Do you think of hot flashes when you think of menopause? Many women in or approaching menopause experience hot flashes occasionally. Many others go through misery because of hot flashes.
But there is much more going on, affecting more than your body temperature and your tendency to sweat.
Emotionally, menopause can be a confusing time as the sense of relief in knowing that an unplanned pregnancy will never happen may collide with a sense of loss, knowing you'll never bear another child, or if you've never had children, you will remain childless.
Do you want to start caring for a baby at age 55? For most of us the answer is no. But the sense of loss can still be very real and pervasive.
For some women, there may be unsettling questions. If they are no longer fertile are they also somehow less feminine? Is sexiness and desirability now relegated to other, younger women?
Weight gain, even for many women who never battled their weight before, can become an ongoing issue. This can make a woman who's well aware that she's getting older, feel older still.
If a woman has for most of her adult life seen herself in terms of her appearance, menopause is a trying time. Disturbing questions may arise. Has her value as a woman dropped? Has her currency as a human being diminished?
If she's focusing on new wrinkles and reduced muscle tone, she may wonder what she has to offer. Will anyone will want it?
While men don't undergo an exact parallel to menopause, middle age can take a toll on the male sex as well. Men get worn out too, and may go through their own crisis of confidence, as energy and erections are perhaps not quite what they used to be.
Put a man and woman together who are weathering these storms and you may have a prescription for a depressed sex life. Frequency, pleasure and confidence can take a nose dive that, if not handled in a straightforward manner, may never get turned around.
If both partners need reassurance and neither can offer it, sexual encounters can become less frequent, their sexual relationship muted, and relegated to nostalgic memories of the good old days long past.