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July is Fibroid Awareness Month

What are fibroids you ask? Uterine fibroids are noncancerous tumors that grow in and around the walls of the uterus. An astonishing number of people get fibroids by the age of 50—80% of black women and 70% of white women, with large variation amongst other races. Unfortunately, the specifics for this large discrepancy between races is unknown, likely because research on women’s health is greatly underfunded, but I digress.

How do fibroids develop?

Fibroids develop during child-rearing age, affecting women as they enter their 30s and 40s, then dissipate after menopause once hormone levels decrease. Fibroids vary in size, some being only a few millimeters, while others can grow to the size of a watermelon. Because of this large range in size, each person with fibroids likely experiences different severity of symptoms. Someone with smaller fibroids might not even know they have them, having little to no symptoms, while someone with multiple or large fibroids could experience a range of pretty intense symptoms. These symptoms unfortunately are very similar to that of PMS, PMDD, or anything related to menstruation and reproduction. 

What are the symptoms of fibroids?

Symptoms include heavy bleeding, feeling full, an enlarged lower abdomen, pain during sex, low back pain, frequent urination, complications during pregnancy and labor, and reproductive problems such as infertility. Because these symptoms are so similar to things we might regularly experience during our menstrual cycle, a lot of people will have fibroids and not even know it. Menstrual pain is often dismissed by the person experiencing it, or even worse, by doctors. We are often told it’s just our period and that we should just accept the discomfort because it’s no big deal. You know your body best – if something doesn’t feel right or if you are experiencing any of these symptoms, go see your doctor.

What are the risk factors?

Although the exact cause of fibroids is unknown, there are a few factors that put some people at higher risk. As I mentioned before, age plays a role in when fibroids might pop up. If you will get fibroids, they will be most common during your 30s and 40s when you are in the throes of your reproductive age. Family history plays a role as well. If you have a family history of fibroids, you are more likely to have them yourself. If someone’s mother had fibroids, they are three times more likely to experience it themselves. As I mentioned before as well, black women are more likely to develop fibroids than women of any other race. Unfortunately, the research is not here to explain exactly why, doctors have just noticed this as a pattern. People that are overweight are also at a higher risk for developing fibroids, being two or three times more likely than the average. People who eat a lot of red meat and ham also have a slightly higher risk of developing fibroids, and finally, a lack of vitamin D can put you at higher risk of developing them as well. 

What are the types of fibroids?

There are four types of fibroids, and the type and size determine the type of treatment needed, if any. Submucosal fibroids are the least common type of fibroids. These grow inside the uterus in the space where a baby would grow during pregnancy. This type causes heavy bleeding when present. Intramural fibroids grow inside the muscular wall of the uterus, embedding themselves in the sides of the womb. This type causes heavy bleeding or pressure on the abdomen. Subserosal fibroids are outside of the uterus but are connected to the outside wall of the uterus. Pedunculated fibroids are also less common and grow on the outside of the uterus along a thin stem keeping the tissue connected.

How are fibroids diagnosed?

Fibroids are diagnosed during a pelvic exam, so make sure you are seeing your gynecologist regularly! Even if you don’t have any symptoms, you should see your gynie regularly, every 1-3 years, depending on your age and family history. Once fibroids are diagnosed, the treatment depends on the type of fibroids you have, as well as how large they are. The size of fibroids can gradually change depending on hormone levels in your body at any given time. When you are pregnant, for example, your hormone levels are higher, so fibroids might grow. During menopause, hormone levels drastically drop, so fibroids will shrink or even disappear. If you are having mild or no symptoms, your doctor may just recommend monitoring your fibroids over time, and not taking any action for treatment just yet. If you are experiencing severe symptoms or develop anemia from bleeding too much, intense pain, or experience fertility issues, treatment is recommended. 

How can fibroids be treated?

Oral medication is often a treatment for fibroids, and works for mild cases. Iron supplements, birth control pills, and gonadotropin-releasing hormone agonists can all help manage symptoms. Birth control pills help by decreasing heavy bleeding and menstrual cramping. GnRH agonists is a medication taken through nasal spray or injections that shrinks your fibroids. It only temporarily shrinks them, so it must be taken regularly. A new medication called Elagolix has been approved to be used for up to two years to relieve serious symptoms, but after 24 months, it can cause bone thinning, so it can only be used for this specific amount of time. 

In some cases, surgery is the best treatment option. A myomectomy is a surgery where the fibroids are removed without harming the uterus, maintaining the ability to get pregnant if that is important to you. If you do not plan on getting pregnant, or if your fibroids have caused infertility issues, a hysterectomy is another option. A hysterectomy is a surgery that removes part or all of your uterus. 

Because fibroids are so common but rarely talked about, the month of July is dedicated to educating people about them. Organizations like The White Dress Project also exist to bring people together to find a sense of community and offer a chance to educate other people about fibroids. If you are in pain, experiencing any of the symptoms I mentioned, or think you might have fibroids, contact your doctor. You do not need to live with this pain. There is treatment, and you can still get pregnant and have a healthy and pleasurable sex life with fibroids. Talk to your doctor and check out organizations like The White Dress Project to learn more.

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Having Good Sex in Menopause

Menopause is when your period stops permanently and your estrogen and progesterone levels go down. You are officially in menopause when you haven’t had your period for one year. The time leading up to the last menstrual cycle that we typically think of having hot flashes and other side effects is actually called perimenopause or the menopausal transition. This transition into menopause can happen anywhere from four to seven years before your last period, and after you’re in menopause, many symptoms can last for up to 14 years! Yowza! Menopause is an experience that all menstruating people will have, and it takes up a good portion of your life. 

Why does menopause affect sex drive?

Because of the changing hormone levels during menopause, your sexual desire and physical sexual experiences might change. Along with the more well-known symptoms of menopause such as mood swings, hot flashes, headaches, and forgetfulness, vaginal dryness can also lead to discomfort during penetrative sex. These hormonal changes, as well as the physical changes happening to the body, can lead to an overall decreased interest in penetrative sex. If you are still wanting to feel physically close and intimate with your partner, there are ways to do that even in menopause.

How else can you enjoy sex?

Open your mind as to what a physical, intimate experience with your partner (or yourself) can be. Penetrative sex is not the only option for pleasure. If penetrative sex no longer feels good due to lack of lubrication, try some other stuff. You can incorporate sex toys like a vibrator that stimulates the clitoris or the nipples or explore other erogenous zones such as the ears, the nipples, or behind the knees. You could read a sexy story together or give each other a sensual massage. Penetrative sex is not the only option, and exploring new ways of touching and pleasuring each other is an erotic experience that could bring you and your partner closer. 

Lubricants are great for menopausal sex

If you are wanting to experience penetrative sex, however, you can use lubricants right before inserting anything into the vagina or talk to your doctor about prescribed estrogen that will increase your vaginal lubrication over a period of several weeks. Lubricants can be found at any drug store and can be used at the moment of penetrative sex. Water-based lubricant is always best, as it is compatible with sex toys and condoms. If you’re wanting prescribed estrogen, visit your doctor and chat about it. 

This can make penetrative sex more enjoyable. You might notice after menopause though, that your body responds to touch a little differently. This is totally normal. Take your time, communicate with your partner, and don’t be afraid to use toys or other sexy items like erotica to turn yourself and your partner on. 

Some people have an increased sex drive after menopause once the risk of unwanted pregnancy is gone. Not everyone experiences a decrease in their interest in sexual activity. If you do though, talk to your doctor, talk to your partner, and get creative. Your body has changed during this time, so it’s natural if your sexual desires and activities change with it.

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How to Deal with Vaginal Dryness

The vagina is a truly magnificent part of the body. Not only can it bring life into this world and then bounce back to its original shape, but it also is a self-cleaning organ. The vagina is lined with a thin layer of moisture that keeps the vaginal pH steady, preventing irritation/infection, and allowing sperm to become fertilized during procreative sex. This moisture is caused by estrogen, one of the female sex hormones. When estrogen levels decrease, the moisture in the vagina decreases as well, causing vaginal dryness.

What is vaginal dryness?

Vaginal dryness isn’t necessarily an unsafe condition, but it can be uncomfortable. Vaginal dryness can cause burning or itching, discomfort, as well as pain during or after intercourse. It can also cause bleeding after intercourse. Although vaginal dryness is a normal, natural part of life, pain during or after sex does not need to be. There are many ways to treat vaginal dryness and ensure you have a fun, pleasurable sex life. Vaginal dryness can also cause urinary tract infections.

How do hormones affect our vagina?

Estrogen levels lower naturally as we age, especially during menopause. One in three women experiences vaginal dryness as part of their menopause symptoms. Dropping estrogen levels can also be caused by childbirth, breastfeeding, excessive stress, rigorous exercise, some medication, as well as some cancer treatments. If you have a vagina, you will experience vaginal dryness at some point. It’s pretty common. If you do experience vaginal dryness and it is causing you UTIs, discomfort, or pain during sex, even a loss of interest in sex, talk to your doctor and find a treatment.

What type of lubricant should I use?

Over-the-counter lubricant can be an easy way to treat vaginal dryness during penis-in-vagina sex, or when inserting toys or fingers into the vagina. Water-based lubricant works best, as it is safe to use with condoms and all types of sex toys. Be sure to get a fragrance-free lubricant so you don’t cause any irritation to the vagina. Lube can be found at any grocery store or drug store, is fairly inexpensive, and can be used in the moment to treat vaginal dryness and make intercourse more pleasurable.

Other treatments for vaginal dryness

If you are wanting a long-term treatment for vaginal dryness, or are having issues outside of discomfort during sex, you can take estrogen to increase the moisture your vagina is naturally producing. You can take an estrogen pill that will also help treat any other menopausal symptoms, insert a cream into the vagina, or use an estrogen ring, also inserted into the vagina. Your doctor inserts the ring into the vagina, and it releases estrogen into the body. Similar to the ring birth control, it needs to be replaced every three weeks. The cream is also inserted once or twice a week, then can be decreased over time and used as needed. 

Although vaginal dryness is a normal, natural part of aging or experiencing life, being in pain is not. Use lubricant or talk to your doctor to find a treatment that makes you and your body feel good.

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How Does a Hysterectomy Work?

March is Endometriosis Awareness Month. Endometriosis is a condition when the tissue lining the inside of the uterus that is usually shed during menstruation, grows outside of the uterus. Oftentimes endometriosis can be treated with hormonal birth control or surgery to remove excess uterine tissue. In some extreme cases, however, a hysterectomy is performed to treat severe symptoms of endometriosis.

What is a hysterectomy?

A hysterectomy is a surgical procedure where the uterus is removed. A hysterectomy can be done to treat uterine fibroids, a uterine prolapse where part of the uterus slides into the vagina, endometriosis as mentioned above, chronic pelvic pain, abnormal vaginal bleeding, adenomyosis (a thickening of the uterus), or uterine, ovarian or cervical cancer. 

What are the different types of hysterectomies?

Depending on the reason for the hysterectomy, different parts of the reproductive organs will be removed. In a supracervical hysterectomy, the upper part of the uterus is removed. A total hysterectomy removes the whole uterus and the cervix. A radical hysterectomy removes the entire uterus, the cervix, the surrounding tissue, and the top part of the vaginal canal. A radical hysterectomy is less common than the other types and is used only when cancer is being treated and removed.  

Either an open hysterectomy or a minimally invasive hysterectomy will be performed. The type of hysterectomy performed depends on the surgeon doing it, and also the reason for the surgery, as well as the patient’s overall health. There are differences in healing time, as well as how invasive the surgery is, so it is important that the type of surgery best serves the patient and their condition. An open or abdominal hysterectomy is most common and includes an incision being made across the patient’s belly. The uterus is removed through this five- to seven-inch incision. Because the patient has to be surgically cut open, they often spend a few days in the hospital afterward for recovery. There will also be a visible scar on the patient’s belly as they heal. 

What is a vaginal hysterectomy?

A minimally invasive hysterectomy has a few different approaches. One minimally invasive option is a vaginal hysterectomy. This consists of a surgeon making an incision in the vagina and removing the uterus this way. Since the incision would be inside the body, there is no visible scar left behind. A laparoscopic hysterectomy is done using a laparoscope to guide the surgeon as they perform the hysterectomy outside the body. The laparoscope has a camera on the end and is inserted into a small cut made in the belly or belly button. The surgeon is able to remove the uterus by viewing the inside of the body through this camera. Wild!

A laparoscopic-assisted vaginal hysterectomy combines the two options listed above, using the laparoscope to help remove the uterus through an incision in the vagina. Because this procedure is less invasive and doesn’t require as large of an incision, the recovery is a little less intense. A minimally invasive hysterectomy is only a good option depending on the person and severity of the condition, which is why an open hysterectomy is much more common. 

What can you expect from the recovery process?

The recovery process after a hysterectomy is similar to recovery after any major surgery. An open hysterectomy requires about four to six weeks of recovery time. The patient needs to rest, refrain from physical activity, and shouldn’t do any heavy lifting during this time. For a minimally invasive hysterectomy, recovery time is similar but lasts about three to four weeks instead. After the hysterectomy, the patient should feel relief from the symptoms associated with whatever condition prompted the surgery. 

If the ovaries are still in the body after the surgery, the patient shouldn’t experience any hormonal changes. If the ovaries are removed, however, and the patient has not experienced menopause yet, they are now in menopause. The ovaries contain the eggs that are released every month that causes menstruation, so if you no longer have ovaries, you can no longer menstruate, thus entering menopause. Because of this, the patient will likely experience symptoms associated with menopause such as mood swings, hot flashes, change in sex drive, and vaginal dryness. These symptoms can be treated with hormone replacement therapy. If the patient is under the typical age when menopause usually begins (between 45-55), their doctor will very likely have them use hormones so they are better able to navigate these changes. 

No matter the type of hysterectomy, it is recommended to wait to have sex for at least six weeks as the body heals. Some patients might notice their pelvic floor feels weaker after this surgery, which can cause less control over your bladder, as well as loss of sensation during sex. Pelvic floor exercises or even pelvic floor therapy can help with the healing process as well. Kegel exercises are a great option to strengthen the pelvic floor.

Who should consider having a hysterectomy?

A hysterectomy is not taken lightly and is performed to treat uterine fibroids, a uterine prolapse where part of the uterus slides into the vagina, endometriosis as mentioned above, chronic pelvic pain, abnormal vaginal bleeding, adenomyosis (a thickening of the uterus), or uterine, ovarian or cervical cancer. Because the uterus is removed, it is no longer possible to experience pregnancy. Despite that consideration, hysterectomies help treat a variety of serious conditions and can be life-changing in terms of pain relief and cancer removal for those experiencing any of the conditions mentioned above. 

It is important to stay on top of your reproductive health. Women and people with uteruses should visit their gynecologist on a yearly basis, receive scheduled Pap smears, as well as physical exams. If you’re experiencing any severe pain abdominal pain or abnormal bleeding, contact your doctor right away. You should not have to live in severe pain due to your reproductive organs, and this intense pain could be indicative of something much more serious. Because reproductive organs are tucked away inside of us, it is hard to know what is going on without consulting a professional. Looking after your reproductive health is just as important as maintaining your physical health overall. 

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Weight-Bearing Exercise and Menopause

From the beginning of time, people with uteruses have experienced menopause. Menopause occurs when a person’s estrogen and progesterone levels decrease and their period permanently stops. This decrease in hormone levels typically starts between the ages of 45 and 55 in people with uteruses, but it can sometimes start earlier or later. Once you have gone without a period for a whole year, you are officially menopausal. Congrats! If you want to start preventing symptoms now, you may be able to thanks to the connection between exercise and menopause. 

What to expect in menopause

The time leading up to menopause where you experience symptoms like hot flashes, mood swings, and decreased muscle mass is called perimenopause. This begins during the ages of 45-55 (sometimes sooner, as I mentioned), and symptoms from this period can last for up to 14 years after menopause is done. That seems unfair to me!! During this time, your baby-making hormones are decreasing, and your body is no longer able to make a baby. That’s why it causes someone’s period to stop. Similar to puberty when all of your sex hormones are gearing up, menopause can come with a lot of symptoms. In addition to hot flashes and mood swings which we are typically aware of, menopause can also cause a decrease in bone density and a decrease in muscle mass. 

Estrogen levels are linked to healthy bones and muscles in women and people with uteruses, so when these levels decrease, bone mass and muscles decrease as well. Many studies have shown that people who practice some form of exercise, particularly weight-bearing exercise, experience some milder symptoms related to this decrease during menopause. 

How exercise can help symptoms

Lifting weights and doing strength training helps increase bone density. It’s recommended that women in the early 40s start exercising intentionally to lessen the symptoms of menopause even before they begin. If you lift weights, even light ones, and build up that bone density and muscle mass for years before your menopausal symptoms even begin, your body will be in an even healthier state to make up for some of those losses once those hormones start to fluctuate. 

Cardio exercise is also recommended for menopausal women. Dancing, going for walks, light jogging, and yoga are all great for relieving stress and mood swings that accompany changing hormones, but they also ensure the body is fit and healthy, creating as pleasant of a menopausal experience as possible.

Start to exercise and menopause may be milder

If you begin weight training now, when perimenopause beings, hopefully, some of the physical changes in the body will be less noticeable or less painful. Although a great stress reliever, unfortunately, weight training won’t stop hot flashes from happening. Some women will treat this with hormone replacement therapy, or HRT. During this treatment, patients take either estrogen, progesterone, or both to help alleviate menopause symptoms. By adding in some hormones through treatment, the decline in these hormones in the body will hopefully be milder. 

Although I am decades away from experiencing menopause myself, it’s something I’ve become increasingly fascinated with. Despite learning about my period and birth control very thoroughly, no one has ever talked to me about what to expect in menopause. It seems like a scary adventure no one is talking about. 

Resources such as The Menopause Manifesto by Dr. Jen Gunter talk in-depth about this time of life and ways to handle the changes and live a wonderful life after menopause. This, in addition to exercising and talking with your doctor can make menopause a less scary thing to navigate.

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What to Expect in Menopause

The first time I heard about menopause was when I was in grade school. My family was visiting my great aunt who is always theatrical and fun, and I remember seeing her have a hot flash. She got up and walked around fanning herself vigorously and all of the adult women in my family giggled together. Since my aunt is already so theatrical, I thought she was just being silly. I didn’t understand what a hot flash was or how intense it could be.

Menopause is something I suppose I have always known I would experience one day, but other than knowing my baby-making hormones will slow down, I’ll stop getting my period, and I’ll have horrible hot flashes, this period of time seems almost like a caricature or something scary and unknown. So other than feeling uncomfortable and having intense hot flashes, what really happens to our bodies during menopause, and what are all of the side effects?

What is menopause?

First thing’s first: menopause is when your period stops permanently and your estrogen and progesterone levels go down. You are officially in menopause when you haven’t had your period for one year. The time leading up to the last menstrual cycle that we typically think of having hot flashes and other side effects are actually called perimenopause or the menopausal transition. This transition into menopause can happen anywhere from four to seven years before your last period, and after you’re in menopause, many symptoms can last for up to 14 years!!! That’s crazy to me! That means that even after your body has gone through these hormonal changes and you’re officially not producing reproductive hormones, you can still experience these pesky symptoms for up to over a decade. How did no one ever tell me this?!

People typically enter into perimenopause between ages 45 and 55, although it could be a little earlier or a little later. This transition begins when your body naturally starts producing less estrogen and progesterone, which are your reproductive hormones. During this transition, you’ll still get a period and can still become pregnant, although your periods might be irregular due to the hormonal shifts. Other side effects during this transition period include hot flashes, migraines, anxiety or depression, vaginal dryness which can lead to pain during sex, memory loss, and trouble sleeping. 

All about hot flashes

Hot flashes are due to these dropping hormone levels and can come and go at any time. Many women will experience really bad hot flashes at night, waking them up from their sleep. These can be treated with hormones, so you can see your doctor and get help managing those. The fluctuating hormones can also cause mood changes and anxiety or depression. Similarly, you can see your doctor about this and find a treatment plan.

Because your reproductive hormones are significantly decreasing, your vagina no longer produces natural lubrication. This can lead to pain during penetrative sex for many women, and can even lead to a lower desire for sex because of how uncomfortable it is. This can be treated by using a water-based lubricant during sex, and can even be treated with vaginal moisturizers, which are put into the vagina and can be used daily or every other day to treat dryness—not just for sex-related purposes. You can also use estrogen cream or talk with your doctor about taking hormones as well. Your sex life doesn’t have to end just because you’re hormones are shifting!

Some women experience memory loss during perimenopause or feel foggy-headed and confused. Getting enough sleep, staying active, and staying social can help with this, but if memory loss is a big problem for you, talk with your doctor. These symptoms slowly start happening as you approach your last period, and like I said they can start four to seven years before that even happens. Once you do have your last period and are officially in menopause after a year of no periods, these symptoms persist. Just like any other hormonal-related thing, some people are affected more than others. Some women experience minor menopause symptoms and are generally unaffected, while other women experience hot flashes so intense they have to eat dinner outside on a cold November day to cool off (a true story my mom told me).

Talking more about menopause

Regarding menopause, I’m most struck by how no one has ever really talked to me about perimenopause and menopause, and what exactly these symptoms look like. I had no idea these symptoms lasted so long and could carry on way past your last period. From the time I was a kid, I remember hearing all about when I would get my first period and what that would be like, but no one talked with me about this transition as well. I spend a lot of time reading and writing about women’s sexual health, yet I somehow still knew very little on this topic. 

I’m honestly quite overwhelmed thinking about all of these symptoms and anticipating this time in my own life, and I think talking about menopause openly with young women could help make this time seem less scary. Women already have to work to manage their periods and period symptoms as well as their fertility during their whole reproductive life, and then after that time winds down, we then have to manage a whole new set of symptoms. We should talk more openly about our reproductive hormones and what all menopause entails. This not only will empower women as they enter menopause themselves, but will also offer support for those women who are already experiencing it.

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