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Perimenopause & Menopause
Mastering the Challenges

Menopause begins naturally when a woman's ovaries start making less estrogen and progesterone; the hormones that regulate the menstrual cycle. This gradual hormonal change gets underway as early as a woman's late 30's but typically takes place between 45-55 years of age.

This transitional period is called perimenopause and can last from two to ten years starting with the first year after your final period. The perimenopause phase is a natural part of aging and is a sign of the beginning of an end to a woman's reproductive years. During this period many women experience uncomfortable symptoms that may feel overwhelming or challenging to understand and manage. This article offers some information and tips on how you can master the symptoms of this natural transitional phase of a woman's life.

Lisa Lawless
By Lisa S. Lawless, Ph.D.
Psychotherapist & Sexuality Expert

CEO & Founder of
Holistic Wisdom, Inc. & NAASAS

Copyright: Holistic Wisdom- Do NOT Copy Warning

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Sexual Health Products For Perimenopause & Menopause Symptoms

Personal Lubricants
Vaginal Dilator & Speculums for Painful Sex
Vibrators help increase blood flow to the genital area and thus bring helpful circulation which can aide in increasing the sex drive (libido), increase lubrication and assist in achieving orgasms. Lubricants help to reduce friction during vaginal penetration but can also be used as vaginal moisturizers to help with vaginal dryness that can cause painful sex during perimenopause and menopause. Sometimes during peri-menopause or menopause vaginal tissue can become dry making sex painful. With sexual inactivity the vaginal walls may also become tight making sexual penetration more difficult. Using dilators to stretch can be helpful.

The symptoms of perimenopause are the result of changing hormone levels that women begin noticing long before menopause takes place. Here are some telltale signs of perimenopause:

Menstrual Irregularity

Irregular menstrual cycles are characteristic of perimenopause. When hormones fluctuate and ovulation becomes more erratic, you may experience much heavier or lighter menstrual flow and menstruation may last a longer or shorter period of time.

You may even skip some periods. However, if any of the following occurs you should see your doctor as these maybe symptoms of a serious gynecological problem -

  • Extremely heavy bleeding where you are replacing your tampons or pads every hour.
  • Bleeding that lasts longer than 8 days.
  • Bleeding occurs between periods.
  • Regular occurrence of periods less than 21 days apart.

Problems with Sleep

Women who have slept soundly their entire lives may find that fluctuating hormone levels wreak havoc with their sleep cycle. Difficulties falling asleep or staying asleep are often caused by hot flashes or night sweats along with hormonal fluctuations.

Changes in Mood

Some women can experience mood swings, irritability or depression during perimenopause but there is debate as to what actually causes these mood changes. Some researchers believe brain changes that cause depression, irritability and anxiety, are brought about by the change in estrogen levels. Others believe these mood fluctuations are influenced by other symptoms of perimenopause including hot flashes, night sweats, fatigue, and troubled sleep and not by changes in your hormones. Still, others are speculate that it is a combination of both changing hormone levels and the symptoms of perimenopause. The good news is you don't have to accept mood changes as a "normal" part of perimenopause, with proper treatment and holistic health support you can feel like yourself again.

Vaginal Changes and Bladder Problems

Estrogen plays a key role in maintaining the function of a woman's vagina and surrounding tissues, uterus, urinary bladder, and urethra (the organ through which urine is passed from the bladder). As these tissues weaken they can lead to the involuntary leakage of urine, infection, or painful urination. The vaginal tissues also become less lubricated which can cause uncomfortable or even painful sexual intercourse and more frequent urinary tract infections.

Low Libido

You may find your sexual desire and arousal change during perimenopause. Hormonal imbalance is the most common cause of low sex drive during this phase of life. The hormone progesterone play a significant role in libido. As progesterone levels drop it can effect your sexual desires and state of arousal. Declining estrogen levels also affect testosterone which plays a role in sexual response and orgasm. Fatigue caused by hormonal imbalance and / or poor nutrition can also effect your interest in sex.

There are also changes to the body that may not create symptoms but that you should be aware of such as those reviewed below.

Decreasing Fertility

As hormones fluctuate and ovulation becomes irregular your ability to conceive decreases. As long as you're having periods, pregnancy is a possibility. If you do not want to conceive it is recommended that you use birth control until you have reached menopause and have not had a period for 12 months.

Bone Loss

As estrogen levels decline you naturally begin to lose bone more quickly that you replace it, thus increasing your risk of osteoporosis.

Change in Cholesterol Levels

Declining estrogen levels may also negatively affect your blood cholesterol levels. This could include an increase in low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) decreases in many women as they age, which also increases the risk of heart disease.


Menstrual Irregularity Vaginal Changes
Problems with Sleep Bladder Problems
Changes in Mood Low Libido

For some women this transitional period can last for years, whereas others transition to menopause within just a few months. What seems to matter most in the severity of symptoms is the other burdens women may have placed on their bodies over the years. Chronic stress, lack of exercise and poor nutrition are three major players as they greatly affect the body's ability to detoxify and maintain homeostasis. Other lifestyle choices such as consuming excessive amounts of alcohol and smoking are also compounding factors. With this said, healthy lifestyle modifications will make a significant difference in lessening the uncomfortable symptoms associated with perimenopause.

Lifestyle Modifications

1) Exercise

Exercise releases endorphins in the brain which stimulates a feeling of well being that can last several hours and help alleviate some depression and mood swings. Hot flashes are also less common among physically active women who exercise regularly. Recommendations are three to five days a week of exercise including resistance or weight training with weights, bands, machines and cardiovascular training such as brisk walking, cycling, swimming or aerobic type classes. Also, stretching should be done most days of the week to maintain range of motion. Yoga, pilates and tai chi classes can be a very valuable activity for woman of this age group. Exercise will assist in preventing heart disease and further rev the metabolism to burn off the extra fat gains associated with change in hormones.

2) Nutrition

As your risk of heart disease and osteoporosis increases at this time, a healthy diet is more important than ever. Choose a low in saturated and trans fats, and high-fiber diet that's rich in fruits, vegetables, beans and whole grains. Add calcium-rich foods or take a calcium supplement, however supplements are not as good as dairy products such as milk, cheese, yogurt etc. Brewers yeast is also a great source of calcium, which is important for maintaining bone health.

Eliminate foods rich in synthetic or hormonal estrogens. It's best to obtain organic version of these foods and to switch to organic soy in place of meat and poultry. Soy products contain important isoflavones and it has been proven that soy products are associated with fewer hot flashes. Recommended soy products high in isoflavones: Raw green soybeans, soy flour (textured), dry roasted soybeans, instant beverage soy powder, not reconstituted Miso soup mix, soybean chips, tempeh, soybean curd cheese, tofu, tofu yogurt, soymilk. Women who eat a plant-based diet that is rich in a variety of fresh fruits and vegetables are less likely to experience premenopausal or menopausal symptoms.

3) Reduce or Eliminate Stimulants

It's definitely best for your overall health to stop smoking altogether and try to reduce or avoid alcohol and caffeine.Smoking increases your risk of developing heart disease and reduces bone strength. Alcohol can also reduce bone strength and has been associated with a higher risk of breast cancer. Experts recommend that women drink no more than one serving of alcohol each day. Stimulants can also trigger hot flashes and interrupt natural sleep cycles.

4) Stress Reduction

Stress creates an imbalance in body, mind and spirit and aggravates the symptoms of perimenopause. If practiced regularly, stress reduction techniques, such as meditation, yoga and self imagery, can promote relaxation and good health and are particularly helpful during this phase of a woman's life. Women tend to take care of everyone else, but don’t make time for themselves. Treat yourself to relaxation periods throughout your busy schedule to renew your energy and to help create a positive attitude.

Complementary and Alternative Therapies

Complementary and alternative therapies are medical treatments that are considered nontraditional. They include dietary and herbal supplements, acupuncture, chiropractic and massage therapy, biofeedback, homeopathy and eating certain foods that are thought to prevent disease or heal. Alternative treatments are often used alone, while complementary treatments are alternative treatments that are used in combination with traditional treatments, such as drug treatments or surgery. Alternative treatments, such as phytoestrogens (plant-based substances) and black cohosh (an herb), should be discussed with your doctor or naturopath because they may interfere with some medications and/or have possible risks and side effects.

Herbal Remedies and Supplements That Have Shown to be Helpful in Counteracting the Symptoms of Perimenopause While Increasing Overall Health -

Bayberry (Morella cerifera) - The fruit of the Bayberry tree can increase blood flow and capillary dilation in the mucus membranes of the vagina. This can increase vaginal lubrication. Bayberry also has beneficial effects on female reproductive muscle organs by increasing muscle tissue tone and circulation.

Black Cohosh (Cimicifuga racemosa, Actea racemosa) - A member of the buttercup family and native to North America. Some clinical research has shown shown that black cohosh is as effective for relief of hot flashes, night sweats, and vaginal dryness. This herb has been proven to reduce lutenizing hormone secretions. High levels of lutenizing hormone are responsible for the onset of menopause.

Calcium - Essential for the normal growth and maintenance of bones and teeth. Perimenopause and menopause represent depletion of estrogen, which, in turn, is associated with increased risk of bone loss and heart disease. Should be taken with magnesium for optimal absorption.

Damiana (Turnera diffusa) - Damiana is a small shrub native to Mexico. The leaves are used for medicinal purposes. Damiana is considered a powerful aphrodisiac. It stimulates the function of the sympathetic nerves controlling the sexual organs, the urinary system, the digestive organs and the respiratory organs. The herb strengthens all the functions of the sexual organs and urinary system. This herb is especially effective for women as has been shown to have the same effects as the hormone progesterone and regulating estrogen which can benefit pre-menopausal and menopausal women.

Evening Primrose (oenothera biennis) - A biennial herb that is common in North America Parts  The seed oil is a good source of GLA, an essential fatty acid. An essential fatty acid is a nutrient that the body can't make but is essential to good health. Evening Primrose Oil has been used for premenstrual syndrome ( PMS ) and mastalgia ( sore breasts ) Studies to date have been conflicting, some show a significant reduction in breast pain, while others fail to confirm this. There are no known contraindications or drug interactions reported.

Flax Seed Oil ( Linum Usitatissimum) - A perennial herb growing to 3 ft. with oily brown seeds, native to Europe and Asia. The seeds and seed oil contain the active ingredients essential fatty acids - palmitic, steric, oleic, linoleic and linolenic. Flax seed oil is a good source of essential fatty acids. Flax seed oil is rich in (GLA) gamma Linolenic acid used by many for PMS and breast tenderness. No reports of toxicity, when used at recommended doses.

Gingko Biloba - Many research studies have shown Ginkgo Biloba can assist in improving blood flow. Enhancing blood flow to the genitals heightens sexual sensations. Gingko Biloba significantly increases mental activity and memory. Since sexual desire begins in the brain this herb can be a powerful sexual aid.

Ginseng (Panax quinquefolius) - The several species of Ginseng are native to East Asia and Northern America. Ginseng stimulates neural functions and stimulates and normalizes cerebral and sexual organ blood flow. Ginseng also stimulates nerve growth, blood production and sperm production. This stimulation will in turn give a revitalizing effect, stronger sexual arousal, improved genital function and increased physical sensation.

Horny goat weed (Epidemium) - Epidemium is native to East Asia. The entire plant except for the root is used in herbal preparations. This herb stimulates the sexual organs, giving enhanced genital sensations. It can also increase sperm production, which may improve fertility. It further stimulates sexual desire by acting upon the central nervous system. This herb has been used for over 2,000 years as a libido enhancer for both men and women and to improve erection in men.

L-arginine with Choline- This combination is recommended daily for promoting better blood flow to the pelvic organs and tissue to assist with low libido.

Maca (Lepidium meyenii) - Maca is native to Peru and has been passed down as from the Incas as a legendary sex-enhancing root. Maca root is known for it's ability to stimulate sexual desire and drive, increase energy energy, libido and sexual function. This Peruvian herb may also help with hot flashes and night sweats.

Magnesium- Helps with calcium absorption, acts as a muscle relaxant, produces a sense of calmness, reduces mood swings and irritability, promotes a peaceful nights sleep, and reduces food cravings.

Natural Progesterone Cream - Natural progesterone creams usually contain extracts from Mexican wild yam, which contains a substance which is believed to be similar to the progesterone produced in the body. Many women have found natural progesterone creams to be very effective in treating menopause symptoms, but there is no evidence to show that the creams lower the risk of breast and uterine cancer, or are free from the risk of side effects as is sometimes claimed.

Peppermint (Mentha piperita) - Leaves of the peppermint plant stimulate genital secretions which enhance lubrication. This facilitates the sexual act and protects the sexual organ against injury.

Sage (Salvia officinalis) - The leaf of the sage plant has been used medicinally for centuries. Sage leaf will assist in improving mental focus energy restoration. Sage is a natural antiperspirant that contains estrogen like substances to help alleviate "hot flashes" and the adverse reactions to hormonal changes.

Suma (Pfaffia paniculata) - Suma is native to the Amazon Basin. The indigenous people of the Amazon have been using Suma for centuries as a sexual tonic. Suma root is an adaptogen that normalizes hormone production, increases libido and calms nerves. An improved hormonal system can in turn improve mental and physical sexual function.

Valerian (Valeriana officinalis) - Sleep disturbances are common during perimenopause caused by hormonal fluctuations. Valerian is an effective herbal supplement that decreases the time it takes to fall asleep, improves the quality of sleep, and reduces the number of night awakenings, all without any associated daytime drowsiness.

Vitamin B6 (Pyridoxine) - Natural sources of vitamin B6 are whole grains, bananas, potatoes, nuts and seeds and cauliflower. Vitamin B6 levels can be low in depression or in women taking estrogen, in the form of birth control pills or hormone replacement therapy. Pyridoxine, folic acid and vitamin B6 deficiencies have been associated with osteoporosis in postmenopausal women. At least 10 studies have been done on the use of pyridoxine for PMS and have shown improvement of PMS symptoms with pyridoxine supplementation. Vitamin B6 is also associated with a decrease in the incidence of heart disease in women. Vitamin B6 is safe when taken in recommended dosages.

Vitamin C- best when taken with Bioflavonoids (such as Hesperidin), helps to boost the immune system, reduce hot flashes, and aid the adrenal glands

Vitamin E (d-alpha tocopherol) - An antioxidant that found in high amounts in polyunsaturated vegetable oils, wheat germ, seeds and nuts. In natural vitamin E the small d in d-alpha tocopherol signifies a natural source which is preferable to synthetic vitamin E signified by the dl in dl-alpha tocopherol. Mixed tocopherols contain d-alpha, beta, delta and gamma tocopherols. Mixed tocopherols offer the greatest benefit. Look for natural mixed tocopherols. Vitamin E has been shown to help in reducing hotflashes and vaginal dryness. Vitamin E potentiate (cause a greater effect) of anticoagulant drugs such as Coumadin or aspirin. If you are on either of these drugs consult your doctor or naturaopath before starting vitamin E.

Traditional Medical Treatments

If you have severe symptoms, you may want to ask your doctor about prescription medicines. Some choices include -

Low-dose hormone replacement therapy (HRT) - HRT consists of medications containing female hormones to replace the ones the body is no longer making. In 2002, a large clinical trial called the Women's Health Initiative (WHI) reported that hormone therapy actually posed more health risks than benefits for women in the clinical trial. As the number of health hazards attributed to hormone therapy grew, doctors became less likely to prescribe it. And up to two-thirds of women on the therapy discontinued its use, often without talking to their doctors. Today, there's plenty of confusion about hormone replacement therapy, which is now commonly called hormone therapy. The truth is that hormone therapy is not the magical cure for aging that it was once believed to be, but it's still the most effective treatment for unpleasant menopausal symptoms for most women. If you're facing menopause, learn more about the benefits and the risks of hormone therapy.

Low-dose Birth Control Pills - Helpful in preventing pregnancy and may also have some health benefits. They can reduce hot flashes and vaginal dryness. Very-low-dose birth control pills can also help regulate your periods if they are heavy or irregular. They may also prevent bone loss, and helps protect you from osteoporosis. Another potential benefit is protection from cancer of the ovary and uterus. The lower dose of estrogen in low-does birth control is believed to be safer for women who are perimenopausal. Perimenopausal women who have a history of deep blood clots, breast cancer or heart disease should not take very-low-dose birth control pills. Women who smoke also should not take them.

More Education

Your Next Step

How do you decide what to do? Carefully review your medical history and re-examine your personal values and beliefs. You will then be better able to determine your goals and how best to achieve them. For example, some women choose only lifestyle changes, like diet, exercise, and relaxation. Others favor herbal remedies and acupuncture. And still others prefer to use medication. The choice is up to you.


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