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What To Expect From Premature Menopause

by Dr. Beth Boatman, PhD

You probably landed on this blog because you’ve been told by your doctor that premature menopause is likely in your future. Or maybe you’re already on the premature menopause train and want to know if what you are experiencing is normal. Well, let’s break it down and discuss the nuts and bolts of premature menopause.

First, let me just say kudos to you for doing some research and learning more about a topic that most people are not super excited to learn about. I want to tell you that premature menopause is “not a big deal” and “you really don’t have to worry about it,” but it really can have a big impact on your quality of life. Please know that if you are struggling, there are treatments (some medical and some not) that can be helpful...but more on that later...or if you don’t have time, just scroll down to the bottom of this article to read sexual side effects of premature menopause and their treatments.

What is premature menopause

Premature menopause is defined by totally stopping menstruation (AKA; your period, Aunt Flo, Code Red, etc.) before age 40. Causes can include the following:

  • Premature ovarian insufficiency (POI)
    • This is the dysfunction of ovarian follicles due to chemotherapy and/or radiation. You don’t have a period, and infertility is likely. POI is often temporary with recovery possible over time.

  • Permanent damage to the ovaries from chemotherapy or radiation

  • Surgery to remove your ovaries

  • Certain prescription medications

  • Chronic disease

  • Brain tumors involving the pituitary or hypothalamus

What to expect from premature menopause

You may have heard of some common side effects of slowed metabolism, night sweats, infertility, mood changes, and of course hot flashes. I was teaching a sexual health class once and a student called hot flashes “power surges”, which I think is a much better name and a nice way to reframe something that can be really uncomfortable.

Some lesser known side effects that you should be aware of include sleep problems, dry skin, thinning hair, osteoporosis, and difficulty concentrating. If you are doing chemotherapy treatments this can also cause difficulty concentrating/thinking or what some refer to as “chemo brain”. So, you sort of get double whammy from the premature menopause and the chemo that can cause some intense brain fog. If this is you, it can be helpful to carry a journal with you to write things down or to have a good support person that can be your “second brain” if needed.

Sexual side effects and treatments

Premature menopause has been cited as one of the major reasons for sexual dysfunction in cancer survivorship. Here are the 6 most common sexual health side effects and their evidence-based treatments. This information is from the American Society of Clinical Oncology guidelines for treating sexual dysfunction in people with cancer. Sometimes it can be helpful to print off these guidelines and bring them to your doctor’s appointment with you to help advocate for your healthcare needs and start a discussion with your provider about your sexual health.

A note on the term “evidence-based”: This basically means we have good scientific research to back up the claim that these treatments can be effective. There, of course, are other types of treatments that can be helpful or therapeutic as well, but the below highlights the treatments that have research to back them up.

  1. Sexual Response Issues (desire, arousal, orgasm) - Sexual response is traditionally broken into different stages. Desire is the feeling that builds in your body that makes you want to be sexually active. Arousal is your body's response in the middle of sexual activity (flushing, vaginal lubrication, heavy breathing, etc.). Orgasm is the climactic brain and body response sometimes characterized by rhythmic pelvic pulses.
    1. Some treatments that may help with sexual response issues include:
      1. Mental Health Counseling
      2. Flibanserin (Rx) or Bremelanotide (Rx) for low desire
      3. Regular physical stimulation (including masturbation and genital massage).
  2. Body Image Issues
    1. Individual Counseling

    2. Couples Counseling

    3. Group Therapy

  3. Intimacy/Relationship Problems
    1. Couples therapy

  4. Sexual Functioning & Satisfaction Problems
    1. Individual counseling, couples counseling, and/or group therapy.

    2. General physical exercise

    3. Pelvic floor physiotherapy

  5. Vasomotor Symptoms (aka menopausal symptoms)
    1. Hormone therapy (if appropriate)

    2. If hormone therapy is not appropriate then alternatives exist (e.g, paroxetine, venlafaxine, gabapentin, or clonidine) but must be under doctor guidance.

    3. Mental Health counseling (cognitive behavioral therapy and/or hypnosis therapy) and

    4. Breathing and mindfulness techniques

  6. Genital Symptoms (vulvar/vaginal atrophy) - Estrogen keeps vulvar and vaginal tissue plump and moist. When your estrogen decreases, your skin and mucous membranes are less elastic and often dryer. Additionally, this thinning and drying can lead to increased likelihood of inflammation and infections. This can cause general pelvic pain, frequent urinary tract infections and/or yeast infections, and pain with intercourse.
    1. Some treatments that may help with genital symptoms include:
      1. Vaginal moisturizers (applied often) and Sexual lubricants (water or silicone based)

      2. Low dose vaginal estrogen, pain relievers, and other prescription medications.

      3. Vaginal dilator therapy

      4. Cognitive behavioral therapy

      5. Pelvic floor exercises

      6. Pelvic floor physiotherapy

If you’re experiencing premature menopause, we encourage you to find the treatment options that may best suite your needs and improve your quality of life. Learn more in your personalized Wellness Plan. Start your journey to sexual wellness in the Rosy App today!

Beth Boatman is a licensed marriage and family therapist and AASECT certified sexuality educator. Beth graduated with her PhD in Family Therapy at Texas Woman's University and specializes in sexuality education and counseling/psychotherapy for individuals and couples facing issues related to sexual dysfunction, intimacy issues, chronic illness, and medical family therapy.