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You’ve noted that in addition to vaginal dryness, you’re now using drops for dry eyes, a treatment for dry mouth, and more hand lotion than ever before. Yes, dryness is generalized in menopause, because the estrogen receptors we have from head to toe (and especially in genital tissues) have far-reaching influence! As we lose estrogen, we lose moisture in all kinds of tissues.

Systemic estrogen is a possible solution; it can make remarkable improvement. Every woman is different, though, in the extent of the effect, so a three-month trial might be considered to see if there is a notable benefit.

Otherwise, it sounds like you’re taking advantage of the topical solutions available to you—moisturizers for every body part! This is a good time of life to develop a good hydration habit, too, if you don’t have one already.

A recent Wall Street Journal headline read, “Sex in Old Age May Lead to a Sharper Mind.” The article describes a study in which Dutch researchers looked into the way cognitive function and attitudes toward sexuality might be related among older people. Nearly 2,000 adults, with an average age of 71, were given a variety of cognitive tests. They were also asked a series of questions about sex—whether it was important for older people generally or themselves personally, whether they found it pleasant or unpleasant. They were asked whether they still benefited from intimacy and touching.

Quite a few—41 percent—said that their current sexuality wasn’t important, but 42 percent said it was important for older people in general. A quarter considered sex important or very important. Only 6 percent found sexual activity unpleasant. More than two-thirds believed that intimacy and touching were still vital.

The results of these questions and the cognitive tests were correlated. Both men and women who thought sex was important and were satisfied with their current sex lives tended to do better on the cognitive tests.

The Wall Street Journal article points out that the study made no claim that sex improves brain function, or vice versa: only that the two are associated. It can be difficult to disentangle cause and effect.

Another study looked at how cognitive function affects sexual behavior interest and sexual behavior among the elderly. The 352 Italians studied were between 65 and 105 years old. They were asked, “Are you interested in sex?” and “Do you have sexual relations?” They were also given two tests of cognitive functioning. One third were still having sex and 40 percent were still interested. This study suggested that a sharper mind might help keep a sex life going.

It could be that older people who are healthy enough to have sex are also healthy enough to do well on cognitive tests. Generally, whatever is good for the brain is also good for sex. That’s a good reason to keep on exercising, or to start.

We women deal with many physical and emotional changes during and after menopause. Both in my medical practice and as part of the MiddlesexMD team, I’m alert for “kindred spirits” who understand the transition—and are willing to talk about what changes in hormones mean for real women leading real lives. The people at Vibrant Nation, the leading online community for women 45 and older, have been among those kindred spirits. I’ve published articles on the VibrantNation.com site for almost five years and have had some of our liveliest online discussions there.

Among the things we’ve talked about is how hormonal changes—and the painful or less pleasurable sex that can come with them—can take a real toll on our relationships. And I know from the women I see in my office and the emails I get from around the world (literally!) that we’re not talking enough about how sex changes and what we can do about it. We’re not talking enough to our doctors, to our partners, not even with our girlfriends.

VN-BSB-ad-15_01-v7-300x250And for many of us, it’s hard to find straightforward, trustworthy information about how to deal with issues like pain during intercourse, diminished orgasm, and changes in libido.

That’s about to change. I’m excited to have been asked by Vibrant Nation to lead a panel of women who will share their stories and advice for getting that spark back in the bedroom. Vibrant Nation is having its first-ever live webcast discussion, Sex After Menopause, on March 31, 2015, at 1:00 p.m. EST. We’ll have real women telling their stories, with experts providing perspective and solutions. And you can participate! Pre-register by following this link (Online Form – Pfizer Attendees List – Pre-event – Barb Depree) and you’ll have the opportunity to submit your own question or story and to win a $100 Amazon gift card.

Join us. Let’s stop the silence and extend the conversation. Let’s support each other by sharing our questions, our successes, our struggles. Let’s build the community of kindred spirits!

 

Disclosure: This post is part of a Vibrant Influencer Network campaign. MiddlesexMD is receiving a fee for posting; however, the opinions expressed in this post are Dr. DePree’s. Neither MiddlesexMD nor Dr. DePree is in any way affiliated with Pfizer and does not earn a commission or percent of sales.

Your primary care provider will continue to be your health resource for the spectrum of things that can happen at any age and especially at midlife: hypertension, sinus infections, asthma, joint injuries, and so on. A menopause care provider is a specialist; gynecology is typically also supported through health insurance (but individual plans vary). Some insurance plans require that your primary care provider provide a referral for “menopause care,” which I recommend begin as soon as women are aware of symptoms of perimenopause.

When you’re reviewing options for menopause care, look for certification by The North American Menopause Society (and get help from the NAMS website to find a practitioner with the NCMP credential). Certification means a health care provider has completed extra training to gain competency in menopause. (Those who are “members” of NAMS have access to the specialized information the organization provides but are not certified.)

The conversation about women’s sexual health has continued, sometimes with heat, sometimes with light. For the first time I can remember, the International Society for the Study of Women’s Sexual Health, of which I’m a member, responded directly to a New York Times op ed piece, calling it false and demeaning (The New York Times published a number of responses this weekend).

I’m grateful to my colleagues who are setting the record straight.

As a practicing physician, I have conversations every day with women who are navigating changes in and challenges to the intimacy they want.

Some women have no problem wanting sex. They may encounter pain with intercourse, diminished capacity, or more difficulty experiencing orgasm. As a doctor, I have plenty of treatments options I can recommend and see what works best. Many of the options are neither prescription-only nor pharmaceutical: moisturizers and lubricants, dilators, and vibrators can do a lot. If those don’t work, there are some drugs that could.

Other women, though, come to me because while they love their partners, they no longer get the sexual urge. They find it difficult to respond when their partners initiate. If I close my eyes, I can see their faces, hear the grief in their voices. They’ve told me about their own sense of loss, of incompleteness; they’ve told me their concerns about the unintended messages their partners are receiving; they’ve told me about their fears for their relationships.

And of course I do the obvious assessments, ask them the obvious questions, make the obvious suggestions. I check their overall health to see if there’s an underlying condition that could explain their loss. I check out—and ask them about—medications they’re taking, which sometimes have unintended consequences. I probe for signs of depression. I inquire about their relationships, alert to any clue that it may not be a healthy one.

And sometimes, I do find an underlying cause. I’m able to treat a medical problem, make a referral for counseling, provide compassion to a woman who acknowledges that a relationship is over.

But other times, there’s no apparent reason for a loss of desire. And for those women, it doesn’t occur to me to say “Nothing is wrong with your sex drive,” which is what the New York Times op ed piece asserted. If nothing were wrong, they wouldn’t be in my office, asking—sometimes pleading—for help.

There’s not a lot in my toolkit to respond to those women. And I’d like some options, because I think #womendeserve them. There have been very few silver bullets in my line of work—solutions that work all the time for every woman. I don’t expect that. I do firmly believe that women—with support from their health care providers—can make decisions about what might help them and the trade-offs that affect their quality of life.

Each woman can decide. For herself. From among options not limited by lack of priority or double standards at the FDA. And not limited by the opinions, however well-intentioned, of other women or men.

You say a prescription for estrogen seemed to increase your libido at first, but that effect has diminished. No, you haven’t become immune to estrogen. Unfortunately, libido is a bigger and more complicated issue than just one hormone. Many women don’t find any improvement in libido with estrogen; I tell patients it certainly won’t make it worse, and it may make it somewhat better. And it’s not uncommon for the initial effect perceived from a new treatment to wane over time.

You also ask whether where you apply the estrogen cream makes a difference to its effect on your libido. The medical answer is that because its effect depends on its entering the blood stream, it can be applied to skin anywhere it is likely to be absorbed. If you have pain with intercourse or dryness because of menopause, applying the cream to genital tissues may help, but that’s a different issue than libido.

Women’s libido is complicated (several hormones and numerous neurotransmitters in the brain are involved, as well as emotional and psychological factors), and the treatment options for low libido are currently limited. We offer a number of suggestions on our website, but I also encourage women to talk frankly with a menopause care specialist.

It’s March 1: Do you know where your New Year’s resolution is? You may be thinking, “It’s here, somewhere.”

I have a guess about where it is—collecting dust in a corner, where you left it when you “failed.” I’ve left a few there, myself.

Making a resolution is a positive step that makes it more likely we’ll change a behavior. But when we don’t follow through in the way we envisioned, that resolution becomes something that makes us feel worse about ourselves. When we don’t meet whatever goal we’ve set—whether it’s doing Kegels every day, ramping up a moisturizer habit, or setting aside time for intimacy—the easiest thing to do is give up altogether. “I don’t know why I even bother to make a resolution,” you might say. “I never keep them.”

I’d like to suggest that that’s a story you tell yourself. And the great thing about stories is that you can change them. In fact, research shows that telling yourself a different story has a lasting effect on performance. The researcher had students who thought of themselves as “bad at school” do a story editing exercise that included the idea “everyone fails at first.” Those students went on to get better grades and were more likely to stay in college.

So if you’re telling yourself that old story about your lack of self-discipline or your complete inability to follow through, stop. Retire that old story. Get yourself a new one. Tell yourself you’re learning how to integrate that new thing into your life, and learning takes time. Congratulate yourself on the effort. Look to the past for a time when you did follow through and change something about yourself or your life, and draw inspiration from it.

Then dust off that resolution—yes now!—and try again. Haven’t you heard? March is the new New Year.

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