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Posts Tagged ‘menopause’

I’ve got much to catch up on, study up on, and share with you from my trip to the North American Menopause Society (NAMS) annual meeting a couple of weeks ago. It was a whirlwind of great talks, and such a marvelous time to catch up with colleagues who are doing wonderful work.

One of my all-time favorite people, Dr. Susan Kellogg-Spadt, who’s been a medical advisor here at MiddlesexMD, spoke at the conference! She was fantastic, of course.

She’s a nationally recognized expert in pelvic and vulvar pain and the Director of Female Medicine at the Bryn Mawr office of Academic Urology at the Center for Pelvic Medicine, in Rosemont, Pennsylvania. She treats patients throughout the United States as a vulvar specialist, sexual dysfunction clinician and therapist.

At her NAMS talk, Susan talked specifically about the sexual needs of menopausal women, and in some detail. We gain so much from having her in our field! But without further, um… gushing? Here are Susan’s top clinical pearls for our sexual health and happiness:

Add moisture daily. If we use a water-based, bio-adhesive lubricant several times a week, regardless of sexual frequency, we can get a lot more comfort and satisfaction with sex and just make it easier to have an orgasm whenever we want to.

Nourish yourself. A Mediterranean diet has been shown to promote sexual function, (and, we just learned, perhaps lower breast cancer risk). And regular exercise improves mood and overall health, both of which contribute to better sex.

Talk it out. When we use “I” language to talk with our partners about sex honestly and in a non-accusatory way, we increase the chances of sexual success. Your NAMS doctor or therapist can help provide the vocabulary and communication tips.

Prioritize pleasure. Don’t wait for intimate time to just happen. Even a 20-minute block of time, scheduled weekly, for touching and intimate conversation can clear the way to better sex. Putting it on your checklist may seem like a cold thing to do, but trust us, it gets hotter with practice.

Mindfulness matters. Reading or watching even the softest erotica, being mindful of erotic thoughts as they occur, and focusing on sensation rather than distractions during arousal are all important. All mindfulness training can contribute to your ability to stay in the moment during your most intimate moments.

Intensity, baby. After menopause, many women need more intense stimulation to reach orgasm. Consider introducing vibrators into sex play. The term, “Doctor’s orders!” can be very useful here. You have our permission to use it.

Do try. Just opening up and talking about sex problems, and finding what can still be sexual successes, shows that a woman is committed to her partner, and taking action shows her level of care and concern for the relationship. Mutual affection, honest attempts at exploring what is possible, comfortable, what still feels good, does amazing things for a relationship.

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You say you experienced “pins and needles” during intercourse in your last relationship, and of course it’s difficult to feel amorous when you’re expecting pain. That’s a common description of what it feels like to have genitourinary syndrome of menopause (also called vulvovaginal atrophy) or vulvodynia. A careful pelvic exam by a skilled practitioner can diagnose the condition.

There are treatments available, starting with moisturizers and including hormones, either local or systemic, and other medication options. But a clear diagnosis is the first step.

And then the relationship component. A strong and supportive relationship is an important part of libido and desire for most women. At midlife and beyond, though, we face the “use it or lose it” phenomenon: Here’s a blog post that addresses a “maintenance plan” so that when you find the relationship that’s worth it, you’re ready for intimacy.

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My car’s license plate reads “HOTFLAS.” I take it for granted, until someone rolls down his window to talk to me at a stop sign.

“Hey, I like your license plate,” he says. “You must be about 50. Wow, my wife is going through that. It’s really tough. It’s been a real challenge.”

Only a few days later, I was meeting with a colleague from a nonprofit for whom I volunteer. “Remind me what you do,” he said. It took about half a sentence from me (“I’m a doctor specializing in menopause care…”) to strike a nerve with him. “It’s like a stranger is living in my house,” he said, of his wife’s journey through menopause.

It’s Menopause Awareness Month. These men—among so many others who regularly cross my path—are aware of menopause. Now. I think it’s safe to say that the experience has taken them—and their wives—somewhat by surprise. I can’t think of another medical condition that affects so many of us—directly and indirectly—yet about which we have so little advance education.

Six thousand American women become menopausal every day (defined as not having menstruated for a year). In the U.S., the average age of menopause is 51; that’s the age the youngest of the Baby Boomers are now. We have the highest proportion of menopausal women in our population we’ve ever had—and may ever have again.

And yet, women I meet in all areas of my life—and the men who are living with them—are surprised by the range of effects from the change in estrogen in their systems. While lots of jokes (and T-shirts) circulate about hot flashes, women don’t realize that they may also have

  • Difficulty with memory and cognition
  • Increased joint pain
  • Urinary urgency and frequency, including susceptibility to bladder infections

About half of women have pain with intercourse five years after menopause. For whatever reason, many women don’t associate that symptom with menopause. Too many of us think it’s just “what happens.” Too many of our doctors don’t ask about our sex lives, so women don’t tell about their experiences. While there are a range of treatments—both over the counter and prescription—that would help, too many of us are unaware of them.

Avoiding the topic doesn’t make menopause go away. I’ll keep talking—to patients, to colleagues, to men and women on the street. I encourage you to learn everything you can, pay attention to your own health, and to join the conversation! We midlife women are indispensible resources to our families, our companies, our communities. We deserve to have this natural phase of our lives understood!

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You say you’ve had itchiness and dryness and get bladder infections fairly regularly. Those symptoms are completely consistent with the absence of circulating estrogen to the genitals. Until recently, this condition would have been called vulvovaginal atrophy; its current name, genitourinary symptom of menopause, does a better job of describing that it affects both the urinary system and the genitals.

Women have estrogen receptors throughout their bodies, but they’re most concentrated in the vagina, vulva, and lower urinary tract. In the absence of estrogen, symptoms in that area are more notable. That’s the bad news.

The good news is that there are steps we can take to keep our tissues healthy and vital. See our website’s suggestions for vaginal comfort, and I encourage women to consider, with their menopause care providers, the use of localized hormones.

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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.

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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.

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I recently read a book review recounting one woman’s harrowing passage through perimenopause. The Madwoman in the Volvo is a graphic and humorous account of emotional upheaval, distress, seismic life changes, and finally, the author is cast gently upon the slightly less fraught shores of menopause. Perhaps sadder (or more thoughtful), probably wiser, and definitely optimistic about the future.

So, in honor of this season, which is guaranteed to nudge all but the most stoic among us off the ledge, I have two messages for all of us hot-flashing, sleep-deprived, hormonal gals.

If you feel as though you’re losing your mind, you aren’t alone. Hear that? You are not alone. In fact, you are legion—there are many of us.

Google “crazy menopausal women.” Read the forums. Check out the Fourteen Best Menopause Health Blogs of the Year. Take heart. You’re in abundant, albeit somewhat unhinged, company.

There are, in fact, a silent (or, more likely, howling) army of women who feel just like you. I recall the patient who was referred to me by her new therapist, who had refused to treat her until she got her hormones straightened out. (Previously, she had been told to see a therapist by the police.)

I recall a close friend, the very picture of motherly benevolence, who hissed in my ear, “If that kid doesn’t stop yammering at me, I’m going to tape her mouth shut.” She was referring to her sweet but talkative adolescent daughter. I was shocked. A few years later, I was feeling like that myself.

You can assess your lifestyle and experiment with healthy change. You can eat kale and take vitamin B12 and black cohosh. You can meditate and do yoga. You can stop smoking and reduce your alcohol and caffeine intake. You will feel healthier, and your symptoms might become more tolerable. In case you haven’t noticed, I’m a big advocate of healthy lifestyle choices.

But, if you, like many other women, continue to feel like you’re hanging on to sanity with bloodied fingernails, and those you love are suffering right along with you, by all means see your doctor and find out what pharmaceutical options might help you.

Read this article, written by a woman with access to all the current research on hormone replacement therapy (HRT) and an enviable journalistic pedigree. Here’s what she has to say about her decision to go back on HRT:

I would like to be able to tell you that I weighed these matters thoughtfully, comparing my risks and benefits and bearing in mind the daunting influence of a drug industry that stands to profit handsomely from the medicalizing of normal female aging. But that would be nonsense, of course. I was too crazy. I went straight to the pharmacy and took everything they gave me.

Perimenopause—the hormonal roller-coaster years preceding menopause—can be a long and bumpy ride. It usually begins somewhere between 45 and 55, but can start much earlier. These are the years of unpredictably cresting and crashing hormones, when the crazies come out in all their glory. This stage can last from 2 to 10 years.

Menopause officially beings in the thirteenth month (one year) after your last period.

Which doesn’t mean you’re out of the woods. Many women still have hot flashes and emotional turbulence. But life should slowly settle down as your body adjusts to its new, post-hormonal self.

So, that’s my second holiday message: You aren’t crazy, and eventually you’ll be okay. Wiser, maybe more self-actualized, and really, really okay.

With that, a very happy holiday from MiddlesexMD to you. And as the Madwoman in the Volvo said, “Have some cake, for God’s sake.”

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