Sex & Menopause

Sex & Menopause

What women should know about intimacy and midlife changes

If there’s one message that Lauren Streicher, MD, wants to share with every woman who’s struggling with sex after menopause, it’s this: “There is a solution. If you haven’t been given the solution it doesn’t mean there isn’t one. It means someone hasn’t told you what that solution is.”

Streicher, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, which opens in fall 2017, knows all too well the hush that surrounds the topics of menopause and sex. She and other specialists work to encourage women to talk about the changes they’re going through and to get the treatment they need.

Every woman experiences menopause differently, says Streicher, author of Sex Rx: Hormones, Health, and Your Best Sex Ever. Libido, pain with intercourse, orgasm and the ability to become aroused can all be impacted.

As estrogen production decreases, physical changes such as vaginal dryness, thinning vaginal walls and decreased vaginal elasticity can occur, which can make sex painful. In addition, the secondary effects of menopause — such as poor sleeping patterns and weight gain — can make women feel less interested in sex.

“The sexual stuff is sometimes very complex; it’s not always a quick fix,” says Streicher, an associate clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine. “A lot of people expect that they can come in and say, ‘I have no libido, can you give me something for that?’ The answer is yes, we can work on that, but there are often a lot of different things that are going to impact it.”

Use it or lose it

The first thing women should know — and this is something that’s not spoken of frequently — is that there is a “use it or lose it” phenomenon when it comes to menopause, sex and the vagina. “One of the risk factors for vaginal dryness, thinning and loss of elasticity is lack of use,” Streicher says. In other words, if you’re not having sex regularly, it could increase the odds of sex becoming painful when you become sexually active again.

To address dryness, Streicher says, often a simple solution will suffice: using a good, silicone-based lubricant (she recommends Replens Silky Smooth and Wet Platinum). She says an over-the-counter vaginal moisturizer (such as Replens Long-Lasting Vaginal Moisturizer) can help increase elasticity and lubrication if consistently used twice weekly.

Local vaginal estrogen products, non-hormonal options and systemic hormone medications can be prescribed to reduce menopause symptoms. Vaginal laser treatment — a quick, painless, in-office procedure using the MonaLisa Touch laser — can offer relief for those who aren’t interested in a prescription product to alleviate vaginal dryness. “It restores vaginal and vulvar tissues to the normal elasticity and lubrication for women who prefer to, or have been told to, avoid estrogen,” Streicher says.

The Northwestern Medicine Center for Sexual Medicine and Menopause will offer comprehen- sive care for menopause and sexual health, bringing together physicians, certified sex therapists, pelvic floor physical therapists, dermatologists, internists and others to address health challenges that may come with menopause, as well as other diseases that are more prevalent for women in that age group, such as cancer and heart disease.

“In this country, we have well over 50 million menopausal women, and this center will address all the issues that menopausal women face,” Streicher says. “So while it might be symptomatic things — such as hot flashes, the ability to sleep, cognitive function, bone health, all of that — the center will also address sexual issues, not just in menopausal women but also for women of all ages.”

Importance of self-care

When Nicole Williams, MD, speaks with her patients about menopause, she approaches the discussion holistically. “I’m a big proponent of food as medicine,” says Williams, a gynecologic surgeon and founder of The Gynecology Institute of Chicago.

When patients complain about mental fogginess, decreased libido or pain with sex, Williams starts by asking them about their diet.

“I want them to make sure they’re eating hormone-free food, because you don’t want any extraneous hormones and fatty foods that can affect your normal hormonal balance,” she says.

Williams also encourages women to exercise regularly and eat lots of fruit, vegetables and whole grains, so that their health is in an optimal position when menopause comes along. While most of her patients have usually heard about challenges commonly associated with menopause (hot flashes, mental fog, vaginal dryness, decreasing libido), Williams says they’re often surprised that irritability can also be a symptom.

“They’re ill-prepared for the emotional swings. One of my patients described it as being PMS-y all the time,” Williams says. That, in turn, can impact relationships and sex. Williams suggests that women pursue mindfulness, meditation, yoga or another exercise that can help them stay focused and feel more in control of their moods. Low doses of hormones and antidepressants are also an option, as are some herbal supplements, says Williams, who advises women to discuss supplement use with their gynecologist.

To prepare for what’s ahead, she encourages women to talk to their mother, grandmothers, sisters and aunts about what they went through, because it could shed light on what to expect in their own lives. “I always ask my patients, ‘Did you ever see your mom throwing open windows?’ If the answer is no, then you may not have bad hot flashes,” she says.

By initiating the discussion, Williams adds, you could be making a difference for other women, too. “The sooner we acknowledge this transition in a female’s life, the sooner it’s brought out of the shadows and it’s not taboo anymore,” she says.

“We should start that conversation. It’s up to us.”

Originally Published in Fall 2017/Winter 2018 Issue