What You Need To Know About Menopause In Your 30s, 40s And Beyond

The average age of menopause in the US is 51, so if you’re in your 30s or 40’s, you don’t need to think about it now. Right? Wrong!

Although menopause may be a well-known term worldwide, anecdotal evidence shows low knowledge of the different stages of menopause in the general population.

Take this true or false quiz to find out what you know about menopause.

A woman in her 30s can have hot flashes.

TRUE - but this is a trick question. Yes, hot flashes are a common sign that a woman is approaching menopause or has reached menopause. BUT, hormonal fluctuations during and post-pregnancy can trigger hot flashes in women of any age.

What causes hot flashes during pregnancy and after childbirth? Postpartum hot flashes are linked to fluctuating hormone levels, especially a decrease in estrogen that occurs after childbirth and while breastfeeding. Other reasons for hot flashes during pregnancy include higher metabolism and weight gain.

What causes hot flashes in menopause? Common medical opinion is that hot flashes during menopause and the years leading up to menopause (perimenopause) are caused by changes in the hypothalamus. The hypothalamus is the part of the brain that regulates body temperature. Researchers don’t know exactly why, but the hypothalamus appears to detect a higher temperature in the body and begins the cooling process with sweating, sometimes leading to a cold clammy feeling.1 Symptoms of hot flashes include redness in the face and chest, sweating, anxiousness, restlessness, and agitation. One episode may last 20-40 seconds. Hot flashes usually stop after menopause. There haven’t been any long-term studies to determine if both menopausal and pregnancy-related hot flashes have the same physiological origin.

Estrogen doesn’t really begin to decrease until around 45.

FALSE- At 45, a woman’s estrogen level is about 50% less than it was in her 20s. This stage is called perimenopause and it occurs 8-10 years leading up to menopause. During perimenopause a woman may experience hot flashes, irregular periods and mood swings as hormones fluctuate and decline. Symptoms vary from person to person, with some women not noticing any significant changes. Don't guess what your estrogen levels are; test them with an at-home kit or request a test from your physician.

When a woman reaches menopause, her ovaries stop working.

FALSE- Estrogen production by the ovaries is extremely low in menopause but the ovaries do not stop producing estrogen altogether. Menopause does, however, mark the end of egg release by the ovaries and the menstrual cycle. A woman is in menopause when she has not had her period for 12 consecutive months.

Menopause and postmenopause are the 2 stages of menopause.

FALSE - There are 4 stages of menopause:

Stage 1: Menarche: Occurs on average between the ages of 12 and 13. Menarche is when the menstrual cycle begins.

Stage 2: Perimenopause: The years leading up to menopause when women’s estrogen begins to steadily decline. Perimenopause usually begins in women’s mid-30s to early 40s.

Stage 3: Menopause: Menopause is reached once the menstrual cycle has stopped for a full year and a woman continuously has an elevated level of Follicle Stimulating Hormone (FSH) unrelated to any other medical condition or medication. The ovaries also stop releasing eggs.

Stage 4: Postmenopause: The years following menopause. Menopause lasts one year.

Estrogen levels changes in women

Vaginal dryness and low libido during menopause and postmenopause are irreversible.

FALSE - There are some instances where it can be reversed if therapy is begun early. Important background: Vaginal dryness and low libido are not exclusive to menopause. Women of all ages can experience vaginal dryness, pain during sex, lack of sexual desire, and inability to enjoy sex and/or orgasm. Estrogen can decline after childbirth and while breastfeeding. Stress and illness may also decrease the body’s estrogen supply. Low-dose estrogen therapy with .01% estradiol has been advocated by the North American Menopause Society (NAMS) to help manage symptoms during menopause and postmenopause.3 Estradiol is a naturally-occurring estrogen in the body and has been shown to improve and even reverse some conditions linked to low estrogen. Hormone replacement therapy (HRT) with estrogen may help balance vaginal pH and create an optimal environment for the regrowth of natural healthy bacteria and thicken the vaginal lining, which can relieve pain and restore vaginal lubrication.4

HRT medical guidelines for women with an intact uterus include estrogen plus progesterone. Women who have had a hysterectomy may be prescribed estrogen alone. Only a doctor can prescribe these medications. Discuss your options with your physician. Women with a history of certain cancers may not be advised to undergo HRT with estrogen, progesterone or other sex hormones. Estradiol is available as a pill, cream, suppository, and patch. Brand names for estradiol are Estrace, Vagifem, Yuvafem. Low-dose generic estrogen (estradiol) can cost 40% less than the brands.

In addition to estrogen therapy, Mint Pharmacy is offering Lady V, an exclusive compounded prescription product that may help women who experience low libido and other distressing health issues related to low estrogen.

How does Lady V work? Lady V contains sildenafil, the same active ingredient in Viagra. Sildenafil has been shown to increase blood flow to the clitoris and uterus in menopausal and perimenopausal women. The increased blood flow sets off a host of responses including vaginal lubrication. Increased blood flow to the vagina and clitoris may also help rejuvenate the vagina by providing necessary blood for the vagina to rebuild blood vessels and the vaginal lining.5 Lady V also includes oxytocin, a naturally-occurring hormone in the body that is linked to sexual pleasure and emotional bonding. Oxytocin floods the body during orgasm.6


1 "Dealing with Symptoms of Menopause" Harvard Health Publishing www.health.harvard.edu/womens-health/dealing-with-the-symptoms-of-menopause Last visited, Feb. 5, 2019

2"Female Sexual Dysfunction: Therapeutic Options and Experimental Challenges"
US National Library of Medicine www.ncbi.nlm.nih.gov/pmc/articles/PMC3008577// Last visited, Feb. 5, 2019

3 "The Experts Do Agree About Hormone Therapy" Joint statement by The North American Menopause Society, The American Society for Reproductive Medicine, and The Endocrine Society
Last visited, Feb. 7, 2019

4 "Managing postmenopausal vaginal atrophy" Harvard Health Publishing. www.health.harvard.edu/newsletter_article/managing-postmenopausal-vaginal-atrophy Last visited, Feb. 7, 2019

5 "The Effect of Sildenafil Citrate on Uterine and Clitoral Arterial Blood Flow in Postmenopausal Women"
MedScape www.medscape.com/viewarticle/488894_4 Last visited, Feb. 5, 2019

The Orgasmic history of Oxytocin: Love, Lust, and Labor" US National Library of Medicine www.ncbi.nlm.nih.gov/pmc/articles/PMC3183515/ Last visited, Feb. 5, 2019

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