Menopause Taboos: Thinning Hair, Painful Sex, and What You Can Do to Stop Them
Hot flashes, mood swings, and sleep disturbances are symptoms of menopause that women openly discuss. But they are much more reluctant to talk about painful sex and hair loss, even though these conditions affect many millions of women.
September is menopause awareness month, and Healthline sat down with two doctors to get painful sex and thinning hair — two "forbidden" topics-into the spotlight.
Don Johnson Moore, OB / GYN in Chester, New Jersey, told Healthline that vulva vaginal atrophy (VVA) is one of the most common nor the least menopausal symptoms the doctor has talked about.
"VVA is a condition that occurs over time, and about 50 percent of menopausal women will have significant discomfort due to VVA. The most common form of discomfort is dyspareunia, which is painful sex, " Moore explained.
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"Vaginal dryness is a result of VVA, "Moore added." It is the thinning and aging of vaginal tissue as a result of changes caused by menopause. These changes include a decrease in estrogen production. Almost every tissue in a woman's body reacts to estrogen. When we go through menopause, the big news is that we no longer have periods, but the reason is that we don't produce estrogen from our ovaries.”
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Moore said it's embarrassing for women to mention to their doctors that sex is painful, in part because they think they're the only ones experiencing the symptom. Of the 65 million women in the U.S. who are currently going through menopause, about half, or 32.5 million, experience painful sex, Moore said.
"We know that only about 24 percent of these women even talk to their doctor and are properly diagnosed. Of these women, only about 7 percent receive medical care. So there are many women suffering from this condition who have not communicated with their doctor and have not received adequate therapy, " Moore said.
Pictured from left to right at the Women Take Charge event: Shionogi COO Deanne Melloy, Dr. Margaret Nightingale, Ali Wentworth, Dr. Moore, Don Johnson, Dr. Shannon Chavez. Photo credit Michael Loccisano/Getty Images.
Women deal with this issue with their friends and even their sexual partners. “We have a Don't ask, don't tell situation ... The irony is that baby boomer women in the US and Canada go through menopause at a rate of about 5,000 a day. This is a generation of women who grew up in the 1960s and talked about everything. This is a group of women who started the sexual revolution, and now many of these women are among the millions of women who have painful sex because of menopause, and no one is talking about it," Moore said.
While many women use lubricants to ease painful sex, Moore says lubricants “don't cure the cause. The lining cells of the age of the vaginal wall like the cells on your face. The mucosal cells, the cells lining your vagina, undergo very similar changes. Lube is similar to what a lotion will do on your face. The lotion is a very temporary solution, but it doesn't sink into the deeper layers of the skin like some moisturizers ... It does not harm the cellular structure.”
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Ospemifene (Osphena), a non-hormonal oral drug from Shionogi, was approved by the Food and Drug Administration for the treatment of VVA in 2013.
Moore said the packaging of Ospphena warns that the drug may increase the risk of developing a cancer of the lining of the uterus, called endometrial cancer. Other side effects include an increased risk of stroke, blood clots, hot flashes, muscle spasms, vaginal discharge, and increased sweating.
"These things are also side effects of menopause, "Moore said." Women should talk to their doctors about what's right for them. This is the same situation with estrogen or other prescription medications. With a prescription drug, we always weigh the risks and benefits.”
Moore said that osphena or extra estrogen can make the vaginal cells healthier and stronger.
"I want to be very careful not to imply that this may take you back to where you were when you were 25, "Moore warned," but it may help improve the function of your vaginal mucosa. Osphena and Estrogen act equally in this respect. Ospina acts like estrogen in some tissues of the body, not as an estrogen in other tissues of the body.”
Estrogens, a category of medications containing patches, creams, and gels, can treat the underlying cause of VVA. However, there are concerns about injecting women with extra estrogen, as it has been linked to the rise of some cancers.
"Cancer that most women do most worry about is breast cancer ... Anything that can increase the risk of breast cancer may be even slightly, it will be very appropriate to make women worry, and therefore most women do not take Estrogen. This is probably the biggest difference between estrogen and osphena. Osphena is not an estrogen, it is not a hormone, and it does not increase the risk of breast cancer," Moore said.
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Shionogi has developed a campaign called "Women Take Charge" to raise awareness about women's sexual health.
Moore, who is helping Shionogi raise awareness, said :" We encourage women to make a commitment to talk to their friends about painful sexual intercourse. When I talk about it with my friends, it opens the floodgates of comments. Many of my friends have Doctors, others are not Doctors, but are well trained, and some have said, 'I thought this was how it should be' ... If painful sex, her natural inclination is to say, " Maybe I said I don't want to have sex that often," Moore said.
Comedian Ali Wentworth told Healthline that she hasn't experienced menopause yet. But when she read in a magazine about painful sex as a symptom of menopause, she decided to support Shionogi and spread the word that “we need to talk about this. There is no reason why people should be shy. I don't like the idea that sex will be painful during menopause. I don't want to feel like I'm sexually expired.
"Many of my friends are going through menopause. It seems as quiet as you get the answers," Wentworth said. “This is what women should talk about. Some women are confused and don't want to discuss it with their doctor. You should talk to your doctor about this.”
Why do women lose their hair during menopause?
Thinning hair and hair loss is another taboo for many menopausal women.
Dr. Alan J. Bauman, one Tip from a board-certified physician who specializes in his practice in Boca Raton, Fla., on hair restoration, told Healthline that about 100 million women in the U.S. have thinning hair.
"Most women who come in for thinning hair treatment do so during perimenopause and menopause. The vast majority of hair loss is genetic; it's female hair loss, " he said.
Hair loss occurs gradually, but most women don't notice it until it reaches a certain point, which means they lose coverage in a certain area or that their hairline has changed dramatically. When women notice this, it seems that their hair has thinned overnight.
"You can lose 50 percent of your hair volume in a certain area before it looks noticeably thin," Bauman said.
There are very specific hormones that regulate the growth cycles of hair follicles. When women are pregnant, more hair follicles are in the growth phase than usual. Women's hair becomes thicker and shinier. After giving birth, your hormones return to normal, and the hair follicles go back to the resting phase. Hair loss occurs six to 12 weeks after birth.
Menopausal hair loss is slower, Bauman explained. "It's not a big shift where you see a massive barn," he said. “During menopause, this is a gradual decrease in either the ratio of hormones or the number of hormones in the body. We are talking about estrogen and progesterone and the ratios compared to testosterone. When these values change or decrease, the quality of the hair also changes and decreases.”
A patient at the Dr. Baumans Clinic before and after treatment for baldness. Photo courtesy of Bauman Medical Group.
Bauman said hair loss can include changes in the hairline, partial line, and less scalp coverage in these areas. "Sometimes women already change the color, curl and hairstyle to match these changes. It can be very stressful and very damaging to your self-confidence and well-being, " Bauman said. "Very often, the vast majority of patients have no problems with their blood work and no medical problems. Hair loss is a hereditary thing that happens at a certain age, and usually, with menopause, you'll see it happen the most.”
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For early-stage hair loss, non-invasive treatments include platelet-rich plasma (PRP), topical minoxidil (formula 82M), and low-level laser light therapy. "The laser is a painless, most cost-effective treatment over time, and it can be done at home," Bauman said.
Hair grows by about half an inch a month, and changes can be measured after 90 days. “We measure different areas of the scalp to see which areas are responding. If they don't apply, we can change the treatment regimen to take that into account," Bauman said.
"However, if you have a problem with density, which means that the amount of hair is exhausted, we need to do a transplant," he added.
Andrea W., one of Baumans ' doctor patients, was willing to share her story about the hair transplant, however, asked about publishing her last name.
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Andrea told Healthline: 'My hair was thinner in the front and I felt like I had to find a new hairstyle again and again to disguise it. I knew it would be worse. I had a hair transplant. It was a session that lasted a good day.
"Overall, all of my hair has strengthened and thickened, and I'm very happy. I was in menopause. My hair has become thinner over time. I didn't feel good," she said. "Now I can wear my hair as I want. It looks fantastic. Nothing is more comfortable than natural teeth and natural hair.
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