The word menopause literally means the end of the female monthly cycle. The Greek word ‘pausis’ means ‘cessation’, and the word ‘men’ from ‘mensis’ means ‘month’. In western culture, menopause occurs in midlife, around 40 to 60 years of age, with a means of 51 years. In rare cases, menopause may onset much earlier. Medical menopause may occur at any age as a consequence of surgical or medical intervention in gynecological illness.

Completed menopause, or post menopause, is the permanent cessation of ovarian function. Female sex drive and sexual desire are typically not permanently affected. Menopause transition, or perimenopause, is a natural and healthy life change. The transition itself may be challenging for some women, while others experience little discomfort. Women in western culture live long enough to spend almost half their adult life postmenopausal, while staying sexually attractive, active, and energetic.


Equipped with good menopause medicine and modern sex education, women embrace menopause as a new part of their sexuality. The ‘golden time’ is marked by freedom of periods and cramps, freedom of contraception and unwanted pregnancies, freedom of abortions and miscarriages. Women can express themselves spiritually and sexually free and fully. In fact, sex after menopause can be more fun and fulfilling than prior to the change.

To keep physical wellbeing and sexual function in top shape, women may benefit from menopause nutritional advice, engaging in regular exercise and pelvic floor workouts, mastubating regularly with, or without, sex toys, and continuing sexual intercourse. Menopause induced vaginal discomfort during sex can be overcome by generously using vaginal lubricants and vaginal prescription creams.


In perimenopause, ovarian functions slow down and hormonal levels fluctuate significantly. Fertility declines, but does not cease totally. Periods become increasingly irregular and may alternate between spotting and light or heavy flows. Menstrual cycles can be as short as two weeks, or may stop for several month.

First signs of perimenopause may begin as early as 35 years of age, although most women become aware of any first changes in their mid-to-late 40s.

Most common symptoms of perimenopause include hot flashes. Hot flashes are caused by a sudden increase in body temperature, soaring up multiple degrees. This temperature differential may leave women weak, and breaking out in heavy sweat as the body attempts to cool down. Despite this stark discomfort, hot flashes are not considered a disease but the body’s natural regulation of sudden temperature differentials.

NOTE**Pharmaceutical HRT and natural hormone replacement therapies, prescribed by medical health practitioners, may ease such discomforts. Some women may develop menopause induced depression, and may benefit from SSRI medication or natural remedies, recommended by GPs.


  • Vascular Instability
  • Hot flashes, Cold flashes
  • Rapid heartbeat
  • Migraine
  • Increased risk of atherosclerosis

Urogenital Atrophy/Vaginal Atrophy

  • Thinning of the membranes of the vulva, the vagina, the cervix, outer urinary tract
  • Considerable shrinking and loss of elasticity of all outer and inner genital areas
  • Itching
  • Dryness
  • Bleeding
  • Watery discharge
  • Urinary frequency, urgency, possible urinary incontinence
  • Increased susceptibility to infection, inflammation, vaginal candidiasis, and urinary tract infections


  • Back pain
  • Muscle pain
  • Joint pain
  • Osteopenia, and increased risk to developing osteoporosis

Skin, Soft Tissue

  • Breast atrophy, Breast tenderness +/- swelling
  • Decreased elasticity of the skin
  • Increased dryness and thinning of the skin
  • Formication – itching, tingling, burning, pins and needles, and sensations of ants crawling under skin


  • Increased anxiety/depression
  • Fatigue, loss of energy
  • Problems with concentration and temporary memory loss
  • Mood disturbance, irritability
  • Sleep disturbances, insomnia


  • Painful intercourse, dyspareunia
  • Vaginal dryness, vaginal atrophy
  • Decreased libido
  • Problems reaching orgasm


Postmenopause denotes the complete cessation of ovarian function.

Women are considered postmenopausal 12 month after their last menstrual flow including spotting. Reproductive hormone levels continue to drop and fluctuate for some time into postmenopause.

Any period-like flow or spotting, occurring in postmenopause, must be reported to a medical doctor, and a possibility of endometrial cancer must be considered.

Initially, menopause may cause mild to severe physical strain, emotional distress, and relationship upheaval. Treatment from a medical doctor, and sexual health counselling from a qualified sex therapist, is recommended.

Vagial Atrophy

Vaginal Atrophy (also Atrophic Vaginitis) is the thinning and sometimes inflammation of the vaginal walls, caused by a decline in oestrogen.

Vaginal atrophy most commonly occurs during and after menopause, but can also develop during breastfeeding, or at any other time when the production of oestrogen falls low.

Many women, who have developed vaginal atrophy, are likely to experiencing painful intercourse and a subsequent lowering of sexual interest.

NEW **A new medical laser treatment, called Mona Lisa Touch, is now available to help strengthening and rejuvenating affected internal vaginal lining. Medical hormone therapies are also available. Ask your doctor for advice.


Sexual Health Therapist Heide can help. Please call our Sydney office (+61) 2 9380 4486 for booking a discrete and confidential appointment.