Ask the Expert: Dr. Melynda Barnes on Menopause Age, Hot Flashes, & Sex Drive

Let’s talk about menopause. For how totally common and natural this life phase is for women, it can be tough to find helpful, encouraging information out there. So we decided to turn to the experts. We asked Melynda Barnes, MD and Clinical Director for Rory, some of our most pressing menopause questions.

Dr. Barnes

Am I starting menopause at a normal age?

In the United States, the average age of onset menopause is 51. Perimenopause is the transition from having regular menstrual cycles to the complete cessation of menstrual cycles (menopause). It usually begins when a woman who previously had regular menstrual cycles with a predictable length begins having irregular periods before eventually having no periods at all. Women enter perimenopause on average about four years before they stop having periods altogether (the average age of women at the onset of perimenopause is 47.5). Some women begin to have symptoms such as hot flashes, even while they are still having regular periods. Menopause and perimenopause are normal transitions in a woman’s life and are very commonly experienced in the fourth and fifth decades of life.

Why am I experiencing hot flashes as a symptom of menopause?

Approximately 75—80 percent of menopausal women in the United States experience hot flashes, making it the most common symptom of perimenopause. Hot flashes, also known as vasomotor symptoms (VMS), are mostly caused by the hormonal changes associated with menopause. In addition to controlling female reproduction, estrogen is also responsible for influencing the hypothalamus, the part of the brain responsible for controlling appetite, sleep cycles, sex hormones, and body temperature. Somehow this drop in estrogen causes the hypothalamus—which is sometimes referred to as the body’s “thermostat”—to have a more difficult time regulating body temperature.

During perimenopause and menopause, the hypothalamus becomes more sensitive to minor elevations in body temperature and signals mechanisms to dissipate body heat. These mechanisms include dilation of blood vessels in the skin causing heat and flushing, sweating, and palpitations. In addition, certain brain chemicals, called neurotransmitters, also play a role. In particular serotonin, norepinephrine, and endorphins are thought to be involved in the generation of hot flashes. Nonhormonal treatment modalities are thought to help by modulating these systems of neurotransmitters.

What hormonal changes are causing menopause to affect my sex drive?

The decrease in estrogen and testosterone (yes, women do make testosterone as well) are the hormonal changes in menopause that lead to decreased libido or low sex drive. Perimenopause and menopause are defined by fluctuating and decreasing levels of estrogen and most, if not all, symptoms of perimenopause and menopause are due to this decrease and fluctuation. In addition to decreasing estrogen levels affecting your sex drive, the decrease also affects your vagina’s ability to stay or become lubricated. This decrease in lubrication can cause painful sex due to vaginal dryness and the experience of pain during sex can lower your sex drive as well.

Rory is a digital clinic for women’s health offering accessible, high-quality, personalized healthcare. Rory handles everything from online treatment to the delivery of medication and follow-up care for stigmatized women’s health conditions, as well as providing a content platform to give women the tools and education they need to advocate for their own bodies.

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