I collaborated with AMAG Pharmaceuticals to create this post. All opinions are my own.
Recently I was invited to speak to a group of postmenopausal women who were all 50+ (plus) to discuss some of the concerns that we’re encountering from how to deal with wrinkles and weight gain to sleep and yes, we talked about one of my favorite topics – Sex!
Many admitted that talking about sex was something they learned early on as girls was a taboo topic, too personal and private to disclose, even with their closest friends. I’ve heard this at every talk I’ve given, so I asked everyone to close their eyes and then asked them to raise their hands if they had a concern about painful sex after menopause. I’m sure you can image what happened next. Over half of the women raised their hands! Over half!
Then I asked these brave women to open their eyes. After the nervous laughter died down, we realized that surprise, surprise – we’re not alone. An estimated 32 million postmenopausal women in the United States suffer from vulvovaginal atrophy, also known as VVA, and while experiences vary, painful sex is one of its symptoms! I get it, for most of us, it’s a lot easier to have sex, than to talk about it.
I just don’t know where to start
One courageous woman said, “Look, this is a very personal and private issue and it’s embarrassing. Sometimes I feel like it’s easier to just ignore it and focus on other aspects of my life, but then I think, ah, am I really ready to give up my sexuality and the intimacy in my relationship? But, I just don’t know where to start.”
I saw a lot of women in the audience nodding their heads. What I’ve found is that once we open the door to this topic, women rush in and are eager and willing to have the conversations, and let me reassure you, they don’t have to be Painfully Awkward.
What is going on?
What I heard that night and what I hear from my patients every day are these questions:
The Low Down
After 50 and sometimes a little earlier, our bodies experience shifting hormone levels that can lead to hot flashes and night sweats and eventually impact the vulvar and vaginal tissues. They become thinner, drier and less able to stretch. This collection of symptoms is known as Vulvar and Vaginal Atrophy or VVA and can cause pain with sex, also known as dyspareunia.
Unlike hot flashes and night sweats which often improve over time, VVA just gets worse. That’s right, without treatment, these symptoms generally will not improve over time. Some women relate that just wearing tight workout clothes or using certain soaps leads to vulvar and vaginal irritation. Others say that the tissue is so dry that no amount of lubricant makes reduces the pain associated with intimacy. Many have tried various remedies from their pantry to help things slide and glide but find those are just as irritating and they’re not making a lot of progress.
(Images courtesy of AMAG Pharmaceuticals, Inc.)
Don’t just accept this
One of my patients said what many others have expressed. “We get started, and I’m a little nervous, but willing to try again. But then, as soon as we try, it hurts and then poof, the mood vanishes and I’m done. I feel bad for me and for my husband. This is not fun!” She wondered out loud if she should just give up on having sex. And, the answer to that is NO! Do NOT give up on your sex life. You don’t have to put up with this and there’s a lot that can be done. Women deserve to have a sex life after 50!
Treatment options
There are many treatment options available. This video from my friend Dr. Sheryl Kingsberg explains why you deserve better if you’re experiencing pain with sex. https://www.pausesexpain.com/dyspareunia-treatment
Finding a Health Care Provider
Unfortunately, many health care providers are so busy talking about when to have a mammogram and getting cholesterol and diabetes testing that they don’t bring up any aspect of sexual activity, let alone painful sex. Some haven’t been trained to talk about sex and honestly, don’t know how to start the conversation with you. But that doesn’t have to stop you or discourage you from finding a health care provider with whom you are comfortable talking about sex and who has the knowledge and experience to help you find treatment options. Do talk to your friends, read reviews and consider going to the North American Menopause Society’s website, Menopause.org for more information and if you want to find a certified Menopause Practitioner in your area.
Preparing to Talk to Your Health Care Provider
Now that you’ve found a provider to talk to, here are a few questions to jot down.
Talking to Your Health Care Provider
Now that you’re prepared, don’t let embarrassment prevent you from living life and enjoying sex. You can visit www.PauseSexPain.com to learn more.
Taking the Birth Control Pill after 40, 45 and beyond.
Many women I speak to are surprised to learn that they can take birth control pills in their 40’s and early 50’s as long as there are no contraindications.
Many women who are in Perimenopause, that is the time when there are a lot of menstrual irregularities, the start of hot flashes, night sweats and vaginal dryness, will benefit from taking a low dose birth control pill to help with their symptoms as well as provide contraception.
Fertility after 40
While fertility rates do decline after 40, if a woman is still having her period, even if it’s irregular, she can become pregnant. Contraception is advised if a woman does not want to become pregnant.
Photo by Thomas Hafeneth
There’s lots of reasons why sex might be painful after you turn 50. For many women as estrogen levels decline during midlife, their vaginas become much more dry and don’t have the same elasticity or ability to stretch.
What you might notice
There are as many different experiences of menopause as there are women. For some women, menopause arrives like a gentle breeze with barely a feeling of warmth or any other bothersome symptom, while others experience menopause like a Class 5 Tropical storm with overnight drenching hot flashes and night sweats, mood changes and a complete disruption in life.
While many clinicians understandably and appropriately focus on hot flashes and night sweats, many women may be more concerned with sleep disturbances, weight gain, loss of libido, vaginal dryness, incontinence and mood changes.
Like many of my patients at midlife, Michelle*, was relieved when I asked about her sex drive, pain and interest in sex at her annual visit.
“I wasn’t sure that there’s was anything I could do, and I was just ready to give up.”
Don’t Give Up!
I hear this sentiment a lot, but it doesn’t have to be this way at midlife or at any time in our lives. The good news is there are a multitude of choices and options for women no matter what their situation when it comes to intimacy, sex and comfort.
New ways to enjoy sex
As women, we put up with a lot and often are too embarrassed to discuss how overnight, we suddenly needing to use lubrication or are having pain with sex. Our biology is complicated, but now the solutions are not. There are a lot of new ways for women to have more satisfaction and enjoy sex.
What’s New? Non-hormonal treatments
Vaginal Re-moisturizers:
Not to be confused with lubricants for sex, these help attract moisture to the sensitive vaginal tissue and keep the moisture there. (more…)
Lots of things change as women continue on their journey through mid-life. Some, like increased confidence and less worry about what others think, are fantastic aspects, others like unwanted changes in our bodies can be frustrating to deal with. What’s worse? Insensitive comments, such as the one’s I’ve compiled below.
Want to learn more?
This Saturday, Sept 26, 2015, El Camino Hospital will be hosting a FREE women’s health fair from 9:30 to 12:30. Seating is limited, so register by clicking here or call: (800) 216-5556
• Is that a beard? Have you ever considered electrolysis? – The fact is that during the menopause transition, lots of women start to lose the hair on their heads and around their pubic areas (which is probably age related) and at the same time discover alarming new hair growth where we don’t want it! – Our upper lips, chins and necks.
Blame hormonal changes for the thick, coarse hairs that seem to sprout every day. Plucking, waxing, threading are good temporary measures. If the hair is dark then laser will still work. Personally, I have my electrolysis expert on speed dial. She has vanquished both dark and light hairs over many months. (more…)
Menopause is that one magical day when a woman hasn’t had any menstrual bleeding for 12 months. The following day, she is considered post-menopausal. Women may experience menopause starting in their 40s or 50s. The average age is 51.
Peri-menopause
What most of us consider menopause is actually Peri-menopause, or as I call it, the Hormonal Roller Coaster. This is the time in life when periods are erratic, symptoms like hot flashes and night sweats begin and women start to feel more fatigued, notice some leaking urine, less sex drive and more wrinkles. (more…)
Recently I had the pleasure of interviewing Dr. Mache Seibel, the founder and creator of My Menopause Magazine that’s available on iTunes.
Dr. Seibel teaches at Harvard and is an expert in many areas of women’s health. He offered up a wealth of information about how we can stay healthy as we age.
#1 Eat well – it almost goes without saying, but we can’t say it enough. Eating more vegetables, fruits and whole grains while avoiding packaged and pre-prepared foods is one of the best ways to stay healthy.
Years of research will tell you what you see with your friends and family who are healthy. By eating choosing to have at least ½ of your plate filled with vegetables and having less red meat, you can avoid heart disease and diabetes.
#2 Sleep – We often forget how important sleep is for our well being. We all know that less sleep means more irritability and a shorter fuse, but you may also be surprised to learn that more sleep means a lowered risk of high blood pressure, diabetes and obesity. Studies on night shift workers have found higher rates of obesity.
Many of us find that being tired leads to more food cravings. (more…)
Every woman knows that there are days when all a man has to do is open his mouth and he takes his life in his hands!
Here’s a handy communication tool I received in a mass email. This is for men who love someone dealing with hormonal swings from PMS or Menopause.
If you’re a risk taker, then by all means stay in the Red zone of communication. If you want to live a longer healthier life, then steer toward the Right side of the guide. In any case, there are some fool proof phrases here to keep the peace. (more…)
Lori* called me the other day because she is having horrible night sweats and wanted to get advice about hormone free remedies that might help. She is desperate to have more sleep at night and feels as if she’s popping up out of bed every hour to stand in front of her fan or the open fridge. She’s given up on changing the sheets, but has been running cold water on her wrists to try and get some relief.
Lori’s in her early 50’s and is still having regular periods, so was surprised when I mentioned that her night sweats sound suspiciously like she’s in the midst of what I affectionately call the wild hormonal roller coaster ride of Peri – Menopause.
(more…)
