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.
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.
TO SEE IF TESTOSTERONE IS RIGHT FOR YOU CLICK HERE
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.
Check out my website today for more information.
Or call 314 934 0551 to make your appointment today!
Why can't I climax anymore?
Menopause can wreak havoc on your sex life. Difficulty with or inability to reach orgasm is just one thing menopausal women face. Great news though there is a way to get back to your normal sexual self again!
Why can’t I climax anymore?
“I just have to work sooooo hard to reach orgasm nowadays”, said my patient. My husband thinks it is him and it’s not. “I just don’t know what is wrong with me”. I hear this from my menopausal patients day in and day out. They feel bad, they are worried something is wrong with them, it is causing concern in the relationship.
You can blame menopause.
Difficulty reaching orgasm or inability to orgasm is super common during menopause. During menopause your ovaries pretty much stop making estrogen and by this time they aren’t making much testosterone either. Both the vagina and the clitoris need these hormones to function normally. So, reaching orgasm requires a lot more work, for some women. Some women then decide to forgo that elusive orgasm (or they fake it). “oh, don’t worry about taking care of me” my patient says to her partner. “You can get me next time”.
The problem with this scenario is that for the woman, the sex isn’t always that great when she doesn’t get that pleasure release of orgasm. When a woman reaches orgasm, she gets a flood of dopamine in her brain. Dopamine is that feel good hormone, it is the one that is released if you do heroin or cocaine that keeps you coming back for more. (NO, don’t do heroin or cocaine). After orgasm, your body releases oxytocin, the cuddle hormone, that makes you want to curl up next to your partner. A good orgasm is an important part of good sex. When sex starts to become not so good, sex drive decreases too. In order to want to have sex, it has to be sex worth wanting.
We just don’t learn about this stuff!!
Did anyone tell you this was going to happen during menopause? Heck, no!! Women’s sexual pleasure is a bit hush in our culture. Well, it shouldn’t be. All women should know that there is treatment for difficulty with orgasm due to lack of necessary hormones. Low dose vaginal hormones can be used and these do NOT increase your risk of breast cancer, stroke, heart attack or blood clot. I repeat, no increased risk when used vaginally. Low dose vaginal hormones bring the healthy blood flow back to the vagina. They allow the vagina to make the cells that make moisture and they allow the vagina to be stretchy again, so sex is much less likely to hurt- another menopausal trouble, to be discussed in another blog.
I have to mention that there are a variety of other things that can affect a woman’s ability to orgasm and the list is long. If you are having trouble, see your doctor. No let me change that, see your sexual medicine doctor!
Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO. She is licensed in Missouri, Tennessee and Illinois. Call today to schedule your appointment. (314) 934-0551 or Click here to schedule an appointment.. If you are not located in Missouri, Tennessee or Illinois, Dr. Lynn offers an E Health. Click here to learn more about E Health and meet with Dr. Lynn today!
Check out our website today for more information.