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!

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”.

 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. 

 Vaginal laser

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!

DOES THIS SOUND FAMILIAR? CLICK HERE FOR MORE INFORMATION

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.

How having breast cancer affects your intimate life

Breast Cancer- that thing that turned your world upside down, breast cancer survivor.  You never thought it would be you.  No family history, you eat right, you exercise, but somehow you found a lump that turned out to be cancer. And you are young! Cancer is for old people.  But no, now you embark on the road to recovery, see the oncologist, the breast surgeon, the plastic surgeon, the radiation oncologist so you can fight this disease. You get your care and it’s done. Time to get your life back.

But no one told you what was going to happen to your intimate life!

 Did you know your breast would look funny or that you would lose sensation in your chest?  Your nipples would be gone? Did they tell you what lack of estrogen does to the vagina?  Did anyone mention that sex was going to become excruciatingly painful or you would never want to do it again? No, no and no. Because, as they should be, everyone is working on making the cancer go away for good. At the end of the day, you still have to lead your life. But should you even worry about intimacy when you should feel lucky to be alive?

 The answer is YES! Intimacy matters!  Sex Matters!

 Finding your new sexy

 Sex is going to be different now.  One of the most common issues in women with breast cancer is vaginal dryness that causes painful sex.

 Vaginal dryness

 If your breast cancer is estrogen and/or progesterone receptor positive, then the treatment to prevent it from coming back is to prevent estrogen from working or to get rid of as much estrogen as possible so there isn’t any left to stimulate a breast cancer cell to grow.  Vaginal dryness is the most common side effect of low estrogen levels. Lack of estrogen changes the vagina.  When your body is making estrogen, the vaginal tissue is thick and moist and it stretches.  It has proteins like collagen and elastin that help it stretch so a baby can fit out of it or a penis can fit into it.  It also has special cells that make moisture when you get aroused or excited.  When there is estrogen around there is a lot of blood flowing to the vagina and this makes a difference in sensation, how good sex feels. When there is minimal estrogen, the vaginal tissue gets thin and dry.  It loses its collagen and elastin so it doesn’t stretch when you try to put something in it.  This can cause a lot of pain, especially on initial penetration.  Also, there isn’t as much blood flowing to the vagina so some women say there is a lack of sensation.  

 What to do about vaginal dryness

 First of all, throw away your water based lubricants.  Some of you may have already purchased a lubricant and yes this is the first step.  Put some in your hand, put it on the outside of the vagina which is called the vulva and put some on your partner’s parts, penis or otherwise.  Invest in some silicone based lube or olive oil.  (unless you are using condoms, then you have to stick with the water based).  Water based lubes pull the moisture out of the vagina and make dryness worse. Avoid any lubes with flavors or tingly sensations.  I recommend the silicone based lubes Uberlube or Wet Platinum. 

 You can also moisturize the vagina.  Just like you use hand lotion for dry skin, you can use a vaginal moisturizer for the vagina.  There are many available on the market, but my recommendation is plain and simple, coconut oil or solid vegetable oil (Crisco).  You can use as much or as little as you prefer.  There is no right or wrong way to do this.  If you use too much, you will feel greasy or messy.  If you use too little, you won’t notice any difference at all.  Put it where you feel dry on the vulva or in the vagina.

 Lubes and moisturizers do a fantastic job at decreasing friction during sex.  They don’t do much for increasing the stretchiness of the vagina or bringing more blood flow to it.  Only low dose vaginal hormones do that.  But you thought hormones were out of the question, right?  Well, there are several national organizations like the North American Menopause Society who have evaluated the medical research about this and come up with some recommendations.  If lubes, moisturizers and other nonhormonal treatments have not worked, women with breast cancer can discuss the risks and benefits of using low dose vaginal estrogens or intravaginal DHEA (a different hormone) with their providers.  Treatment should be individualized, taking into consideration quality of life, risk of the cancer coming back and how bad your symptoms are.  Yes, you can consider the use of vaginal hormones in consultation with your cancer doctor after a thorough discussion of risks and benefits.

 Quality of life matters, relationships matter, human touch and intimacy matter.  So bring it up with your doctor.  Talk about it with your partner.  Don’t just accept sex as a thing of the past.  Find the right provider who can help you.  You need honest and accurate answers. 

 Don’t just survive. . . . . THRIVE!

 Coming soon, a discussion of low libido in breast cancer patients and survivors.  Stay tuned!

 I am a Sexual Medicine Gynecologist

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.

Schedule an appointment with Dr. Lynn

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