Permission for Pleasure
A podcast to educate and equip women with the information and confidence they need to express, experience and enjoy their sexuality. Cindy Scharkey RN, BSN, brings her 35+ years of experience as a healthcare professional to open the doors to healthy conversations about sex. This is a community where you can listen and learn to give yourself permission for pleasure. Visit www.cindyscharkey.com for educational blogs and newsletter.
Permission for Pleasure
Perimenopause 101: Hormones and Symptoms
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Education is key to entering the menopause transition knowledgeable and prepared! In this episode, learn what you need to know about perimenopause with Dr. Shyama Mathews, a Board Certified OB/GYN, Minimally Invasive Gynecologic Surgeon, and NAMS Certified Menopause Specialist. We discuss when changes start, the common symptoms experienced, and what your hormones are doing. Don’t “gut out” the menopause transition, instead feel empowered to advocate for your health.
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No, it doesn't make it necessarily 100% better or easier, but when they know what they're facing, I feel like they approach it a little bit differently and they can give themselves that grace.
SPEAKER_01Welcome to Permission for Pleasure. I'm Cindy Sharkey your host. I am positively delighted that you are here listening and tuning in to this educationally packed episode with Dr. Shama Matthews. She is a board-certified OBGYN, minimally invasive gynecological surgeon, and a North American Menopause Society certified menopause specialist. Here's the thing we all need education about the menopause transition. Many women begin this stage of life in their mid-40s and it can continue into your mid-50s and beyond. I've divided this discussion into two parts for easier listening. In this episode, part one, we are discussing what perimenopause is, as well as the whole menopause transition. You'll learn more about when this stage of life starts and what to look for, as well as what in the world your hormones are doing and the many symptoms that women can experience. As you'll hear, one of those symptoms is painful sex, which can occur because our hormones fluctuate and our estrogen is decreasing. That results in lack of lubrication. When we don't have enough lubrication, there is too much friction. That can result in discomfort, micro-tears, and painful sex. So, friends, this is your PSA from the lube fairy to use a good lubricant for sex. My favorite silicone lube is Uber lube, which perfectly decreases the friction, but not the sensation. It is body-friendly with no parabens, no glycerin, and no flavor. Truly, I love this product. You can try it at the link in the show notes and use my code Cindy for a discount. All the savings goes to you. And I appreciate when you purchase it on their website and use my code because they are a generous supporter and sponsor of this podcast. And it helps me continue to bring you education and healthy conversations. One episode at a time. Now let's get into this conversation with Dr. Shama Matthews. Welcome to the show.
SPEAKER_00Thank you. Thanks for having me.
SPEAKER_01Delighted you could be here. And I wonder if you would start with just introducing yourself a little bit and your work in the world.
SPEAKER_00Sure. I am a gynecologist, board certified. I also did a fellowship in minimally invasive GYN surgery. So I spend my time in the office with patients and in the operating room doing robotic surgery. And I'm also a NAMS certified menopause specialist. That's the North American Menopause Society. A lot of the patients that I see in the office are seeking care for their menopause symptoms.
SPEAKER_01Right. That's why you're the perfect doctor to talk to about perimenopause, menopause, the whole menopause transition. Because there's just a lot of education out there. You know, people are struggling with just the stigma, the myths they've heard, the garbage they've taken in about the menopause transition. So let's start, get to the basics, and define the menopause transition for people. Because everybody just calls it menopause when in fact there is perimenopause and menopause. So could you kind of flush that out a little bit?
SPEAKER_00Sure. So menopause, by definition, we call that one full year without getting your period. Average age is about 51. However, perimenopause can be anywhere from five to seven years preceding that. So the years leading up to that menopause transition. And in those years, you can start having fluctuations in hormones that cause all of the different symptoms of menopause. And different women experience this completely differently. You know, the typical symptoms are hot flashes, night sweats, period irregularity, sleep disturbance, anxiety or depression, and then sexual dysfunction as well.
SPEAKER_01Right. And we're going to get into more specifics about that, listener. So don't freak out if you think, oh, she's glossing over that. No, we're not going to. But what if I'm someone who's I skip a couple periods in a row? This is a frequent question I get. I skipped a couple periods in a row. So, like, when am I gonna really be in menopause or the transition?
SPEAKER_00That's the million dollar question. Okay. I wish I knew. Problem is the hormone levels fluctuate so much that it's really difficult to tell. So there really isn't like a very good blood test or any sort of predictor to say, you know, oh, if you skipped three, that means it'll be in six months. Like there's nothing like that. So it could be, I tell it could be this might be the beginning of the end. So it's basically like it could be within six months or it could be within six years. There's no way to tell.
SPEAKER_01Yes, I think that's super important for people to hear. Of course, we all would like a A, B, C, let's let it go like this, but it doesn't work like that. And I think if women give themselves a little more grace around this, too, in the sense of this is a phase and stage of life we're going through. I mean, I'm on the other side, but you're still young, Dr. Shala. So, you know, people say, Oh, you're gonna go through that, or you're gonna get through it, or get over it. And what I want to tell women is this is a stage of life that we're gonna be in, and then continue to be in in different ways. Right. It's a different way of looking at it. I think the language around menopause is pretty skewed and negative.
SPEAKER_00Negative, I was gonna say, yeah.
SPEAKER_01Yeah, and yes, it's hard. There's hard things about it, a hundred percent. Also, there are wonderful things about it that I have found freedom and just a renewed sense of myself and all of these things. So there's a hard things and good things that's all part of the package of going into this stage of life.
SPEAKER_00Absolutely, I agree with you. And I love how you said it's about giving yourself that grace and you know, approaching it with that, because I think that is what is often lacking. Like there's that negative connotation to it. There's always, you know, people always speak about the downsides, no one's ever talking about the positives, no one's ever giving you a lot of guidance for how to, you know, approach it and how to embrace it. And honestly, I think when you have that mindfulness surrounding what the symptoms are, what's happening to you, like there isn't as much of that fear surrounding all of it. I also think patients and women in general, like I feel like they handle it a little better because they know what's happening to their bodies with that education, with knowing that. And I feel like, you know, no, it doesn't make it necessarily 100% better or easier, but when they know what they're facing, I feel like they approach it a little bit differently and they can give themselves that grace that you mentioned.
SPEAKER_01I agree with that a hundred percent. I think that's some of what my podcast is about is about educating people so that they feel more prepared. I feel like the menopause transition is so unpredictable. It's just doesn't what your mom did doesn't mean you're gonna do that way, or you're probably closer to what your sister's doing than more than your mom, yes?
SPEAKER_00Yeah, to some degree. Yeah. To some degree. The only thing that really I say often matches up is like if you know around what age mom went through it. Like on is it on the earlier side or the later side? If women in your family tend to go one way or the other, that seems to be a bit more reflective, not necessarily their experience. And I think that's just because there's so many variables.
SPEAKER_01And I'm glad you brought that up. You know, I think if women could just look at themselves individually, I want them to talk to their peers and talk to their providers, but also sit with yourself. Like, what are you experiencing individually? And what is your own health history? This is so important for people. Women sometimes, you know, we kind of dismiss our own health, and yet this is the stage of life where I finally get women to start thinking about their cardiovascular history, their bone health, their thyroid, you know, all of those things that sometimes we do push our health to the side in lieu of taking care of everyone else.
SPEAKER_00Absolutely. And I think that's that was actually kind of one of the reasons that drew me towards women's health in general is because I felt like there's so many women that do that. And also like that, the the fact that I spend time doing minimally invasive surgery is part of that too, right? Because it's about allowing a woman to actually take care of herself. And I know she's got the things that she wants to get back to, right? So getting her back to all of those things, but you're right, I don't think they can do that well if they don't take care of themselves first. And so, you know, kind of guiding people through those choices and letting them know what choices are available because you don't necessarily have to just suffer through it and you know, deal with it, which I feel like a lot of women get that too, either from whether it's peers or media or even providers like clinicians will say that too. Oh, it's just m it's menopause. Like this is you, you know, you're stuck with this. This you can't, there's nothing to do. And I think that's not right at all.
SPEAKER_01No, it's not. I'm glad you brought that up. I often get DMs from women. Do I just have to gut this out? Like, do I just have to power through? That's typically what women are kind of told or it's inferred from providers, and that's such a disservice to women. Absolutely. Yeah. I'm curious because I'm sure some listeners heard you say twice. I'm gonna backtrack minimally invasive surgery. For those who aren't familiar with what that means, I'm gonna backtrack because I think this is important. I'd love for you to share a little bit about that, what that means.
SPEAKER_00So um, minimally invasive surgery means doing things through small incisions. So laparoscopic or robotic surgery, robotics just a newer technology, but basically it allows us to do some pretty big surgeries, like hysterectomies, removing fibroids, removing ovaries, whatever, ovarian cysts, endometriosis through these small incisions. Often they're same-day outpatient surgeries, and the recovery time is you know half of what, if not less, than what an open surgery would be. So that's what I spent half my time doing. I love it.
SPEAKER_01So Well, I think it's important to talk about because often I think people don't understand what their options are, like you said, and then they can't make a really good informed choice for themselves. Right. So thanks for kind of sharing a little bit about that. Let's go back to hormones and talk about which hormones are fluctuating and how they're fluctuating. People think it's all about the estrogen, but there's more going on here. So let's talk about that.
SPEAKER_00Absolutely. So, yes, estrogen is sort of the main one, but then there's also progesterone and testosterone. So all of these levels are sort of fluctuating. More the estrogen and the progesterone, because that's very ovarian-driven, and that's what's sort of you know declining is our ovarian function, our body's ability to make those hormones. And then testosterone, it's more just that the levels definitely fluctuate, but it's more like that the other ones are going down, so the body's perceived levels are ship sort of shifting. So that's why certain effects of each of these hormones are gonna kind of appear differently for different people.
SPEAKER_01Right. And we're gonna talk about those symptoms, but we did mention about testing. I get so many questions about this, as you do. People say, Well, I can't just test my hormones today and like figure out what I need and fix it, you know, or what isn't there just like one test I can do, and then I'll know what's going on. Let's talk about this and what the truth is about this.
SPEAKER_00So the hormones fluctuate, they're different, they're different hour to hour, day to day. So it's very difficult to see. There may be some hints. So I'm never opposed to checking hormone levels. Like I will check. The ones I typically check are not just estrogen and progesterone levels that are coming from the ovary, but actually what's more telling is the hormones coming from our brain telling our ovary what to do. So that's called follicle stimulating hormone or luteinizing hormone, FSH and LH. And it's really the ratio of those hormones to the estrogen levels that really tell us what's kind of happening. The thing is it's not pinpoint, right? So you can't look at the number and say, oh, you're in menopause, because remember, it's that transition, right? So you have to have, by definition, the no periods. And the thing is, you can have one set of numbers one week and then a few weeks later have a completely different set of numbers. So it doesn't necessarily mean you're in it and staying there, but it could suggest that, yeah, it's kind of happening, you know, with depending on that ratio of numbers. So it's not completely useless, but at the same time, often I'll I'll say to him, I mean, is it gonna change what we're doing here? I mean, I'm gonna tell you, I think you're in perimetopods, right? And we're gonna treat it like that. But sometimes it's helpful for people to wrap their head around.
SPEAKER_01So sure, sure. But what you're saying is you're looking at the symptoms they're experiencing.
SPEAKER_00Yes. A lot, a lot of the time, yes, because that's what's important.
SPEAKER_01So, number one with the symptoms. I mean, I know we'll get to hot flashes because it gets all the pub, right? But let's talk about periods because this is what's not talked about, and we're talking like it's roulette every month. So you can be in this transition. It is so maddening for women to not know what's gonna happen with their period. Let's just call this out for what it is, because I mean I personally went through the whirlwind, and you don't know if it's gonna last forever, if it's gonna be so heavy, you think you're done, and then you're you get on a plane and you're, oh my word, it's not done. This is so hard because you can't plan. It's frustrating, it's disruptive, right?
SPEAKER_00Disruptive disruptive. It's hard to plan anything around it. You know, it sneaks up on you, and you're right, like when you're at the worst possible moment, flights and meetings and whatever that you know you've got going on, busy lives. So, yeah, I think that that is definitely one of the most frustrating things. And, you know, it's not just that it stops and goes away forever. It's you know, that it is, it sort of stutters here and there. It could be prolonged, it can be heavy, it can be light, it can be for a couple of days and disappear for a week, and then all of a sudden it's there full force. So it's so unpredictable. And I think, especially women who have very heavy and prolonged periods, it's very frustrating and it can be very difficult because, you know, not only all that bleeding and everything can lead to anemia and fatigue and it's and cramping and the pain, it it's just very disruptive to our whole bodies and to our lives. So yeah, I agree that I think that's probably one of the worst kind of things to happen.
SPEAKER_01Mm-hmm. And I do think that if we talked about that more, you know, I think women would start paying more attention. I always tell people it's so helpful if you would chart, you know, if you for your own benefit and then to be able to talk really, you know, wisely and informed with a provider. This is when I had a period. Actually, two weeks later, I I bled for three more days. And then, I mean, get specific and do it in your phone or in a little journal or what have you, so you have good information to then come to a provider and talk through what's happening.
SPEAKER_00Agree. And I think that's really helpful because when you know people come with that kind of information, I'm able to kind of help guide. Okay, well, what can we do about that? Because again, there are options. So depending on how things are going, we can have a conversation around well, how do we treat that bleeding?
SPEAKER_01Yes, good. What about the ones who aren't bleeding? What if I what if I have an IUD? What if I had a uterine ablasion? What if I've had a hysterectomy and kept my ovaries? Let's talk about those people and what do they do? They they say, I can't gauge off my periods. Well, yes.
SPEAKER_00Yeah, I know. That one's also very frustrating. But at the same time, again, it's about the symptoms, right? So we're just gonna focus on that. We don't have the period marker, that's fine, but okay, we can check off the things that are true, right? Like what age demographic are you in? Could this be perimenopause? Let's rule out a few things. So I do often do labs just to make sure it's not a thyroid problem because often those can mimic a lot of the same symptoms. So because I'm checking thyroid, I'll say, okay, let's throw in an FSH and an estradiol and see what happens. It maybe if it's indicative. But I remind them if it's normal, that doesn't mean you're not going through menopause, right? So that's sort of the important piece of it too. It's helpful to know and can again talk about then at that point dealing with the symptoms and how we get through that.
SPEAKER_01Good. Yeah. So do you hear what Dr. Shaw is saying here, people? Like the symptoms are are a lot of your guide in this phase. I mean, your periods, yes, but this is why it's important to pay attention to what you're feeling and even note it down like, wow, I am really experiencing this or this. So let's talk about some of those things. Let's talk about the hot flashes, hot flushes, night sweats, whatever people want to call them, because many people do have these kinds of symptoms.
SPEAKER_00Yeah, that's probably one of the most common ones. And it's basically like our body's inability to regulate temperature. There's physiology behind that that happens with relation to the hormone shifts. But you're right, people experience it different ways. It could be hot flashes during the day, it could be night sweats, it could be some people actually feel they get extreme cold. Like, I mean, there's a lot of variety there. But hot flashes and night sweats are probably the most common. We call them vasomotor symptoms. And it's interesting you mentioned taking note of them and you know paying attention to them because that actually does help them. It helps if you note that you're having a hot flash and you can kind of almost name it, call it out, and say, this is what's happening to me, this is what's happening to my body, and kind of, you know, breathe through it, think through it, don't get worked up over it. And it actually is shown to help decrease the intensity and the duration. So even just being mindful of it, the mindfulness piece of it is actually really important because that can actually, you know, filter back to affecting how you experience it.
SPEAKER_01I had to learn how to do that because I had really serious hot flashes at a time when I was doing clinical care, you know, with mask and gloves and the whole scene and you're just dripping wet. And I had to keep reminding myself, this is this is gonna go away. This is not gonna last forever. I mean, listen the way I'm starting to talk to myself, right? Take a deep breath. But when we fight it, it almost makes it, you don't tell your brain you're okay and that the temperature's okay, and you can let that go almost that that sense of you know basic cognitive therapy almost, right?
SPEAKER_00Yeah, yeah. 100%. And it does, it kind of spirals out of control then, right? Because it intensifies and you kind of it you work yourself up and that intensifies the half flash. For sure, that happens. So yeah, I often will point point that out. And even just that's one of the things, like when you name it, you call it out, you say, okay, this is what's happening, it makes people feel a lot better because they have a name for what they're going through.
SPEAKER_01And the night sweats can be really severe for some people. I mean, you know, you're basically sweating through your pajamas, your sheets, your sleep is disrupted because of this. This is such a big factor, is the sleep disruption.
SPEAKER_00Absolutely. Sleep is so important, right? For everything from our, you know, our our cognitive function, our ability to function the next day with all the things that we're that we obviously have on our mind. We're more prone to anxiousness, you know, you're prone to the hot flashes, you're more prone to the brain fog. I didn't even add that to the prior list, but that's a big one. So, yeah, the sleep disruption I think is real.
SPEAKER_01Mm-hmm. And mood dischanges. I mean, people do have mood changes, not only just because their sleep's disrupted and they're having, you know, roulette with their periods and hot flashes, but there can be with the hormonal changes, right? Some mood changes, anxiety, tearfulness, top.
SPEAKER_00Talk about that a little bit. Yes. So that's another one because I literally will have people come in and say, I think I'm going crazy. Am I going crazy? Like, what's going on? It's not. It's that their hormones are so disrupted that it's affecting their brain chemistry, it's affecting their neurotransmitter levels. And if you think about it, that's not that mysterious, right? We know that that happens around PMS and PMDD, around our periods, right? When our hormones fluctuate. Many women go through mood swings and uh tearfulness and depression. Maybe if they have underlying anxiety or depression, it may worsen around their cycles. And then we know that about postpartum depression. We've been trying to shed a lot of light on that. So we know that that's a reality as well, with again, hormone chips. So why wouldn't it happen with perimenopause and menopause? It makes sense, right? That it would do that. But that is something that often really gets women because you know, they're used to being high, functioning, and really taking care of everyone else and doing all of the things. And what I tell them is it's like their threshold for what they can cope with is suddenly shifted on them, right? Even people who have baseline anxiety and depression, they're like, Well, I've been, I was doing fine. I managed it. I was able to, you know, function, I was able to do all the things every day. And then they would say it's just like all of a sudden they can't anymore. And it's like their ability to cope is a little bit off. And that's that throws them. It throws a big wrench in their, you know, in their daily lives. So that's a very real one. I spend a lot of time talking about that one because I feel like that too needs to be normalized and it needs to be talked about. And, you know, often those things do eventually resolve, but it doesn't mean, you know, that you you should ignore it. It's really about again calling it out.
SPEAKER_01I actually don't know the research behind, I'm curious. Is for those who do really experience a lot of PMS or experience postpartum depression, and my brain's going, well, ding ding, it would make sense, then they would be the ones who would be more sensitive to the hormone fluctuations in perimenopause, yes?
SPEAKER_00Very correct. Absolutely. There is data on that. And I will tell people that too. I'll say, listen, if you know this about yourself, if you know you had a hard time after you know your pregnancies or you always had a hard time with PMS or, you know, PMDB at any point in your life. It could have been when you were younger and maybe it wasn't so bad later, you are more prone to it with the hormone shifts. Absolutely.
SPEAKER_01That's really good for people to know.
SPEAKER_00Yeah.
SPEAKER_01Wait, you're mentioning PMDD. Where did you define that for listeners? Yeah.
SPEAKER_00Sure. So PMS is premenstrual syndrome. We know that, right? The kind of basic mild shifts in mood, and it could be acne, it could be headaches. There's a lot of different symptoms. PMDD is called premenstrual dysphoric disorder. So basically, that's where just for that time surrounding your periods, it's usually about the seven to ten days prior, for some women it's after, they will have symptoms that are actually they meet the criteria for anxiety or depression. Like for anxiety or depression that you would typically be diagnosed clinically, there's like a checklist of things. If you meet those criteria, but it's really only for that time frame, and it's because of these hormone shifts, that's what we call PMDD or premenstrual dysphoric disorder.
SPEAKER_01Thank you. So many people are not familiar with that. I think it's important to keep talking about it's very common. It's it's actually it should be again normalized and more talked about. Thank you. Thanks for that. Let's go back to the temporary. I always say temporary cognitive changes. Temporary. Do you hear me, people? People think I'm gonna be like this forever.
SPEAKER_00Yeah, so that's where this the brain fog, some people call it nano fog. I mean, there's so many different names for it, but it's basically this again, it's your mind kind of unable to necessarily carry all the things that you carry around in your brain all the time. So something's gotta give. And it's often these little short-term kind of things like where'd I leave my keys, or you know, did I lock the door? You know, these kind of things that we do, we go and we have these sort of automatic motions, and then we can't remember if we did those things. And a lot of it has to do with some of that brain chemistry. And then, like I said, the sleep disruptions absolutely affect that too.
SPEAKER_01So glad you brought that up. Because, you know, it's all related. There, all these factors factor in in relation to each other. It's not just a one-off here and a one-off there. So I think that's important to talk about. And it does even out. So there's yes, it doesn't last forever.
SPEAKER_00Right. It does even out. All of these symptoms do eventually even out. What I do also mention is that many times though, you may find that, okay, kind of got over the hump, I'm coasting now, I'm okay, that these things can sort of pop up every now and then, particularly surrounding stress. So that could be life stress, it could be health stressors, whatever it might be. But when your body is again taxed because it's dealing with too much, these symptoms can kind of flare a little bit. So, you know, be mindful of that as well.
SPEAKER_01What I keep telling people is what's happening in your life at this point? Think about your mid-40s to your early, mid-50s. What is happening here? Some of us are we're taking care of teens, tweens, aging parents, we're at the peak of our profession. Just all of these things are also part of the picture.
SPEAKER_00I agree. And I I think that's actually kind of a fascinating thing, too, because you're right, all of those things happen, and that's when we're going through that transition. And it really is, it's a lot. So, you know, kind of again, the grace to kind of accept that there's a lot going on, and you know, how do you piece through it?
SPEAKER_01Yeah, okay. Let's keep on with the symptoms. I want to bring up joint pain because this is a big one for people. Let's talk about what that and bone health a little bit.
SPEAKER_00Yeah. So joint pain is actually more at the time related to again the hormone fluctuations and the um, you know, sort of joint aches and pain, sometimes inflammation surrounding it as well. Now, we know that estrogen is incredibly supportive of our bone. So our bone health, we know, starts to decline after we pass through menopause for most people. Now, there are people who have other risk factors, other things going on in their life or their health, family history, you know, exposure to steroids, other medical conditions, um, inflammatory and autoimmune conditions. There are other things that can speed it up or start it earlier. But generally speaking, it's very estrogen dependent. So as our estrogen levels kind of decline and stay low, our bone doesn't have that support that it needs. So that's where it's really important to give the bone the building blocks it needs to stay healthy and then do the things that will help keep the bone healthy. And that's where we say, you know, make sure you're getting enough vitamin D and calcium, whether it's through diet or supplements, and then also weight-bearing exercises because that supports the bones and the joints specifically.
SPEAKER_01Right. And let's talk about weight gain. I know you speak to this so well, so let's get after this one because it's such a concern for women.
SPEAKER_00Everyone, everyone. I hear it, oh gosh, I don't know how many times a day. And it's such a, I wish we had a better and easier answer for it. But again, name it. It's weight gain. Why? Because our metabolism slows down. It comes, and that sometimes sets in even earlier than some of the menopauses. And so I warn women of this in their early 40s, you know, late 30s, early 40s. I'm like, listen, this is coming for all of us. So, you know, be mindful of it. Your metabolism is gonna change. You can't cheat anymore, your body won't allow it. So, how you approach that is what's really important. Again, how your body processes food is gonna be different. So, your nutrition may need to, you know, drastically change for some women and for others, it may be some, you know, tweaks and corrections about what our body needs. And then also exercising. Even if you are a pretty active person, remember that's what you were at baseline. So when your metabolism slows down, you often have to change what you're doing to counter some of that effect. So that's where some making some of those adjustments is really important.
SPEAKER_01Okay, let's talk about. I mean, we could spend actually a whole episode just on that and just the negative baloney, whatever. Just we could do a whole thing on. Well, we talk about that on this podcast all the time, but just know that's I love the way you're addressing that, your metabolism, the changes you can make, some tweaks you may need to make, and also the reality of what is, and accepting that our bodies do change and go through stages and phases.
SPEAKER_00Absolutely. And I agree. And I often will say, don't focus on the number, focus on your health, right? Like you're making these changes, it's for everything else because you also have to protect your heart, you have to protect your bones, you have to, you know, you're eating healthier and and you know, exercising more, not just to make sure that that number looks good on the scale, it's about how you feel and you know how you're kind of approaching this next phase of life.
SPEAKER_01Sure, sure. And let's talk about GSM. This is getting so much more known, and I'm so happy. Let's talk, let's talk about this and what it is and what the symptoms are surrounding it.
SPEAKER_00Sure. So GSM is genitourinary syndrome of menopause. And why that's important is it's not just the vagina, but it's everything around it. So it's the vagina, it's the labia, it's the vulva, it's the clitoris, it's the urethra, it's the bladder, I mean it's everything, right? The pelvic floor. So it's all of the that whole area is very estrogen supported dependent. So when our hormone levels start to change, that tissue changes as well. And so the effects that happen are directly related to that loss of estrogen. So without the estrogen there, what happens? The vaginal mucosa thins, it's not producing as much lubrication, it doesn't have as much elasticity, abrasions are easier and tears are easier. There's pain because there's less stretch to it. The vulva as well also thins out. It's not as, you know, robust, it's not as plump. The tissue around the urethra also weakens. So that's where things like UTIs are more common potentially. Bacterial and yeast infections are more common as well because the estrogen levels shift, and so does then the pH of the vagina. So then that makes those things more common as well. So it's about addressing all of those things. And well, I didn't get into pelvic floor, but that's kind of a secondary sort of thing as well. The pelvic floor can weaken as well because of this loss of estrogen that happens after menopause. So a lot goes on down there.
SPEAKER_01We're gonna talk more about this. People are I can just see people going, wait, wait, wait, wait, let's talk more about because some of those symptoms also then can result in painful intercourse or penetration.
SPEAKER_00Correct. And that is where I again a lot of other downstream effects from that. But my big thing that I try to drive home sex should not be painful at any time. So if it is, then we need to figure out why, and there's ways to correct it. So that's an important one because a lot of people accept that it's gonna be painful, and then they try to power through, and then they don't want to have sex anymore, and then they think that part of them is gone, and it's not okay.
SPEAKER_01No, it is not okay. My listeners know I am the lube fairy, and this is often a time if people haven't pursued using a lubricant for sex that we're just talking about for sex right now. This is the time when they realize something's not right, like you're describing. And this is where a lubricant for sex is a key time for women to have sex that's pleasurable, not painful, doesn't result in these micro abrasions you're talking about, and they don't need to give up sex over this if it's just this one issue of lubrication. So you know I'm a fan of Uber lube listeners, they are a favorite silicone lube, and this is a beautiful time to try that. And I think the other symptom that people bring in here is decreased libido at this stage. And sometimes I want to say, well, if you're experiencing painful sex, your libido is gonna go in the toilet.
SPEAKER_00Absolutely. I bring that up a lot too. So when libido is the first thing often is brought to my attention, I'm like, well, wait a second, is it painful? Because if it's painful, your body's not gonna want to do it. Why would you, right? You don't desire something that's gonna hurt, you know, you deter from that. That's uh just an instinct. So you have to make sure that part is corrected before we even start going down the whole, you know, libido conversation, right?
SPEAKER_01Which is a big conversation. So we're gonna just pause here and then we're gonna talk a next episode about all the treatment options and more about sex related to this phase of life. So don't miss out and join us for the next episode where we're gonna continue this conversation. Friends, thanks for tuning in. I know this is a lot of information, so perhaps uh save this episode or mark it to come back to so that you know where the information is and can find it easily. Please do share the episode with a friend and follow the podcast. That way you won't miss the rest of my conversation with Dr. Shamma in the next episode. Or remember to check the show notes. That's where the links are for the topics we talk about, as well as your link and discount code for Uberloop. Until next time, let's keep giving ourselves permission.
