Sex after Menopause Jared C. Robins Chief, Reproductive Endocrinology and Infertility Northwestern Feinberg School of Medicine

Definition Menopause is the cessation of a woman's reproductive ability, the opposite of menarche. Menopause is usually a natural change; it typically occurs in women in midlife, during their late 40s or early 50s, signaling the end of the fertile phase of a woman's life. -Wikipedia

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Menopause- patient’s perspective Cessation of menstrual periods Change of life Changing emotions Changing body Aging Increased disease risks, medical care needs Woods et al. Menopause 1999.

“Type a quote here.” –Johnny Appleseed

Myths Sexual activity in people over age 65 increases the risks of a heart attack The sex urge increases with age in men Most older females are sexually unresponsive There is an inevitable loss of sexual satisfaction in post-menopausal females

Truths Prescription drugs may alter a person’s sex drive Fear of inability to perform may cause sexual dysfunction in males Fear of health effects may cause sexual dysfunction in men and women Sexual activity has beneficial physical effects

Menopause or depression?

Sexual Dysfunction

Effect of menopause on sexual function Sexual responsivity Libido Pain with intercourse Partner problems Sexual frequency

FSH Estradiol

Estrogen depletion Hot flashes Sleep disturbances Vaginal atrophy Loss of desire

Sleep disturbances Affect 1/3 - 1/2 of women Nocturnal hot flashes Other causes: sleep disorders (eg. apnea), stress, chronic illness, allergies, pharma Insomnia produces fatigue, irritability, depression Decreased sexual desire

Treatments Relaxation techniques: yoga, massage, meditation Exercise Avoid triggers - spicy food, caffeine, alcohol Supplements - Phytoestrogens, black cohosh, red clover SSRI Clonidine Estrogen

Sleep hygiene Lower light/noise Cool down the room Keep a regular sleep schedule (6-9 hrs) Use relaxation techniques Use the bedroom only for “bedroom activities” Avoid heavy meals, alcohol, nicotine, caffeine Exercise daily, not close to bedtime

Estrogen replacement Decreases hot flashes/night sweats Reduces sleep latency Increases percentage of REM sleep Improves insomnia even in the absence of flashes

Vaginal atrophy

Vaginal atrophy Loss of collagen and adiposity in the vulva Clitoral glans loses its protective covering Vaginal surface thinner, less elastic, more likely to blood

Symptoms Dryness Itching / burning Change in structure - pressure, leaking uring Increase in discharge Dyspareunia - painful intercourse

Treatments Vaginal moisturizer and pH balancer Vaginal lubricants Continued sexual activity /stimulation Estrogen replacement AVOID petroleum-based products antihistamine douching

“Dressed to Impress”

Loss of estrogen impacts libido

Testosterone and DHEAS Lethargy Strength Vitality Sexual desire

DHEAS levels

Barriers to sexual health Healthcare providers do not ask questions about sexual health Lack of training Lack of time Not wanting to embarrass Rooted perceptions and beliefs Lack of Privacy in communal living

–Johnny Appleseed

“Type a quote here.” –Johnny Appleseed

Conclusion Sexuality does not end with menopause There are many reasons for a decrease in sexual function. Discuss with doctor Expect a referral if necessary There a natural remedies that may be effective Pharmacologic intervention may be useful

“Type a quote here.” –Johnny Appleseed