1. Sex, Menopause, and Aging

2. 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?

3. 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

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

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

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

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

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

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

10. www.agelessforever.net www.youngeryounger.com www.no-wrinkles.com
“Study after study documents the astonishing effects that estrogen makes women not only feel better but healthier. Estrogen vastly improves the quality of day-to-day life for women by making them more youthful, energized, and healthier.” –

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

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

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

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

15. 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

16. 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

17. 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?