How the Menopause Landscape Is Changing

These days, it’s a menopause renaissance, where we’re finally changing decades of hush-hush social norms. And thanks to all that hard work, we can finally get into the not-so-expected changes that occur during this change of life. From taboo talk to surprising symptoms, the world of menopause and its treatment is expanding.

Featured Experts

• Tamsen Fadal is an Emmy Award–winning journalist and author of the best-selling How to Menopause
• Naomi Watts is an actress and founder of Stripes Beauty
• Monika Pierce is a health coach for Respin and the American Fitness Professionals Association
• Anita Sadaty, MD, is an OBGYN and a medical advisor for Womaness
• Dr. Angela DeRosa, aka Dr. Hot Flash, is a women’s health expert

Building the Roadmap

“Menopause is a natural life stage that all women are going to go through if they are lucky enough, but it still is a taboo topic,” explains Emmy Award–winning journalist and author of the best-selling How to Menopause, Tamsen Fadal. And as we open the conversation and talk more openly about this change of life, you may find that some of the most frustrating body changes are actually menopause complaints.

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“For me, it was dry skin,” says actress Naomi Watts, founder of Stripes Beauty. “It came out of nowhere and completely threw me off. My skin was itchy and irritated, and all the products I was using before just weren’t working. I didn’t realize at the time that it was connected to perimenopause, which made it even more frustrating. There wasn’t a roadmap or open conversation when I was going through it. I felt completely alone and uninformed.”

Thankfully, women everywhere are starting to build that roadmap themselves.

Perimenopause vs. Menopause

Menopause itself actually occurs in a single day. While the symptoms feel like they can last a lifetime, menopause is defined by the day you’ve gone 12 consecutive months without a period. Before that, you’re in perimenopause; after, it’s post-menopause.

“Understanding menopause this way shifts how we talk about it and experience it,” explains Monika Pierce, a health coach for Respin and the American Fitness Professionals Association. “Women can begin experiencing symptoms as early as their mid-to-late 30s. This perspective helps us focus on supporting them through the changes before menopause occurs, as well as ensuring they thrive afterward.”

Temperature Changes

“I’ve definitely had hot flashes—those sudden waves that make you feel like you’re on fire from the inside out,” explains Watts.

But, you might not realize that swings in the opposite direction are also a common symptom of menopause. Cold flashes, also called “the chills,” are thought to be linked to hormone levels, just like hot flashes. “Once estrogen production declines or shifts rapidly, the brain’s temperature regulation centers become highly intolerant to shifts in ambient temperature, drops in blood sugar and stress hormones,” says OBGYN Anita Sadaty, MD, a medical advisor for Womaness. “These are the most common triggers for these hot and cold flashes.”

Body Changes

With 80 percent of women reporting hot flashes, experts believe odor changes during menopause are widespread. (Source: NIH)

“Body odor is one symptom that was really embarrassing for me,” says Fadal. “I would run into the bathroom and try to put paper towels under my arms to stop the smell. It’s one of the reasons I partnered with Secret deodorant, because I realized we don’t have those kinds of conversations out loud—it’s embarrassing. Body odor can be embarrassing.”

Dr. Sadaty explains that one cause is a shift in the skin microbiome that is impacted by changes in estrogen levels and pH levels. “The second is that the body’s detox system changes in menopause, and this could impact the need to eliminate more toxins in sweat.” Changes in pH, the amount we sweat, and the oil we produce can all change how our sweat smells.

Dry Eyes

50 percent: the percentage of women who report dry eyes during stages of menopause. (Source: NIH)

“When estrogen levels decline, not only do women develop vaginal dryness, which can lead to painful sex and urinary incontinence, but they can also experience dryness of the eyes, nose and mouth,” explains women’s health expert Dr. Angela DeRosa, aka Dr. Hot Flash, who is founder of the Hormonal Health Institute. “The eye changes may begin as just dry eyes, but can ultimately develop into vision changes.”

And, many women don’t associate these changes with menopause. “I actually did have dry eyes, and at first, I had no idea it was related to menopause,” says Watts. “My eyes felt irritated and sensitive, especially during excessive screen time or while traveling for work. It’s not a symptom you hear about often, but knowing what was going on helped me find better ways to treat it.”

Low Libido

1 in 10 women struggle with low libido (Source: NIH)

Surprisingly, testosterone deficiency is the prime driver of lowered sexual desire, given it is the major hormone of love and libido, explains Dr. DeRosa. ”Testosterone works in the brain to stimulate sexual desire, and in the genitals to increase clitoral sensitivity, increased strength of orgasms and uterine contractions. Estrogen, on the other hand, is important to keep the vaginal tissue healthy. Lack of estrogen can lead to vaginal atrophy, which leads to painful sex. This exacerbates the testosterone-deficiency lack of desire, as no one wants to have painful sex.”

Hot Flashes

19 years: The number of years post-menopause that women report experiencing hot flashes (Source: JAMA Intern Med. 2015)

According to a long-range study on a cohort of over 200 women in Pennsylvania, the average woman will experience hot flashes for four to five years after menopause. But they can occur for much longer, with a third of women reporting hot flashes at the 10-year mark and beyond.

“I actually still get night sweats every now and then,” Watts confirms. “Managing those symptoms was part of what pushed me to be more vocal about menopause, so more women know that it’s normal and know how to cope with products and services tailored specifically to them.”

Allergies

Changes in immune responses, hormone levels and histamine levels are all thought to contribute to an increase in allergies during menopause.

“That same excessive dryness that can irritate eyes can also cause an increased sensitivity to allergies, as well as more frequent nose bleeds,” Dr. DeRosa explains. “A dry nose can’t filter allergens as well.”

And perhaps unsurprisingly, taste and scent changes are also common complaints. “I definitely noticed sensory overload,” Watts says. “I was sensitive to scent and couldn’t wear any of the perfumes I had been wearing before; I could only tolerate subtle scents. It’s one of those symptoms you just don’t expect, but it’s surprisingly common when you start talking to other women about their journeys.”

Burning Mouth Syndrome

Up to 1/3: Studies suggest that between 18 and 33 percent of menopausal women experience something called Burning Mouth Syndrome.

“For women in menopause, some research says declining estrogen levels impact the nerves in the mouth, making them more sensitive, or even causing them to misfire,” Pierce explains. “Estrogen plays a role in maintaining saliva production and nerve health, so when it drops, it can lead to dry mouth, changes in taste and heightened nerve sensitivity. All of these contribute to a burning sensation that is called Burning Mouth Syndrome (BMS).”

BMS is seven times more common in women than in men, and the causes (while suspected) are not very well understood. “Hormone therapy can improve symptoms in 50 percent of women, so it is by no means the full story,” Dr. Sadaty says.

Recurrent UTIs

55 percent: More than half of women in menopause suffer from recurrent UTIs. (Source: UT Southwestern)

Some of the issues that lead to decreases in sexual desire are also responsible for the increased rate of urinary tract infections in post-menopausal women.

“The drop in estrogen creates a higher-than-normal vaginal pH, which allows more UTI-causing pathogens to grow,” says Dr. Sadaty. “This lack of estrogen simultaneously depletes the beneficial bacteria that serve to protect the vagina and bladder from infection.”

The very integrity of vaginal tissues can also change during menopause. “Estrogen is important to keep the vagina tissue healthy,” Dr. DeRosa says. “When estrogen drops and vaginal tissue atrophies during menopause, it leads to an increase in the risk of infections like UTIs.”

“That, in conjunction with the decrease of healthy, good bacteria, makes it easier to experience an imbalance that can cause UTIs,” adds Pierce. “You can help mitigate this risk by focusing on vaginal and urinary tract health. Increase your daily water intake, urinate regularly and get a prescription for vaginal estrogen.”