sleep, and mood changes, hot flashes and night sweats, and changes in the physiology of the vulvar/vaginal tissue.  

Menopause doesn’t need to be feared or dreaded, though. The transition into the post-menstrual years of life can be physically and mentally challenging, but if we view it as a continuation of a normal, healthy life, we can embrace it. The average age of menopause is fifty-one, and the average life span of women in the U.S. is eighty point five, so if all goes well, we’ll be postmenopausal for almost 40% of our lives. It’s best that we come to terms with this and work on loving our bodies through every phase.  

“Most women don’t come to their providers about negative menopause symptoms until it’s effecting their relationship,” Dr. Heeringa says. “Women tolerate so much (too much) when it effects just them, but when the natural physiological changes to the vulva and vagina start to be noticed by the partner, that’s when she comes looking for help.” According to NAMS, “the drop in estrogen around menopause leads to vaginal atrophy (the drying and thinning of vaginal tissues) in many women. It can cause a feeling of vaginal tightness during sex along with pain, burning, or soreness.”

Dr. Heeringa reminds us that sex is never supposed to hurt and reassures us that there are options. She also says that some people complain of a decreased libido following menopause. For both those concerns, she starts by reminding us that this is all normal and not a “problem,” and then has us evaluate the dynamics of our sexual relationships (discordant sexual expectations with a partner is really where the conflict comes from- explained beautifully in this book on sex and sexuality), and relationships with their own bodies. Our heads and hearts have to be in the same place for the pelvis to work how we want it to. Finally, she offers her patients vaginal lubrication, moisturizers, suppositories, even topical Viagra, and hormone therapy, when appropriate.

Before the 2002 Women’s Health Initiative was released, hormone replacement therapy was used widely by postmenopausal women. The W.H.I. showed correlation between hormone replacement therapy and breast cancer, and the trend went down. Now we realize the many benefits of estrogen and use it judiciously. According to the National Institute of Health, “In the following years, a reanalysis of the WHI trial was performed, and new studies showed that the use of HRT in younger women or in early postmenopausal women had a beneficial effect on the cardiovascular system, reducing coronary disease and all-cause mortality.”

Since then, hormone therapy options have improved and are much more like naturally made estrogen. Dr. Heeringa advises against the bio-identical compounds some providers offer, because they’re not controlled or tested for efficacy and safety. She says that there are now fantastic FDA-approved options that a local menopause expert can provide- including patches, suppositories, creams, vaginal rings, and pills. For those who cannot or choose not to have hormone therapy, acupuncture might be a good option, as well as avoiding caffeine and being mindful of our sleep, exercise, and diet. Paxil, an SSRI (antidepressant) has been proven to help with hot flashes. Other SSRI’s may help as well, and there are some supplements that demonstrate reliable results. Dr. Heeringa cautions against spending precious money on the newest “miracle cures” and reminds us to verify that studies have shown that the agent works better than placebos to improve symptoms. Some she recommends are these and these. 

Changes around menopause can be challenging, but after “The Talk Part II,” with a menopause guide like Dr. Heeringa, we will feel more prepared and positive. Dr. Heeringa also advised finding an AASECT certified sex therapist to walk through the intimacy and sexual identity changes that sometimes come with menopause. Together with a team of experts, we can thrive through menopause!

Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.