Demystifying Menopause - Dr. Arianna Sholes-Douglas

Demystifying Menopause: What is Normal?

One of my main goals is demystifying menopause. That includes letting women know about symptoms that aren’t as well-known as hot flashes and weight gain but are, nevertheless, normal. Are any of these familiar to you? If so, rest assured they’re normal – and so are you!

NORMAL: “My vagina looks… different”

Mama may have told you about the birds and the bees but I bet she didn’t tell you about this. The fact is, age and hormones affect the appearance of the vagina. The pubic hair can go gray, thin, or disappear altogether; the skin can change color; the labia minora can lengthen, and the labia majora can sag. All of these changes are completely normal and natural with age.

NORMAL: “I pee a little when I laugh/cough/sneeze”

Changes don’t just affect the outside of your vagina, but the inside, too. Decreasing estrogen is responsible for the thinning of the vaginal walls, which means the urethra doesn’t have the support it used to in order to hold urine in. The result: incontinence. If you find yourself having second thoughts before lifting heavy objects, you’re not alone. Urine leakage is not just normal, it’s very common! Around 50% of women will experience some form of stress or urge incontinence in their lifetime. 

NORMAL: “I’m losing hair where I want it and growing hair where I don’t want it”

The dreaded chin hair! This is a prime example of menopausal hormones growing hair where you least want it. At the same time, these hormone changes – specifically, decreasing estrogen and the changing ratio of estrogen to testosterone – are responsible for thinning hair on the scalp, especially on the crowns and near the forehead. (Worth noting: Thinning hair is also a common symptom of a thyroid disorder.)

NORMAL: “I’m feeling anxious and/or depressed”

I hate to be the bearer of bad news, but if you have a history of anxiety and/or depression, you are likely to experience it again in perimenopause. Decreasing progesterone and overactive adrenals may be partially responsible for the anxiety you’re feeling, and progesterone has been implicated in depression, too. Depression and anxiety are not just “all in your head,” either, so don’t ignore it – treat it.

NORMAL: “I’m less patient and nurturing than I used to be”

Again, all in your head? Not at all. Estrogen is actually a key driver of women’s nurturing behavior and desire to take care of others. When levels decline in perimenopause, women can find themselves thinking, feeling, and behaving in a way that’s unfamiliar. This very real biological change can have huge consequences for family dynamics. If you’re not feeling like yourself anymore, and your partner has noticed – and possibly complained – now you know why it’s happening, and that it’s normal.

What’s Your Normal?

Part of demystifying menopause means understanding what’s normal for other people, and what’s normal for you. I encourage all women to get to know what’s normal for them. What does your vagina look like? What are your orgasms like? How is your mood? Pay attention to yourself so you can keep track of what’s your normal, and when that’s changing.