Sex, Menopause, and Aging

Overview The menopause transition Sexual changes during and after menopause Early menopause Hormone replacement therapy Aging and sexuality in men and women The “andropause” - male menopause?

Menopause Ovaries become less responsive to FSH and LH Patterns of GnRH release from the hypothalamus become altered Pituitary gland becomes less responsive to GnRH

Perimenopause Average age at onset in the late 40’s Irregular menstrual cycles Somatic and psychological symptoms emerge

Post-menopause 12 months of amenorrhea Elevated FSH levels On average, reached by the early 50’s

No! The ovaries continue to produce androgens after menopause! Is that all? No! The ovaries continue to produce androgens after menopause!

Factors that may affect timing of menopause Smoking Genetics Number of pregnancies Body mass

Symptoms of menopause Hot flashes Mood swings Vaginal dryness Vaginal atrophy Fatigue, weight gain, sleep disorders, headache, cognitive changes…..

Menopause across cultures Do all women experience menopause as a major negative life event?

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Sexual changes at menopause Decreased sexual desire Lower levels of vaginal lubrication More painful sexual intercourse What doesn’t change?

Early menopause Surgical menopause Removal of the ovaries, usually accompanied by hysterectomy Menopause induced by treatment for cancer Radiation therapy Chemotherapy Early natural menopause

Early natural menopause Autoimmune disorders Genetics Problems in ovarian development Chromosomal irregularity Triple X syndrome Faulty second X chromosome

Hormone replacement Estrogen: systemic or local Estrogen + progesterone Androgen replacement? Potential benefits Possible side effects

Aging and sexuality How do you tell what is caused by menopause and what is caused by natural aging? A recent longitudinal study concluded that sexual arousal and orgasm are affected by both aging and menopause

Sexuality in the elderly Healthy sexual relationships may continue into old age Common problems associated with aging include: Sexual dysfunction Death of partner Cultural attitudes towards sexuality Health problems

The “andropause” Progressive decline of androgens over time Symptoms: erectile dysfunction, cognitive impairment, fatigue, vague somatic symptoms 40% of men have ED by age 40 Over two-thirds of men by age 70 Is the andropause a disorder?