One of the things that excites me most about WomanLab is the dedication to shedding light on taboo topics. Growing up, the only talk about sex in my family was “don’t do it.” About menopause, the picture of my mom suffering with the symptoms was worth the thousand words of discussion we never had. The lack of information about sex made it difficult to view myself as a confident sexual being. My mom’s suffering made me feel terrified of menopause. I have learned that many of my patients and friends had similar experiences. As a gynecologist, I spend a lot of my time with patients trying to fill basic gaps in knowledge about sex and menopause. My patients over forty commonly talk about their loss of sex drive. They say,
“If I never had sex again it would be ok.”
“Once I’m in the act of sex, my body responds, the issue is finding motivation to start.”
“My marriage is suffering because I have zero interest in sex. It was never this way before.”
Many of my patients attribute these changes in sex drive to getting older and many ask “Is this hormonal?”
Let’s talk about perimenopause
Perimenopause is the transition leading up to the end of periods otherwise known as menopause. Before perimenopause, periods usually occur at the same time each month. This happens because the ovaries produce regular amounts of the hormones estrogen and progesterone. During perimenopause, periods change and become less regular or predictable. These changes occur because the ovaries stop producing regular amounts of those hormones. Menopause happens when periods stop altogether because the ovaries are no longer making estrogen and progesterone.
In perimenopause, hormone levels can go up and down without much rhyme or reason. One day the levels might be high. High hormone levels may result in symptoms like bloating, mood swings and breast tenderness. Low hormone levels over an extended period may cause hot flashes, night sweats and vaginal dryness. The fluctuations in hormone levels also cause irregular and often heavy, prolonged menstrual cycles, along with mood swings.
The symptoms of perimenopause can start up to ten years before menopause. Since the average age of menopause is about 51 years, perimenopause can start in a person’s mid-30s and early 40s. Typically, by the late 40s, most people have experienced some perimenopausal symptoms.
Can Perimenopause affect my sex life?
The short answer is “yes.” The long answer is “it’s complicated.” Hormones play a huge role in libido, arousal and orgasm. During perimenopause, changes in the normal hormonal cycles can interfere with all aspects of sexual function.
Besides hormone changes, other factors in the lives of adults in midlife can also affect sex. Many of my patients live with a great deal of stress in midlife. They are working full-time, taking care of their children and aging parents all while trying to maintain a healthy relationship with their partners. A patient recently shared that between teenagers barging in to borrow money or Grandpa screaming for the TV remote, it was hard to find any privacy for sex. In my clinical experience, I see that poor sleep, busy lifestyles and other midlife stressors can negatively affect sexual function. It can be hard to sort out how much of the problem comes from these factors or from hormone changes.
Can I have a good sex life during perimenopause?
I find treating many of the bothersome symptoms associated with perimenopause also helps make people’s sex lives better. To help manage the symptoms of perimenopause, and because a sexually active perimenopausal person can still become pregnant, I often turn to birth control methods. Using hormonal birth control helps to stabilize the fluctuating hormone levels. For many people, this stabilization helps control heavy or irregular bleeding, improve hot flashes and night sweats, and helps with mood. Birth control options contain either the hormones estrogen and progesterone or just progesterone. There are many options, so it is best to discuss with a healthcare professional which option is best for you. If you try hormonal birth control to help with perimenopause symptoms and you lose your interest in sex, your vagina gets dry or your mood gets worse, this might not be the best treatment for you. Most times, these symptoms improve when you go off the pill and talk to your healthcare professional about other options.
For those that want to avoid hormones, there are still options. Antidepressants are effective in treating mood symptoms and, in some cases, hot flashes and night sweats as well. Adhering to a healthy diet, engaging in regular exercise, maintaining adequate sleep and practicing stress reduction techniques help improve overall well-being and sexual function. New research is emerging to inform whether and how acupuncture and a treatment called “stellate ganglion block” might help with hot flashes, especially in women who can’t use hormones.
Although we often don’t have control over life stressors, we can be kind and gentle with ourselves. Sometimes sexual function difficulties in midlife are a result of a changes in a partner’s sexual function. I recommend patience for my patients and their partners, good communication, finding time for sexual self-care and privacy (which may mean installing a sturdy lock on the door). Doctor’s orders.
Edited by Leilani Douglas and Danielle Grubb
Photo by @terricksnoah from nappy.co