S2E9: Menopause: What You Need To Know About Your Second Spring

PTBE 9 | Menopause


At some point in time, we will hit menopause. It could arrive early for some, while others may have it later. Either way, it will come and create changes for the rest of your life. And wouldn’t it be great to know more about it before it happens to help you through? In this episode, Clare Sente takes the hot seat opposite Rachel Watson to share her experience with menopause. She talks about some of the changes and adaptations she discovered since going through it nine years ago and how it has impacted her body and sex life. Menopause is not an event. Once it hits, it will continue for the rest of our life. Don’t let it scare you; celebrate it. Join this episode to learn more about your second spring!

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S2E9: Menopause: What You Need To Know About Your Second Spring

This is season 2 episode 9. This episode is a little bit different. If there’s any episode you choose to watch rather than listen to, this is the one because Clare has brought her demo models. We have our plastic vagina or our vulva with us.

Yes, we do.

We’re going to talk about something that I hope is going to be fun. I’m a little bit nervous about it. One of the beautiful things about the way that we work together is that we are at different points in our life. We have different relationship statuses and experiences. Clare is our resident 60-year-old and she has a lot to tell me in my 30s, and all of us even if you’re in your 60s and beyond, about the way that our bodies change during menopause.

Clare is going to do a lot of talking and I’m going to do a lot of questions and answers like, “What about this?” When I was getting ready to start my period, I knew what to expect physiologically, hormonally, and emotionally. There was a lot of education around that. It was in schools and mainstream in education. Now, I’m thinking menopause is coming soon and I don’t know anything. Am I going to get hot flushes? That’s nearly the limit of my knowledge. Clare, over to you. Menopause.

I told Rachel that I wanted to do an episode that I wish I would have heard ten years ago. A lot of it was trial and error for me. At this point with so much data out there, I don’t think that it should be for anyone like Rachel who’s in the second half of her 30s or when you’re in your 40s thinking about this. You never know when it will happen because it also can happen from chemotherapy. You can go into induced menopause because your hormones aren’t working and for other reasons too. I am not a menopause expert. As someone who values her sexuality, I am sharing how menopause affected me and how I wish that someone would have been there to show and tell me some of the things that I had to discover.

I have learned so much from people in 2022, from podcasts, meeting them, and finding them on Instagram. Anyone can learn more about it too. If you all know and only tuning in to this episode for the first time, I had a wonderful sexual awakening at 48. I was 18 when I lost my virginity. If I waited 30 years later to realize what true mind-body connection of feeling one with everything and one with my partner, and an ecstatic experience, and then all of a sudden menopause hits at 51, that’s the worst scenario. I don’t want to shut this down or stop this. I was quite motivated to make sure that those feelings lasted because I was just getting a taste of all of that, so to speak.

For me, in all reality, menopause is not an event. Someone is going to be in menopause once it hits for the rest of their life. That’s the actual terminology of it. Your body is continuing to get used to these changes in hormones. We all start with the same girls and boys, then things change when the testosterone kicks in for the boys, and the estrogen and progesterone kick in for the girls.

Menopause is not an event. It hits once, and it hits the rest of your life. Click To Tweet

At 51, that is the average age that it should happen. Does average means everyone? No, it means it takes one end and another end to come up with a middle average. I know someone who started in her early 40s. I know women who are still feeling like everything is beautiful down there like a fresh luscious flower and they’re in their late 50s, and that’s wonderful.

For me, it started at 51 and it started with vaginal dryness, which was disturbing because as I said, my mind was like, “This is so good.” I’m with a partner who spends time on my body. I feel safe. I don’t feel rushed. I feel adored. My body was responding and then all of a sudden, nothing changed except that the estrogen and the progesterone started to go down. What happens with vaginal tissue is when you don’t have that estrogen and the progesterone going there, you’re not as plump. There isn’t as much blood flow. There are just so many estrogen and testosterone receptors, or androgen as they are called, on your vulva.

This is an old world I learned from Dr. Rachel Rubin who is a wonderful urologist who specializes in women’s health. She said, “We don’t use the word atrophy because that sounds so bad.” It’s like your arm was in a cast, and then it was six weeks and it comes out. You’re like, “I have a baby arm. There’s no muscle tone. What happened to it? It’s so different than the other arm or the leg.”

It’s shriveled and stinky.

Who wants to have an atrophied vagina? That actually happens and that’s another reason that it could be painful if someone enjoyed sex. Let’s hit some main points and then we can circle back. The vagina, the vulva, the inner part, the opening of the vagina, which is called the vestibule, the inner lips, the outer lips, the clitoris, and the clitoral hood, all of those have estrogen, progesterone, and testosterone receptors. If we’re not getting it, gynecologists can see that a woman’s vulva looks different. It gets thinner and not as lubricated.

We already know we need to give ourselves 20 to 30 minutes to fully engorged or get erectile tissue plumped. Even after 30 minutes, if you don’t have as much blood flow and estrogen plumping things up, then it’s not as plump. They weren’t there for me. I had to educate a couple of female gynecologists and they were like, “You shouldn’t do estrogen and progesterone.” I’m thinking, “Is that true?” We have this old data that we looked at where women were 10 to 15 years into menopause and then started to give them estrogen and progesterone. What happened was it did not do good things to their bodies. It was too much of a jump. Estrogen had been out of their body for a while, like at a zero level in their bloodstream, and then we’re giving them back stuff and it wasn’t good.

I learned from a couple of good gynecologists and from a pharmacist who works with gynecologists. He was like, “It’s important that if you are going to go with an estrogen-progesterone replacement, you need to do that within the five years of you starting to menopause. You can say you’re in menopause, not perimenopause, when you’ve gone a whole year and you haven’t had a period.” That’s what my friend Carter was saying who is the pharmacist who works with a whole group of gynecologists. He makes these wonderful estrogen compounding cream that has a little bit of vitamin D in them. In his whole practice, all those gynecologists are like, “This is what you need to be taking as a woman who’s in menopause for the rest of your life.”

For a lot of people, that’s a scary thought because there was a huge study that bad things to women. I had these gynecologists who were saying, “No, I don’t recommend it. It could be cancer.” I’m trying to find a non-prescription thing like, “It’s like a cream or a Vaseline. You’re rubbing it on the parts that are dry. ” That feels awful to say even as a woman, “No, I just want to be that moist.”

All plumped and juicy.

Unfortunately, that doesn’t happen. When it does get less of that estrogen, it’s going to start feeling dry and uncomfortable. It could even itch. You’re then thinking, “Do I have an infection?” It’s because none of this is what you had before. You’re like, “Damn it. My body is stopping doing what it’s supposed to be doing.” I want to normalize that some women go through this easily and some have more. That’s why it’s good to find a good gynecologist.

PTBE 9 | Menopause
Menopause: When your vagina gets less of that estrogen, it will start feeling dry, uncomfortable, and could even itch.

In America, we have The Menopause Sisters, Caroline and her sister Claire. We could have them on the show too. In America, they have the North American Menopause Society or NAMS. That’s a great website where you can find a gynecologist who is educated in that. It’s tough to talk to someone who is a doctor when you’re looking to them for advice, and they’re telling you things like I was told, “Here’s some cream.” I wasn’t even told how to do it. I used it wrongly. I was like, “What’s happening? It’s so greasy. I don’t want to have that.” There were things to learn about that.

I had forgotten that the other symptom of menopause that I knew was vaginal dryness. I only knew that because in our medicine cabinet there was prescribed lubricant from the local family doctor to my mom. I was a nosy teenager or whatever. I’m going, “What is this in the medicine cabinet?” I’m reading it and was going, “Okay.”

It was quite clear that it was for women of a certain age and that kind of thing. I didn’t know that was a thing, but I find it very fascinating. That is very much like, “We’re going to treat the symptom and not the cause. You’re dry during sex. We’ll give you some lubricant. You can lube up for sex,” which is very different from what you are saying. This is not just a lube-up-for-sex thing.

Thank you for saying that. It is just treating the symptom. I met two gynecologists before I met the third one and they’re telling me, “No, this increases the higher risk of blood clots, heart disease, and cancer.” I want to help Dr. Rachel Rubin and Dr. Lauren Streicher who are both wonderful physicians. They are dedicated to women’s reproductive health and menopause, and loving menopause. They are both about using estrogen almost the way we’re putting cream on our faces. We don’t shame anyone for putting moisturizer on their face.

I love how Dr. Rachel Rubin says basically how you would have a toothpaste tube that you’d put a little ribbon for about an inch on your finger. A couple of times a week, you are rubbing it into the clitoris, onto labia lips, the outer and inner, and then right at the vestibule. That’s a minimum. She says that after doing that for a whole year, it wouldn’t even be a blip on a blood test. She said that it was like a scale of one on estrogen. Women are 3,000 when they’re pregnant, and men even have more estrogen than that in their bodies. There’s nothing wrong.

She says that she has to educate a lot of doctors that will say, “No, you’ll have cancer. I will say no to that.” I do feel a difference when I use it. I already worked hard on trying to have my body open in different ways of breathing, communicating my needs, and feeling safe. This is that extra thing. There are estrogen receptors there and it’s ready. That is something that I thought was important.

The other thing that happens with estrogen and progesterone going down is the pH in your vagina can change. Sometimes other things can make it uncomfortable because vaginas are self-cleaning. They have a more acidic pH because that helps keep the bacteria and yeast from forming. I remember I had different feelings in my vagina based on when my period cycles would be. Am I ovulating when everything is already more lubricated? When you have your period, it changes.

PTBE 9 | Menopause
Menopause: With estrogen and progesterone going down, the pH in your vagina can change.

Even when there’s semen in the vagina, it makes it more alkaline because semen is more alkaline, and then it can throw some people off. I remember in college there was a girl circle of 21-year-olds saying, “I like being with my boyfriend but it’s a struggle if I let them come inside of me,” or whatever, which would be odd because they’re trying not to get pregnant. Maybe they were using the rhythm method but they’re like, “That throws off the pH of my vagina,” and it totally does.

If someone struggles with reoccurring yeast or bacterial infection, I learned that you can get pH strips from Amazon. It ranges from 3% to 5.5%, of which 7% is neutral. It’s acidic. I heard about this once because I used it in nutrition where we had to help people to see if their urine was too acidic, and then we needed to make it less acidic. In this case, our vaginas have more acidity. They said 5.0% started to look greener. She said that the top is 4.5% for menopausal women because we don’t have that estrogen. We tend to be a little bit less acidic. If getting further away from being acidic, it makes sense if someone says, “I have these reoccurring infections,” and that could be a whole other show.

These are not the sticks that I put in my hot tub. These are specific for this purpose.

These are special ones that you can literally tear off a piece and then put it by your vagina. You wait a couple of minutes and then you compare it to where you’re at, and it’s where I’m supposed to be at 4.5%. That’s important to me because these may seem like little things but they’re big things about why sex isn’t great. If you’re struggling with a yeast infection or bacterial vaginosis, which is a very common bacterial one where you have that bad fish smell. I’m sorry in those years that I had to struggle with some of that. I wish I knew something about pH. Who wants to have sex when you’re embarrassed about what you smell down there? These are all important things.

Summing up so far is that I would like women to find a good physician that is knowledgeable about menopause. I’m not blaming physicians. They have to learn so much. An obstetrician and a gynecologist do, but I want to work with someone who is being more specific. I have a few of my 50 to 60-year-old friends where I’m telling them, “Go to my doctor because my doctor will give you a prescription for this for the rest of your life.” She’s saying, “My doctor is like, ‘There’s no way I’m going to give you that for the rest of your life,’” because she doesn’t know what the latest data shows.

Find a good physician that is knowledgeable about menopause. Click To Tweet

It’s not the doctor’s fault. They have specialties. Find one where the specialty is menopause or gyne.

I made it under the wire luckily that I was not out five years of having begun menopause. I stopped at age 51 having a period. My biggest thing was the hot flashes were interesting because. They lasted maybe 4 to 6 months, and then they stopped. My gyne said that someone could have that for fifteen years. They could be dealing with hot flashes for 10 to 15 years. Two of the things she says most women come to her for are vaginal dryness and hot flashes. Also, night sweats and not being able to sleep at night. That’s important that we get our sleep. That’s where she’s doing the estrogen and the progesterone.

Progesterone to balance it because the body needs that. If a woman doesn’t have a uterus anymore because it was taken out in a hysterectomy, then it’s just the estrogen that is prescribed and not the progesterone. I have my uterus so I need to have the estrogen daily, and then I try and use the minimum amount of progesterone, and I’ve worked that out with her. We won’t get into that here.

One of the things I liked instead of putting one of the options was putting a pill or a patch. My prescription for Estradiol is for a smaller amount and there’s probably a higher amount. My doctor was like, “We’re going to get to the point where you feel you don’t have the vaginal dryness,” because mine wasn’t hot flashes anymore. I realized that I wanted this to go higher, but then the game-changer was adding that locally.

I only found these things from listening to Dr. Streicher’s podcast for all things menopause. I went back to her and said, “I need to be using this.” She’s like, “I told you that, Clare.” I was like, “My brain was on overload.” We’re navigating when you’re pregnant. You have a lot of things coming at you. When you go through menopause, there were a lot of things too. I was like, “You did say that. Sorry.” It is a combo of both of these and it works well. It’s a little patch. It looks like a little piece of cellophane tape. It has a backing and you pull it off. You put it every couple of days over the right or left ovary.

It’s like a nicotine patch.

Yes. I also can put it on my butt and alternate so that you’re not always putting it in the same place. That keeps that low level in there. My girlfriend uses something different and we were talking about it. I said, “I’m going to talk about this on the show. I’ll make it very generic so that no one knows it’s you.”

I’m surprised your girlfriends still talk to you if you’re like, “This is going to be on the show by the way.”

I will never use names and I will change some scenarios so that no one can identify which girlfriend it is. Her husband was the one who was bothering her about “I need more sex. We need to fix this.” She went to her doctor and she got a pellet which the doctor will put under the skin by her hip or buttocks on one side. Three months later, when you do it again, she’ll put it on the other side and alternate.

In her case, she also has testosterone. It’s called off-label because women can be prescribed estrogen and progesterone in menopause by gynecologists because it’s a thing. For testosterone, it doesn’t mean that it’s illegal. It just means you have to find the right doctor that will say, “Sure. We should try this. Let’s try this.” She’s like, “It’s hard to go off of that,” because she could tell when those three months are ending because she’s like, “The energy goes low.” All of a sudden, her drive comes back up.

When that whole Viagra came up for guys, it caused a lot of problems in marriages. Here’s this guy whose wife was happy. He had erectile dysfunction problems and now all of a sudden, he is got a little blue pill and stays erect and is wanting to have a lot more sex. She’s like, “This was not in my plan. This was nice. We only did it a couple of times a month. Now, he’s wanting it every other day.”

She’s getting ready to cruise off into the sunset and chill. She wants to knit and drink tea. That was something I wanted to ask you. You had this sexual awakening at 48 and then quite quickly off the heels a few years later be in menopause. Did anything happen to your desired level? Did that desire stay but it was physical or was there a drop in desire?

It did go down. Let’s talk about that. The main thing that women go to their doctor for is, “My desire level went down. I’m having hot flashes and I’m dry.” Those would be the top three things. I did feel that. In all fairness, there was a time after menopause hit probably at 52 or 53, and that same lover wasn’t in the picture I distinctly remember that my drive did go down because my drive went back up with some estrogen. I’ve never had testosterone but maybe when I’m 70-something they might tell me, “No, that ship has sailed. You’re staying on where you’re staying at.”

PTBE 9 | Menopause
Menopause: The main things that women go to their doctor for are that their desire level goes down, they have hot flashes, and they’re dry.

I love the idea of you as a 90-year-old terrorizing a care home facility knocking down everybody’s doors like, “Come on.” That drop in desire could be caused by your body changing because how we feel about our body very much informs our desires. Is it like, “I feel less attractive and young. I’m aware of my age and therefore my desire drops.” It’s hard to extract and say whether it is a hormonal desire or an emotional one. Is it both?

It is both. I remember there was this partner and I kept trying to tell him, “Don’t take my lack of lubrication as I’m not turned on.” It was frustrating for me because my body feels that way but it was not happening. It’s in my mind and I’m happy but down there, she’s not responding. What happens is when you start getting critical of yourself and focusing on that, that’s not going to help the situation. It’s a dialogue that you’re going to need a good medical provider that understands this process and knows that I started out with a 0.025% and had to go higher. Also, you have to try some different things.

I appreciate that. There are so many things that change. I find the idea of having these resources dually beneficial. Physiologically, here are some things to try to help but also, psychologically, you are not a victim of what is happening. You can have information and knowledge. You can get these things and ask these questions. Sometimes being empowered with some information is half the battle rather than being like, “I don’t know what’s happening, what to do, who to ask, and what to ask for.” The pH strips for example, I was like, “That is crazy,” but it’s a tool in your arsenal of, “These are the things that I have control over and manage. I can look at myself.”

I like that you said that because it’s reminding me that I could talk to my doctor more like, “This might be a reason that I’m having more yeast infections.” I have a couple that I work with and she is in her mid-50s. She said that she doesn’t want to have intercourse anymore. They work around it and it’s not penetrative sex anymore. She’s like, “The bother of what my body deals with afterward makes it not fun.” They work around that, but how about you would say, “This pH strip comes out not the way I want it to. What’s in my diet that I could change? What are some things that are there?”

When I was reading about it, I’m like, “A lot of women are not going to want to hear this.” It’s alcohol and sugar. I’m like, “This start taking away some of the fun things that help you to get in the mood or something with the wine,” or whatever. It’s not an easy process but it shouldn’t be alone. I had this one girlfriend and she was one of the few single girlfriends from my group of girlfriends that I’ve been with since we were all in high school. I was telling her about this vaginal dryness. This was her answer. “I don’t want to hear about it, Clare. That’s not me. I don’t want to hear about it.” I’m like, “Shame. It’s me. What’s wrong with me? She doesn’t have it.” We need to have more groups.

When we did our workshop in Edinburgh and we are at a yoga studio called Calm on Canning Street. It’s got the lotus flower. Caroline is part of The Menopause Sisters. She is a menopause-informed yoga teacher. Her Friday morning yoga class was something I did like to do. I was like, “It’s the last Friday before I leave. I’d love to see how Caroline teaches.” That’s what I wish for all women, that you have these slow yoga things, and then you sit in a circle afterward and share some of the things going on with someone who’s informed that can make you feel like you’re not alone.

PTBE 9 | Menopause
Menopause: You need to have a circle where you can share the things you’re going through with someone who’s informed, and that can make you feel like you’re not alone.

That’s why I wish for more women. It’s to have those circles so that you aren’t feeling like, “What’s wrong with me? I have hot flashes. No one else has it anymore. It’s been ten years.” On that one, I don’t feel like I’m the expert to talk to, but I do want to repeat what I’ve heard from the two doctors. That’s the one that you don’t want to wait five years to treat.

Dr. Streicher is the head of Northwestern, which is a main university here in Chicago. She is the head of their menopause and women’s sexual health center. She’s a powerhouse. She talks about that one thing, “We got to get you on hormone replacement sooner,” because that affects more things. When we were saying, “Maybe I feel bad in my body that I’ve got vaginal dryness. I don’t feel as good down there,” but when you don’t sleep at night, tell me how anything gets itself in order. That’s a big problem for menopause as women. It’s getting a good night’s sleep.

I feel like that’s a more socially acceptable one. That’s the menopause thing that your mom would say. The only menopause thing my mom ever talked about was hot flashes. We all knew that she was having them and we all knew what she needed to do. Although I saw her lubricant in the medicine cabinet, she never said to me, “My vagina is quite dry. It has changed in size and shape.” She never said that. Let’s not ignore our hot flashes, but it’s also removing that shame around talking about things like, “It’s a bit uncomfortable when I have sex” or “I keep getting this thrush.”

Not just a bit uncomfortable. It could get very uncomfortable. That’s the whole reason I am doing what I’m doing with Empowered Enchantress. I want to work with women who some had sexual trauma to try to like and love sex again. What if you’re like me? You liked it before and then your body changes. One of the things that’s magnificent about the vagina is it can expand. What happens is they say without that estrogen it flattens out. There isn’t that give. The inner labia on a vulva on a female body starts to disappear without estrogen. Isn’t that crazy? How can a body part disappear? It’s getting smaller.

Men and women have estrogen and testosterone receptors. For any of the women out there who are tuning in to this, this is a game-changer. I’ve made most of my girlfriends go to their doctors to ask for a prescription for a tube of estrogen. A lot of times, you don’t have to use a whole bunch of it. It can last a long time too. We put cream on our faces and there’s no big deal. Yet no one said it.

I’m like your new mom that’s telling you, “I want to get you all ready for when any of this change happens. It’s normal just like when you got your first period. We’re so proud of you and we want to celebrate.” This is what’s called the second spring for a woman. Instead of talking about all the bad things that happen, there are other things that are wonderful in it.

We want to celebrate the second spring for women. Instead of talking about the bad things that happen, acknowledge other things that are wonderful in it. Click To Tweet

I don’t have periods, but I learned to cycle with the moon to have my cycles with that. I don’t have kids to take care of at home. They’ve flown the nest, but now I’m nurturing some of my dreams and some of the things I’ve put off. I’m getting better with my boundaries of telling people, “No, I don’t want to do something that I said yes to twenty years ago.” Estrogen makes you a little bit more of a people pleaser. It’s funny how you lose estrogen and you become more assertive. There are nice things that could happen with this next stage. The best phase changes happen when we’re supported by other women, and people with who we can share it.

I love that. The best phase changes happen when we’re supported by other women. I appreciate Clare’s support and your support, my dear audience. Thank you so much for tuning in. I would love to talk a little bit more about menopause. It’s such a big subject about what happened to your confidence or skin. There are so many things outside of your genitals that can happen from menopause. We’re going to invite a guest expert to help us with this. If menopause chat makes you uncomfortable, there’s going to be another episode coming up. We so appreciate your support when you tune in. When you tell us that you have enjoyed it, that makes our day. Thank you for being here. Clare, I love you.

I love you too. I’ll see you next time.

We’ll see you next time.


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