5 facts about (peri)-menopause you didn’t know!
We aren’t taught much about what happens during menopause and the few years before. Read on for some things you didn’t know were related to the loss of estrogen that your ovaries used to make!
We aren’t taught much about what happens during menopause and the few years before.
Read on for some things you didn’t know were related to the loss of estrogen that your ovaries used to make!
1. Vaginal dryness may be due to menopause!
You may not realize that dryness is related to the loss of estrogen. You may not get aroused as easily during sex. You may not be able to reach orgasm; orgasms are not as strong, or it takes too long and too much work to get there. Sex may even become painful. No worries, low dose vaginal hormones help treat all of these, (and you are normal if this is happening to you)! Giving back the estrogen helps the vagina lubricate. It also makes the vagina stretchy, with good blood flow, and more nerves going to it, which makes sex feel better! The good news is that vaginal hormones don’t have the same risks that go along with other hormone use. They do not increase your risk of breast cancer, heart attack, or stroke.
2. Menopause makes it harder to lose weight.
It is not that you are lazy or crazy. During menopause women become more insulin resistant. This means your body needs to pump out more insulin to get the same amount of glucose into the cells. Insulin makes your body deposit fat, which is not good for your waistline. Menopause leads to fat deposition around your middle instead of your hips and bust. This “apple” shape, as opposed to the typical female “pear” shape, leads to an increased risk of cardiovascular diseases like heart attack or stroke. Diet and exercise are the first step to losing weight and making your body less resistant to insulin. Some women may need the help of some of the medicines that are available to help you lose weight.
3. Anxiety, depression and mood swings may worsen around the time of menopause.
Typically, hormone levels become erratic before periods stop. Women may feel like they are on a roller coaster ride of emotions. Also, this is the time the kids leave the home and women may be dealing with an empty nest or a lost identity. They may also be taking care of aging parents or have financial stressors. There are plenty of ways to manage anxiety, stress, or depression. Some are with appropriately chosen medicines, other times yoga or soothing apps like CALM may be all you need.
4. Word finding difficulties, forgetfulness happens.
This can be incredibly scary for menopausal women. You can’t seem to remember why you walked into the kitchen or what task you were supposed to complete today. The good news is that brain exercise helps. Learn a new language or learn how to play an instrument. Exercise and diet also keep the brain “fresh”. Be sure to eat a healthy diet, including omega 3 fatty acids which are found in oily fish like salmon or tuna. A healthy lifestyle lowers your risk of Alzheimer’s Disease and delays the progression of Parkinson’s Disease.
5. Low libido.
Menopause is not all about estrogen. By the time women stop having periods, their testosterone is much lower than it was in their 20s and 30s and this may lead to low or loss of sex drive. Loss of sex drive may significantly impact a women’s relationship, and couples that don’t have sex tend to grow apart. There are plenty of hormonal and non-hormonal ways to improve your sex drive.
Make sure you find a practitioner who is well versed in menopause and sexual health.
Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO. She is licensed to practice medicine in Missouri, Tennessee and Illinois. She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee. Call today to schedule your appointment. (314) 934-0551 or click click here to schedule.
Menopause: 4 things you can do when “down there” feels like sandpaper
Sandpaper. That is what my patients tell me about how their vagina feels during sex after menopause. There’s good news though--you don’t have to live that way. There are several things you can do to reinvigorate “down there”.
Sandpaper. That is what my patients tell me about how their vagina feels during sex after menopause. There’s good news though--you don’t have to live that way. There are several things you can do to reinvigorate “down there”.
What is menopause?
When your ovaries stop releasing eggs each month, you have entered menopause. Without the ovulatory cycle, your ovaries are not making estrogen and progesterone like they used to. Testosterone is also decreasing. These hormones play a large role in sexual function.
Vaginal changes after menopause
We call the changes to the vagina vaginal atrophy which is part of the genitourinary syndrome of menopause (which includes changes to the urinary tract). Vaginal atrophy doesn’t usually appear until about 5 years after the last menstrual period. Many women don’t realize that vaginal dryness is due to menopause. They feel like something is wrong with them when sex hurts. Many times, their partner is concerned because they don’t appear to be lubricated or aroused and the couple is unaware that this is a normal change of menopause.
Lack of estrogen causes some major changes to the vagina. Before menopause, estrogen makes the vaginal walls thick, moist and stretchy. There is good blood flow to the vagina and plenty of nerves (just ask anyone who has had a baby!). There are small folds (rugae) in the vagina that allow the vagina to stretch so a penis can fit into it or a baby can come out of it. All of this leads to pleasurable sex. But after menopause, the vaginal walls become thin and dry. They lose their rugae, stretchiness and they don’t naturally lubricate during sex. This loss of elasticity combined with lack of natural lubrication can lead to painful sex.
4 things you can do about vaginal dryness.
Lubricate: There are several types of vaginal lubricants: water based, silicone based and natural oils like olive oil. If you are menopausal and have vaginal dryness, throw away the water based lubes. Although they sound “natural”, water based lubes pull moisture from the vaginal tissues and make dryness worse. Pick a silicone based lube like Uberlube or Wet Platinum. Water based lubes do not affect the integrity of a condom but some silicone based lubes do. If you are using condoms, the silicone based Uberlube is a good choice because it does not affect the condom. Put some on the outside of the vagina, which is called the vulva, and before sex, put some on your partner too. This will help things glide a lot more smoothly.
Moisturize
Just like you put lotion on your hands, you can also moisturize the vagina. There are a variety of products on the market for this, like Lubrigyn or Hyalo Gyn. I tend to recommend coconut oil (solid) or wait for it. . . .Crisco. You can use as little or as much as you want. You can put some on the vulva morning and night, or every time you pee. You can even freeze chunks in an ice cube tray and then insert them into the vagina with your finger. This does not increase your risk of infection.
Low dose vaginal hormones
Low dose vaginal hormones replace what the vagina is lacking during menopause- estrogen. Before you say no to hormones, remember that low dose vaginal hormones do NOT increase your risk of breast cancer, blood clot, heart attack or stroke. Vaginal hormones restore the elasticity to the vagina, allowing it to stretch without pain and return its ability to lubricate itself again. Sex becomes pleasurable again as there is more blood flowing to the vagina allowing for more sensation and engorgement.
There are some several studies evaluating vaginal laser for the treatment of genitourinary syndrome of menopause. Thus far, they show some promising results. Vaginal laser breaks down old collagen and your body replaces it with new healthy collagen and elastin. After laser, the tissue appears more like premenopausal tissue with more superficial cells and women report less dryness and less pain.
Go ahead, reinvigorate the vagina! No need to have painful sex when there are so many treatment options. You will be so pleased with your results!
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Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO. She is licensed to practice medicine in Missouri, Tennessee and Illinois. She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee. Call today to schedule your appointment. (314) 934-0551 or click click here to schedule.
Testosterone for Women: Miracle Drug or Bogus Science?
Testosterone. That lovely hormone of desire, of sex, of muscles and power and strength. We think of manly men with hairy chests when we think of testosterone. But did you know women have testosterone too? They even make more testosterone than they do estrogen. Testosterone is one thing that controls sex drive in women and does a whole host of other things. It starts to decline in your late 20s. This can contribute to low libido in women. So should testosterone be replaced? I hope to answer this question for you with answers based on scientific studies- not bogus internet marketing claims. Does testosterone make for better sex?
If you are a midlife woman, peri or postmenopausal, then in some instances the answer is yes! Testosterone has been shown to definitively improve several aspects of sexual functioning. Testosterone improves sex drive, arousal, helps you have more and better orgasms, and increases pleasure and responsiveness.
Testosterone. That lovely hormone of desire, of sex, of muscles and power and strength. We think of manly men with hairy chests when we think of testosterone. But did you know women have testosterone too? They even make more testosterone than they do estrogen. Testosterone is one thing that controls sex drive in women and does a whole host of other things. It starts to decline in your late 20s. This can contribute to low libido in women. So should testosterone be replaced? I hope to answer this question for you with answers based on scientific studies- not bogus internet marketing claims. Let’s get started.
Does testosterone make for better sex?
If you are a midlife woman, peri or postmenopausal, then in some instances the answer is yes! Testosterone has been shown to definitively improve several aspects of sexual functioning. Testosterone improves sex drive, arousal, helps you have more and better orgasms, and increases pleasure and responsiveness. Who wouldn’t want all this at a time when your sex life tends to get a little dull and unsatisfying and in some women, a whole lot of work as well. When a midlife woman is suffering from low sex drive, testosterone can be used to improve it. This is a big deal for many women because low sex drive is uber common in midlife women and many are very distressed by it. Low drive can add a lot of stress to a relationship.
What are the benefits of testosterone?
Apart from improving your sex life, some data shows that testosterone may also help build muscle mass, improve fatigue and help with weight loss. The data isn’t definitive though and it isn’t recommended to use testosterone for these reasons.
What are the risks of testosterone?
There are no medicines without risks or side effects so don’t believe anyone who tells you a medicine has no risks. Testosterone is a hormone. It gets converted to estrogen in the body. Like estrogen, it increases your risk of blood clot. The medical term for a blood clot is deep venous thrombosis (DVT). DVTs can be quite dangerous because the clot can break away from the blood vessel and travel to your lungs and prevent you from getting oxygen. Good news though, if you don’t have a clotting disorder, are a normal weight, don’t smoke and don’t have certain other medical conditions, your risk of having a blood clot is very low. It is much lower than when a woman is pregnant or on birth control pills.
What about bioidentical hormones? Do they have risks?
Even “natural” things have risks, so don’t be fooled by the term bioidentical. Bioidentical means that whatever you are getting has the same chemical structure as the hormones that your own ovaries used to make or are currently making. Compounded “bioidenticals” are no safer than standard prescription hormones and on the flip side, there are prescription hormones that are bioidentical. Stick with the prescription ones. The companies that make them have to prove to the FDA that they are effective and safe. Compounding pharmacies don’t.
What are the side effects?
When appropriately replaced, some women on testosterone will develop acne or a little bit of facial hair. If the testosterone level in the blood gets into the male range, way too high, there can be some significant and permanent side effects like a lot of facial and body hair, deep voice, male pattern balding, and an enlarged clitoris. Your prescribing physician should be checking your blood levels to make sure you stay in the correct range. Most women do not have these side effects.
How should testosterone be given?
Testosterone should be given in a topical form, either a gel or a cream that gets absorbed through the skin daily. I prescribe testosterone as a topical cream for my patients. Women put some of the cream on their calf. This mode of delivery gives a very steady blood level of testosterone and if there is a bit of local hair growth, you can just shave it off. I don’t like the intramuscular injections of testosterone because they give you a very high dose right after you inject, then your body metabolizes it and the level goes down until your next dose when you get a whopper dose again. This creates a lot of ups and downs in your hormone levels. Not my favorite.
What about hormone pellets?
I don’t recommend certain hormone pellets-namely BioTe. Some of these tend to give women very high levels of hormones. I have seen numerous women with the same blood levels of testosterone as a man would have. At these levels, women grow beards, have deepening of the voice, male pattern balding and the clitoris grows. These changes can be permanent.
Also, pellets have not been studied in women in peer reviewed published medical studies. They haven’t been proven to be any better, safer or more “natural” than anything that has been studied. The North American Menopause Society and the American College of Obstetrics and Gynecology specifically do not recommend treatment with pellets because their safety has not been proven. For BioTe, go to their website and check out the disclaimer at the bottom of the website. It says these are not intended to treat or cure anything!
I will say women come to me feeling fantabulous on their testosterone pellets. They have amazing libido! That is because they have as much if not more testosterone floating around in their blood as their male partners and maybe as much facial hair too. Just keep in mind the permanent changes pellets may cause.
What's the best way to find out if testosterone is a good option for me?
If you are in your 40s or 50s, peri or postmenopausal, testosterone may be a good choice for you to boost your libido, barring certain medical conditions. Make sure to see a provider with experience in treating sexual conditions. A sexual medicine specialist will also look for other factors that may be contributing to your low libido like a not-so-nice partner, depression or certain medications. Testosterone is not going to improve your libido if your partner is a jerk.
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Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO. She is licensed to practice medicine in Missouri, Tennessee and Illinois. She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee. Call today to schedule your appointment. (314) 934-0551 or click click here to schedule.
Where did my 20 something sex drive go?
In my gynecology and sexual medicine practice, I see women every day who tell me they have lost their sex drive. Some women are desperately missing it. They say they “want to want” again. Others tell me they would be completely happy if they never had to have sex again in their entire life. Some have '“duty sex” just to please their partner. How can women improve and regain their sex drive? Yes, there are ways to improve your sex drive. Read about it here.
I was recently watching the Netflix series “You” which deals with an intensively obsessive 20 something man, falling for a somewhat clueless, innocent, sexy 20 something woman. But it’s not the obsession that struck me(or the unusually nefarious plot), it is the crazy, throw me up against the wall, rip off my clothes and have passionate sex with me that caught my attention. That is because in my gynecology and sexual medicine practice, I see women every day who tell me they have lost their sex drive. Some women are desperately missing it. They say they “want to want” again. Others tell me they would be completely happy if they never had to have sex again in their entire life. Had to have it? Where do our 20 something sex drives go as we age? Why do we lose them and most importantly, how do we get them back?
When does sex drive peak?
Sex drive peaks in women’s early reproductive years. Nature’s drive to find a mate and reproduce is super strong. Over time, we tend to settle down, have children, lead busy lives and our children become our main priority, right? Our spouse or partner, who we know is going to be there at the end of the day, becomes our last priority as we raise our kids and/or try to succeed in our careers. Sex lives become stale, boring, and we succumb to you guessed it-Duty Sex.
What is duty sex?
Duty sex is the sex we have because our partner wants it and we do it to fulfill their needs, not ours. Is it rip-roaring, bed-banging, need you NOW sex? Not at all! It is hurry up and get it over with sex. Our partner has needs right? But what are we, as women, getting out of duty sex? Intimacy and closeness, maybe. Pleasure? Not so much. When it comes to our pleasure during sex play, we say, “oh don’t worry about me”, “you can get me next time” or “I don’t need an orgasm today”. So we skip it, and from our standpoint, the sex is not so great. Next time, we want to do it even less, and the sex is even less great. In fact, it is kind of bad, so we don’t want to have sex the next time and the next time and the next time. You get the point. Our drive tanks because in order to want to have sex, it has to be sex worth wanting!!
Boring sex isn’t the only thing that can lower your sex drive.
Low libido is almost never due to just one thing, like duty sex. When I see my patients, I do a complete and detailed history to uncover anything that might remotely be contributing to low drive. If we only see and treat one thing, drive isn’t going to improve because all of the contributing factors weren’t addressed. I ask about depression, anxiety, medicines, pain during sex, communication and relationship problems, body image, what your family taught you about sex, history of sexual trauma, partner sexual dysfunction like erectile dysfunction or premature ejaculation. (I know I am being heteronormative here, but the majority of my patients are in heterosexual relationships). The list is long.
But is there treatment or should I just give up?
YES! There is treatment. Don’t give up. Women may never get back to that same drive they had in their 20s but yes, they can “want” again. My general approach to treatment is to first educate women about what is normal. Many of us operate under certain assumptions about how sex should be, how we should be and how much sex we should want. What is normal for one relationship is different from what is normal for another. Second, we discuss how to mitigate all the contributing factors. For example, if the antidepressant someone is on is contributing to low libido, we discuss possibly changing it. If the relationship needs some help, maybe some counseling is in order. I generally recommend a good regimen of erotic reading if a patient is open to it. The idea behind erotic reading on a regular basis is to get those neurons in the brain that think sexual thoughts firing again and again and again. Those neurons may be out of shape, so to speak. So go ahead, pick up that smutty novel, and exercise your erotic brain.
There are medicines that are FDA approved to treat low drive in women like Addyi and Vyleesi. There are medicines that are not FDA approved for women, like testosterone, that have been shown in scientific studies to improve low sex drive in women. They work in a variety of ways. Each one has its own set of risks, benefits and side effects. One may work for one woman and not for her sister or best friend. None of them will give a woman the sex drive of a 15 year old boy reliably and usually not at all. But for a percentage of women they work! And a good sex sex life is important to a relationship and to overall well-being. Sexual harmony so to speak!
Stay tuned for my next blog with more information on medicines.
Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO. She is licensed to practice medicine in Missouri, Tennessee and Illinois. She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee. Call today to schedule your appointment. (314) 934-0551 or click here to schedule.
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