Menopause

Menopause is actually the time of a woman’s last period. It isn’t really defined until a woman has not had a period for a year. The average age of menopause in the United States is 52 years, but it will sometimes occur much earlier or much later.

The “menopause” is a part of a longer period of time referred to as the climacteric or change of life. During this time, the body makes less female hormones, especially less estrogen and progesterone.

Periods can stop for a while and then start again, so a woman is considered to have been through menopause only after a full year without periods. There is an increase in certain health risks due to the very low estrogen levels. As you near menopause, you may have symptoms from the hormone changes in your body. Many women wonder if these changes are normal, and are confused about how to treat their symptoms. Any woman who is going through a period of menopause is likely to experience many bodily changes, mood changes and other symptoms which are difficult to deal with. You can ease this transition by learning about menopause and talking with your doctor about your health and your symptoms.

Perimenopause

Perimenopause is the phase before menopause actually takes place, when ovarian hormone production is declining and fluctuating, causing a host of symptoms. As you go through the menopausal transition, your body's production of estrogen and progesterone rises and falls. Many of the changes you experience during perimenopause are a result of decreasing estrogen. 

How Long Does Perimenopause Last?

The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends the first year after menopause (when a woman has gone 12 months without having her period).

What Are the Signs of Perimenopause?

You may recognize perimenopause when you begin experiencing some or all of the following symptoms:

  • Hot flashes (keep a dairy to identify any triggers)
  • Breast tenderness
  • Worsening of premenstrual syndrome
  • Decreased libido (sex drive)
  • Fatigue
  • Irregular periods
  • Vaginal dryness; discomfort during sex
  • Urine leakage when coughing or sneezing
  • Frequent urination
  • Mood swings
  • Difficulty sleeping
  • Difficulty concentrating

The symptoms of perimenopause may resemble other conditions or medical problems. Always consult your healthcare provider for diagnosis.

When to see a doctor

Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don't experience symptoms severe enough to need attention. Because subtle symptoms may come on gradually, you may not realize at first that they're all connected to the same thing — rising and falling levels of estrogen and progesterone, another key female hormone. 

If you do experience symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your health care provider.

Treatment for Perimenopause

Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if you've entered perimenopause. Your doctor takes many things into consideration for treatment including your age, menstrual history, and what symptoms or body changes you're experiencing. 

A healthy lifestyle can help you manage symptoms. It can also help lower your risk for heart disease, osteoporosis, and other long-term health problems. 

  • If you smoke, stop smoking to reduce hot flashes and long-term health risks.
  • Exercise regularly to promote both physical and emotional health. 
  • Limit alcohol intake to reduce symptoms and long-term health risks.
  • Make healthy eating a priority. Cut back on simple sugars and caffeine, as these can make symptoms worse. 
  • Pay attention to how the emotional side is affecting you. Have a support network, and seek help as needed. 
  • Make sure you get enough calcium and vitamin D. Eat foods that are rich in calcium, and take calcium and vitamin D supplements. This can help lower your risk of osteoporosis.
  • Improve bladder control with regular Kegel exercises. 
  • Keep a sense of humor regarding “the change.”

To manage hot flashes, try keeping your environment cool, dressing in layers, and managing stress.

To improve vaginal dryness and muscle tone, try using a vaginal lubricant and doing Kegel exercises regularly.

Treatment for menopause symptoms may include: 

  • Healthy lifestyle habits, including exercise, healthy eating, and quitting smoking
  • Hormones and other medicines, such as antidepressants
  • Non-hormone medications such as black cohosh and soy

Remember, it is still possible to become pregnant until you reach menopause. To prevent an unwanted pregnancy, keep using birth control until you have not had a period for 1 full year. 

Hormone Therapy

When a woman begins having menopausal symptoms like hot flashes, irregular periods or mood changes, she will probably wonder at some point whether to take some type of hormone therapy. Sometimes called “hormone replacement therapy,” or HRT, it usually refers to a combination of the female hormones estrogen and/or progesterone. 

There are some proven benefits to at least a short course of estrogen and/or progesterone. While it is a very effective treatment for many menopause symptoms, hormone therapy can increase the chances of other conditions, and the decision to use it is a balancing act of determining whether the pros outweigh the cons. The risks are higher for some women, depending on their personal health history and their family health history. Since a woman’s risk depends on her personal combination of risk factors, it’s important to discuss this decision carefully with your healthcare provider. 

Screenings

Bone Density
Dexa stands for ‘Dual Energy X-ray Absorptiometry’. It is the most commonly used test for measuring bone mineral density. It is one of the most accurate ways to diagnosis Osteopenia or Osteoporosis, both of which are a decrease in the thickness or strength of the bone. 

Bone Density

Who should have this test?

The National Osteoporosis Foundation’s guidelines state that women over 65, younger post-menopausal women who have any osteoporosis risk factors, as well as those with specific fractures. 

Doctors use bone density testing to: 

  • Identify decreases in bone density before you break a bone 
  • Determine your risk of broken bones (fractures) 
  • Confirm a diagnosis of osteoporosis if you've experienced broken bones 
  • Monitor osteoporosis treatment

The higher your bone mineral content, the denser your bones are. And the denser your bones, the stronger they generally are and the less likely they are to break. 

Although osteoporosis is more common in older women, regardless of your sex or age, your doctor may recommend a bone density test if you've: 

  • Lost height. People who have lost at least 1.6 inches (4 centimeters) in height may have experienced compression fractures in their spines. Osteoporosis is one of the main causes of compression fractures. 
  • Fractured a bone. Fragility fractures occur when a bone becomes so fragile that it breaks much more easily than expected. Fragility fractures can sometimes be caused by a strong cough or sneeze. 
  • Taken certain drugs. Long-term use of steroid medications, such as prednisone, interferes with the bone-rebuilding process — which can lead to osteoporosis. 
  • Received a transplant. People who have received an organ or bone marrow transplant are at higher risk of osteoporosis, partly because anti-rejection drugs also interfere with the bone-rebuilding process. 
  • Experienced a drop in hormone levels. In addition to the natural drop in hormones that occurs after menopause, women may also experience a drop in estrogen during certain cancer treatments. Lowered hormone levels weaken bone. 

Why is this test used? Why not use a regular X-ray or a CAT scan?

Bone density tests are not the same as bone scans. Bone scans require an injection beforehand and are usually used to detect fractures, cancer, infections and other abnormalities in the bone. 

Dexa Scans are used to measure bone mineral density because they: 

  • are more accurate than regular X-rays. A person would need to lose 20-30% of their bone density before it would show up on an X-ray. 
  • require less radiation exposure than CAT scans or Radiographic Absorptiometry. In fact you are exposed to more radiation on a coast to coast airline flight than you are during a dexa scan. 
  • are less costly that other tests.

How should I prepare for the test?

This is a non-invasive test and requires very little preparation. You can eat and drink normally on the day of the test. 

Do wear loose clothing that has no metal zippers, metal buttons etc. If you wear any kind of metal jewelry, you will need to remove it before the test. 

Test Results

Your bone density test results are reported in two numbers: T-score and Z-score.

T-score

Your T-score is your bone density compared with what is normally expected in a healthy young adult of your sex. Your T-score is the number of units — called standard deviations — that your bone density is above or below the average.

T Score chart

T-score What your score means
-1 and above Your bone density is considered normal.
Between -1 and -2.5 Your score is a sign of osteopenia, a condition in which bone density is below normal and may lead to osteoporosis.
-2.5 and below Your bone density indicates you have osteoporosis

Z-score

Your Z-score is the number of standard deviations above or below what's normally expected for someone of your age, sex, weight, and ethnic or racial origin. If your Z-score is -2 or lower, it may suggest that something other than aging is causing abnormal bone loss. If your doctor can identify the underlying problem, that condition can often be treated and the bone loss slowed or stopped.

Libido

A woman's desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you're experiencing a problem in any of these areas, it can affect your sexual desire. 

Physical causes

A wide range of illnesses, physical changes and medications can cause a low sex drive, including: 

  • Sexual problems. If you experience pain during sex or an inability to orgasm, it can hamper your desire for sex. 
  • Medical diseases. Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. 
  • Medications. Many prescription medications — including some antidepressants and anti-seizure medications — are notorious libido killers. 
  • Alcohol and drugs. A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs. 
  • Surgery. Any surgery related to your breasts or your genital tract can affect your body image, sexual function, and desire for sex.
  • Fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive. 
  • Depression. Many times depression or the medications used to treat it can decrease one’s sex drive.

Hormone changes

Changes in your hormone levels may alter your desire for sex. This can occur during: 

  • Menopause. Estrogen levels drop during the transition to menopause. This can cause decreased interest in sex and drier vaginal tissues, resulting in painful or uncomfortable sex. At the same time, women may also experience a decrease in the hormone testosterone, which affects sex drive in men and women alike. 
  • Pregnancy and breast-feeding. Hormone changes during pregnancy, just after having a baby and during breast-feeding can put a damper on sex drive. Of course, hormones aren't the only factor affecting intimacy during these times. Fatigue, changes in body image and the pressures of carrying — or caring for — a new baby can all contribute to changes in your sexual desire.
  • Relationship Issues. For most women, sex drive is about emotional as well as physical desire. Many times if a relationship is not going well, a sex drive will disappear.

Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling and sometimes medication. 

Healthy lifestyle changes can make a big difference in your desire for sex: 

  • Exercise. Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and boost your libido. 
  • Stress less. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive. 
  • Communicate with your partner. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex. Communicating about sex also is important. Talking about your likes and dislikes can set the stage for greater sexual intimacy. 
  • Set aside time for intimacy. Scheduling sex into your calendar may seem boring. But making intimacy a priority can help put your sex drive. 
  • Add a little spice to your sex life. Change things up!! Try a different sexual position, a different time of day or a different location for sex.

Low sex drive can be very difficult for you and your partner. It's natural to feel frustrated or sad if you aren't able to be as sexy and romantic as you want — or you used to be. At the same time, low sex drive can make your partner feel rejected, which can lead to conflicts and strife. And this type of relationship turmoil can further reduce desire for sex. 

It may help to remember that fluctuations in your sex drive are a normal part of every relationship and every stage of life. Try not to focus all of your attention on sex. Instead, spend some time nurturing yourself and your relationship. Go for a long walk. Get a little extra sleep. Kiss your partner goodbye before you head out the door. Make a date night at your favorite restaurant. Feeling good about yourself and your partner can actually increase your libido. If these suggestions do not help increase your sex drive, please talk to your health care provider. Sometimes hormones, either estrogen or testosterone, or certain antidepressants can increase your sexual desire.

Vaginal Dryness

Natural lubrication produced by glands keeps the vagina supple and moist. The moisture moves slowly down through the vagina, keeping it clean and removing dead cells. The vaginal moisture is slightly acidic and this helps to keep the area healthy, preventing infections. It is perfectly normal for the majority of women to notice a slight white vaginal discharge. During sexual excitement the Bartholin's glands (two glands at the entrance of the vagina) produce extra moisture to aid with sexual intercourse. However, a quarter of women aged 50-59 experience vaginal dryness problems during sex and 16% experience pain. If you have frequent or severe pain during intercourse, you should see a health care provider. 

Before menopause

Approximately 17% of women aged 18-50 experience problems with vaginal dryness during sex, even before the menopause takes place. Reasons for vaginal dryness before the menopause can be linked to hygiene products such as feminine sprays and harsh soaps, swimming pool and hot tub chemicals and some washing powders. Certain drug treatments such as allergy and cold medications and some antidepressants, can also dry out mucous membranes, including vaginal tissues.

There are a number of simple ways in which to lubricate a dry vagina:

Water-soluble starch based lubricant such as KY Jelly, or Astroglide – these are similar to natural lubrication and should be applied to the area around the vulva and vagina just before intercourse takes place

Vaginal moisturizers – these are often creams used two to three times a week and last for up to two days, therefore they do not have to be applied directly before intercourse takes place

Vaginal dryness can be a common problem for pre-menopausal women with low levels of estrogen, such as breastfeeding mothers, those who have had a hysterectomy, and those who have received chemotherapy.

Pre-menopausal women who have their ovaries removed during a hysterectomy may experience menopausal symptoms, including vaginal dryness, as a result of a loss of hormones. The hormonal changes that women experience due to chemotherapy also tend to be dramatic and abrupt, leading to more intense symptoms. Decreased amounts of estrogen also lead to a thinner, less elastic and more fragile vaginal lining.

After the menopause

The average age of the menopause is 52, and after the menopause women find that their bodies change. The ovaries stop producing the female hormone estrogen and the levels begin to decrease. One of the first signs of reduced estrogen on the vagina is reduced lubrication during sexual activity.

Without the production of estrogen, the skin and support tissues of the vulva and vagina become thinner and less elastic and the vagina can become dry. Around 58% of post-menopausal women experience vaginal atrophy – the medical term for vaginal dryness. 

Symptoms

Loss of lubrication and pain during sex – After the menopause, problems with lubrication and painful sex increase. Thinning of the skin around vagina makes it more easily damaged. This damage can often occur during sex, especially if lubrication is poor – even gentle friction can cause pain, discomfort, and occasional vaginal spotting. Painful intercourse can then cause a loss of sexual desire. The relief of symptoms often leads to an increased sexual desire and arousal.

Pain during other times – in many cases vaginal dryness does not only cause pain during sex it can make it uncomfortable to sit, stand, exercise, urinate or even work. Vaginal dryness can affect everyday life, whether women are sexually active or not.
Changes to the vaginal discharge –many women also find that their vaginal discharge changes, becoming more watery, discolored and slightly smelly. They may experience irritation and a burning feeling. These symptoms can be worrying, but they are simply due to the hormonal changes and not an indication of something more serious.

Emotional impact – vaginal dryness can make women feel different. Changes to the body can be difficult to accept and pain and discomfort caused by the condition can lead to a loss in self-confidence and sexual confidence.

For many women these symptoms can lead to confusion as they are similar to symptoms of some sexually transmitted diseases or infection. Things to look out for if you think you may be experiencing vaginal dryness:

  • Do you experience pain, irritation, burning or dryness during sex?
  • Do you experience bleeding or spotting during or after sex?
  • When you go for your pap smear, has it become more difficult or uncomfortable?
  • Has the appearance of your vagina changed?

Treatment

  • Local estrogen – this is available in the form vaginal creams, rings, or tablets. The creams or tablets are inserted into the vagina. Vaginal dryness can respond well to local estrogen treatments. The treatment can also help greatly with discomfort and pain during sex, correct the vaginal pH, and regulate bacteria. Unlike systemic forms of HRT, the effects are local therefore there are no increased risks of breast or heart problems.
  • Avoidance of perfumed soaps
  • Creams to treat skin irritation
  • Lubricants – vaginal lubricants can be useful, particularly for women who are not suited to estrogen replacement. They can be messy and need to be applied each time prior to intercourse in order to be effective.
  • Take more time during sexual foreplay giving the Bartholins gland time to produce the maximum amount of lubrication before intercourse

Additional Information: