What are the common symptoms of menopause affecting sexual health. How can women manage vaginal dryness and painful intercourse during menopause. What treatments are available for menopausal symptoms impacting sexual wellness.

Understanding Menopause and Its Impact on Sexual Health

Menopause marks a significant transition in a woman’s life, often accompanied by various symptoms that can affect sexual health and overall well-being. The average age of menopause in the United States is 51, though it can occur earlier or later. During this time, many women experience changes that can impact their sexual experiences and relationships.

Common Menopausal Symptoms Affecting Sexual Health

• Vaginal dryness
• Painful intercourse (dyspareunia)
• Tightening of the vaginal opening
• Burning and itching sensations
• Decreased libido

These symptoms, collectively known as vaginal atrophy, can significantly impact a woman’s quality of life and sexual satisfaction. However, it’s important to note that not all women experience these symptoms to the same degree, and there are various treatment options available.

Managing Vaginal Dryness During Menopause

Vaginal dryness is one of the most common and bothersome symptoms of menopause. It occurs due to decreased estrogen levels, which can lead to thinning and drying of the vaginal tissues. This can make sexual intercourse uncomfortable or even painful.

Over-the-Counter Solutions for Vaginal Dryness

Many women find relief from vaginal dryness by using nonprescription, water-based lubricants. These products can be easily found at most grocery and drug stores, providing temporary relief during sexual activity. Additionally, over-the-counter vaginal moisturizers can be used regularly, not just during intercourse, to help replenish moisture and alleviate dryness.

Are lubricants and moisturizers effective for all women? While these products provide relief for many, some women may require additional treatments, especially if symptoms are severe or persistent.

Hormonal Treatments for Menopausal Symptoms

For women experiencing more severe symptoms, healthcare providers may recommend prescription hormonal treatments. These can be particularly effective in addressing vaginal dryness, painful intercourse, and other menopausal symptoms affecting sexual health.

Local Vaginal Hormone Therapies

Local vaginal treatments, such as estrogen creams, rings, or tablets, are often prescribed to treat vaginal atrophy symptoms. These localized treatments offer the advantage of providing lower hormone doses to the rest of the body compared to systemic hormone therapy options like pills or patches.

How do local vaginal hormone therapies work? These treatments deliver estrogen directly to the vaginal tissues, helping to restore moisture, elasticity, and overall vaginal health.

Non-Hormonal Prescription Medications for Dyspareunia

For women who cannot or prefer not to use hormonal treatments, there are FDA-approved non-hormonal options available to treat moderate to severe dyspareunia caused by menopausal vaginal changes.

• Ospemifene: An oral medication that acts like estrogen on vaginal tissues
• Prasterone: A vaginal insert containing dehydroepiandrosterone (DHEA)

These medications offer alternative approaches to managing painful intercourse without systemic hormone exposure. However, as with any medication, it’s crucial to discuss the potential risks and benefits with a healthcare provider.

Lifestyle Changes to Improve Menopausal Symptoms

While medical treatments can be effective, making certain lifestyle changes can also help manage menopausal symptoms, including those affecting sexual health.

Strategies for Managing Hot Flashes

1. Dress in layers that can be easily removed
2. Use a portable fan
3. Avoid triggers like alcohol, spicy foods, and caffeine
4. Quit smoking
5. Maintain a healthy weight
6. Explore mind-body practices like hypnotherapy and mindfulness meditation

Can lifestyle changes alone manage all menopausal symptoms? While these strategies can be helpful, some women may still require additional treatments, especially for severe symptoms impacting sexual health.

The Importance of Open Communication with Healthcare Providers

Discussing sexual health concerns with healthcare providers is crucial for women going through menopause. Many women hesitate to bring up these issues, but open communication can lead to more effective management of symptoms and improved quality of life.

Questions to Ask Your Healthcare Provider

• What treatment options are best suited for my specific symptoms?
• Are there any risks associated with the recommended treatments?
• How long should I expect to experience these symptoms?
• Are there any lifestyle changes that could help alleviate my symptoms?

Healthcare providers can offer personalized advice and treatment plans based on individual health histories and symptoms. They can also address any concerns about the safety and effectiveness of different treatment options.

Exploring Complementary and Alternative Therapies

In addition to conventional medical treatments, some women find relief from menopausal symptoms through complementary and alternative therapies. While scientific evidence for these approaches varies, some women report benefits from certain practices.

Potential Complementary Approaches

• Acupuncture
• Herbal supplements (e.g., black cohosh, red clover)
• Yoga and tai chi
• Massage therapy
• Aromatherapy

It’s important to note that the efficacy and safety of these approaches can vary, and some may interact with other medications. Always consult with a healthcare provider before starting any new treatment or supplement regimen.

Do complementary therapies work for everyone? The effectiveness of these approaches can vary widely among individuals. What works for one woman may not be as effective for another, highlighting the importance of personalized treatment plans.

The Role of Emotional and Psychological Support

Menopause can have emotional and psychological impacts that affect sexual health and relationships. Addressing these aspects is crucial for overall well-being and sexual satisfaction during and after the menopausal transition.

Strategies for Emotional Well-being

• Seek support from partners, friends, or support groups
• Consider counseling or therapy to address emotional challenges
• Practice stress-reduction techniques like meditation or deep breathing exercises
• Engage in regular physical activity to boost mood and energy levels

How does emotional well-being impact sexual health during menopause? Emotional state can significantly affect libido, sexual satisfaction, and overall quality of life during menopause. Addressing emotional health is an integral part of managing menopausal symptoms.

The journey through menopause is unique for each woman, and what works best can vary from person to person. By understanding the available options and working closely with healthcare providers, women can find effective ways to manage symptoms and maintain sexual health and overall well-being during this transitional period.

Remember, menopause is a natural part of life, and with the right support and management strategies, it’s possible to navigate this transition while maintaining a fulfilling and healthy sex life. Don’t hesitate to seek help and explore different options to find what works best for you.

Sex and Menopause: Treatment for Symptoms

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Some women have vaginal dryness when their bodies experience the menopausal transition. This can make sex painful. Women may also experience a tightening of the vaginal opening, burning, itching, and dryness (called vaginal atrophy). Fortunately, there are options for women to address these issues. Talk with your doctor, who can suggest treatment options.

Sex is becoming painful: What can I do?

Pain during sexual activity is called dyspareunia. Like other symptoms of the menopausal transition, dyspareunia may be minor and not greatly affect a woman’s quality of life. However, some women experience severe dyspareunia that prevents them from engaging in any sexual activity without pain.

Read and share this infographic about staying healthy during and after menopause.

Many find relief from vaginal dryness during sex by using a nonprescription, water-based lubricant, a variety of which can be found at most grocery and drug stores.

Other women try over-the-counter vaginal moisturizers, which are used regularly and not just during sex to replenish moisture and relieve dryness.

Your doctor might suggest prescription hormones. Local vaginal treatments (such as estrogen creams, rings, or tablets) are often used to treat this symptom. These treatments provide lower hormone doses to the rest of the body than a pill or patch.

The U.S. Food and Drug Administration has approved two nonhormone medications, called ospemifene and prasterone, to treat moderate to severe dyspareunia caused by vaginal changes that occur with menopause. Your doctor can tell you about the risks and benefits of these medications.

Learn more about menopause, and symptoms like hot flashes and sleep problems. You can also visit MyMenoPlan, an evidence-based tool developed by NIA-funded researchers, to learn about treatments and coping strategies and create a personalized plan.

For more information on sex and menopause

Office on Women’s Health                                             
Department of Health and Human Services
800-994-9662
www.womenshealth.gov

American College of Obstetricians and Gynecologists
800-673-8444 
[email protected]
www.acog.org

North American Menopause Society
440-442-7550
[email protected]
www.menopause.org

Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE)
212-741-2247
[email protected]
www.sageusa.org

Sexuality Information and Education Council of the United States
202-265-2405
www.siecus.org

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 30, 2021

Related Articles

Hot Flashes: What Can I Do?

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Hot flashes, a common symptom of the menopausal transition, are uncomfortable and can last for many years. When they happen at night, hot flashes are called night sweats. Some women find that hot flashes interrupt their daily lives. Research has shown that there can be different patterns of when women first experience hot flashes and for how long, and that African American and Hispanic women have hot flashes for more years than white and Asian women.

You may decide you don’t need to change your lifestyle or investigate treatment options because your symptoms are mild. But, if you are bothered by hot flashes, there are some steps you can take. Try to take note of what triggers your hot flashes and how much they bother you. This can help you make better decisions about managing your symptoms. You can also visit My Menoplan, an evidence-based tool developed by NIA-funded researchers, to identify treatment and coping strategies best suited for you.

Lifestyle changes to improve hot flashes

Before considering medication, first try making changes to your lifestyle. If hot flashes keep you up at night, lower the temperature in your bedroom and try drinking small amounts of cold water before bed. Layer your bedding so it can be adjusted as needed and turn on a fan. Here are some other lifestyle changes you can make:

• Dress in layers that can be removed at the start of a hot flash.
• Carry a portable fan to use when a hot flash strikes.
• Avoid alcohol, spicy foods, and caffeine. These can make menopausal symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Women who are overweight or obese may experience more frequent and severe hot flashes.
• Explore mind-body practices. Some early-stage research has shown that hypnotherapy and mindfulness meditation could help with management of hot flashes.

Nonhormonal medications to treat hot flashes

If lifestyle changes are not enough to improve your symptoms, nonhormone options for managing hot flashes may work for you. These may be a good choice if you are unable to take hormones for health reasons or if you are worried about the potential risks.

The U.S. Food and Drug Administration (FDA) has approved the use of paroxetine, a selective serotonin reuptake inhibitor (SSRI) antidepressant, to treat hot flashes. Researchers are studying other antidepressants, which doctors may prescribe for off-label use.

Women who use an antidepressant to help manage hot flashes generally take a lower dose than people who use the medication to treat depression. As with any medication, talk with your doctor about whether this is the right medication for you and how you might manage any possible side effects.

Buyer beware: Unproven, nonscientific ‘treatments’ for hot flashes

You may have heard about black cohosh, DHEA, or soy isoflavones to treat hot flashes. These products are not proven to be effective, and some carry risks such as liver damage.

Phytoestrogens are estrogen-like substances found in some cereals, vegetables, and legumes (like soy), and herbs. They may work in the body like a weak form of estrogen, but they have not been consistently shown to be effective in research studies, and their long-term safety is unclear.

Always talk with your doctor before taking any herb or supplement. Currently, it is unknown whether these herbs or other “natural” products are helpful or safe to treat your hot flashes or other menopausal symptoms. The benefits and risks are still being studied.

Using hormones to treat hot flashes and night sweats

Some women may choose to take hormones to treat their hot flashes or night sweats. A hormone is a chemical substance made by an organ like the thyroid gland or ovary. During the menopausal transition, the ovaries begin to work less effectively, and the production of hormones like estrogen and progesterone declines over time. It is believed that such changes cause hot flashes and other menopausal symptoms.

Hormone therapy steadies the levels of estrogen and progesterone in the body. It is a very effective treatment for hot flashes in women who are able to use it. They can also help with vaginal dryness, sleep, and maintaining bone density.

Hormone treatments (sometimes called menopausal hormone therapy, or MHT) can take the form of pills, patches, rings, implants, gels, or creams. Patches, which stick to the skin, may be best for women with cardiac risk factors, such as a family history of heart disease.

There are risks associated with taking hormones, including increased risk of heart attack, stroke, blood clots, breast cancer, gallbladder disease, and dementia. Women are encouraged to discuss the risks with their health care provider. The risks vary by a woman’s age and whether she has had a hysterectomy. Women who still have a uterus would take estrogen combined with progesterone or another therapy to protect the uterus. Progesterone is added to estrogen to protect the uterus against cancer, but it also seems to increase the risk of blood clots and stroke.

Research on risks of menopause hormone therapy

In 2002, a study that was part of the Women’s Health Initiative (WHI), funded by NIH, was stopped early because participants who received a certain combination and dosage of estrogen with progesterone were found to have a significantly higher risk of stroke, heart attacks, breast cancer, dementia, urinary incontinence, and gallbladder disease. This study raised significant concerns at the time and caused many women to become wary of using hormones.

However, research reported since then found that younger women are at less risk and have more potential benefits than was suggested by the WHI study. The negative effects of the WHI hormone treatments mostly affected women who were over age 60 and postmenopausal. Newer hormone formulations seem to have less risk and may provide benefits that outweigh possible risks for certain women during the menopausal transition. Studies continue to evaluate the benefit, risk, and long-term safety of hormone therapy.

Before taking hormones to treat menopause symptoms, talk with your doctor about your medical and family history and any concerns or questions about taking hormones. If hormone therapy is right for you, it should be at the lowest dose, for the shortest period of time it remains effective, and in consultation with a doctor.

For more information on treatments for hot flashes

National Institutes of Health Menopausal Hormone Therapy Information
www.nih.gov/PHTindex.htm

National Center for Complementary and Integrative Health
888-644-6226
866-464-3615 (TTY)
[email protected]
www.nccih.nih.gov

North American Menopause Society
440-442-7550
[email protected]
www.menopause.org

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 30, 2021

Related Articles

Age of menopause: implications for clinical practice

Author:
I. I. Knyazkova

12/26/2016

The problem of physiological aging of women, despite the large number of studies conducted in this direction, remains relevant. The change in the demographic structure of society in the second half of the 20th century led to an increase in the proportion of women in the older age group in the population. By the end of the last century, the average life expectancy of women in economically developed countries increased to 80 years. Yes, in 2009In the same year, among the population aged 60 years and over, there were 83 men for every 100 women, and 59 men aged 80 years and over. In more developed regions, there were 74 men of the same age per 100 women aged 60 and over (70 in Europe), and only 49 per 100 women aged 80 and over (46). In less developed countries, there were 89 men per 100 women aged 60 years and over, 70 men aged 80 years and over, and 85 and 74 men, respectively, in the least developed countries. According to forecasts, the number of women aged 60 and over in 2050 will approach one billion, so the issues of maintaining, maintaining their health and quality of life are becoming increasingly important medical and socio-economic importance.

According to WHO, in most countries of the world life expectancy for women after 50 years ranges from 27 to 32 years. Thus, a woman spends more than a third of her life in a state of deficiency of female sex hormones. The number of women entering menopause is increasing every year. Presumably, this figure will reach 1.2 billion by 2030. The significant variability and unpredictable nature of endocrine changes during the reproductive aging of women, especially during the transition to menopause, when a number of relevant clinical symptoms indicate the approach of menopause and cause concern to a woman, attracts the attention of doctors all specialties.

Fig. Stages of the end of the reproductive period in women in vivo

Definition. The period of menopause is a natural biological process of transition from the reproductive period to old age, which includes several phases (Fig.). There are natural and artificial menopause, the latter may be associated with surgery, exposure to radiation, the use of cytostatics and other reasons. Perimenopause is a transitional stage in a woman’s life from the reproductive period to menopause. According to WHO, this is a period of age-related decline in ovarian function, mainly after 45 years, including perimenopause and one year after menopause or 1 year after the last spontaneous menstruation. With the physiological course of the premenopausal period, there is a gradual extinction of ovarian function, which is clinically characterized by the onset of menopause. Pre- and postmenopause – the transition from the reproductive period to the post-reproductive period with the loss of childbearing and the extinction of hormonal function (table).

The mechanism of the development of age-related aging and the consequences of turning off the reproductive function of a woman V. M. Dilman characterized it as follows: “In the mechanism and manifestations of menopause, violations of homeostasis are quite obvious, and, therefore, by definition, menopause is a disease. But menopause is a disease not only by definition, but also in essence. For example, a decrease in the level of classical estrogens in the body contributes to the development of osteoporosis, which, in turn, is often the cause of bone fractures, often ending in death in old age. Estrogen deficiency accelerates the development of atherosclerosis.

An increase in the concentration of gonadotropins probably contributes to ovarian cancer, since contraceptive steroids, which have an antigonadotropic effect, reduce the incidence of this tumor. A decrease in the content and rate of dopamine metabolism in the hypothalamus causes mental depression, which sometimes reaches the severity of involutional psychosis during menopause. But if menopause is a disease, then it is in many ways a special disease. According to the theory of V.M. Dilman, menopause can also be called a hypothalamic disease, since it is changes in the hypothalamus that cause the cessation of childbearing function. Thus, although aging and menopause are diseases, they are not incurable because they are based on dysregulation, a process that is in principle controllable.

In accordance with modern ideas, menopause is a long process, which is based on the decline and cessation of ovarian function, and menopause is the most striking event in menopause. Around this event, reproductive aging processes before and after menopause are evaluated. These processes do not take place in isolation, since everything in the body is interconnected. Since the sex hormones synthesized by the ovaries affect many organs and tissues, as the level of sex hormones decreases, estrogen deficiency symptoms may occur.

Statistics. According to publications from 26 countries, the average age of menopause is 49. 24 years (SD±1.73). It has been established that the age of natural menopause depends on genetic factors associated with the region, ethnicity and other factors, in particular socio-economic status, lifestyle and culture. A recent meta-analysis by D. Schoenaker et al., which included 46 studies in 24 countries, found that the average age of menopause was 48.8 years (95% CI 48.3-49.2) with interstudy heterogeneity partly due to geographic region. It has been shown that the lowest average age of menopause is noted in the countries of Africa, Latin America, Asia and the Middle East, and the highest in Europe, Australia and the United States. It was found that education and work were associated with a later age of menopause. The mechanism underlying these associations remains unclear, but associations with lifestyle factors such as hard physical labor, smoking, and eating habits have been noted. So, smoking was associated with a decrease in the age of menopause by 1 year. There was a trend towards a later onset of menopause with obesity.

A number of studies have noted that an increase in body mass index (BMI) was associated with a later onset of menopause. It was found that the menopausal period in women with BMI >25 developed later than in women with BMI <25. It has been shown that overweight and obese women have higher levels of estrogens in the blood in combination with lower levels of sex hormone-binding globulin, which may contribute to delaying menopause. At the same time, clinical studies evaluating the relationship between BMI and menopausal age have shown conflicting results, as both higher and lower BMI values ​​are reported to be associated with early menopause.

In addition, a number of studies have found no correlation between BMI and timing of menopause. Among the reasons for this heterogeneity of results may be the ethnicity and culture of the populations studied, as well as the statistical methods used. Cigarette smoking was also found to be associated with lower BMI and early menopause.

Of note is the fact that lower social class in childhood and throughout adulthood was associated with early menopause. Adverse childhood experiences may include domestic overcrowding, father’s occupation, lack of hot water in the house, shared bedroom, and lack of access to a car. Some of the relationships between educational attainment, occupation, and age at menopause may explain childhood experiences.

Age at menopause is an indicator of ovarian function and aging, and therefore a critical factor in women’s health. Both early and late ages of menopause have been found to be associated with adverse health outcomes for postmenopausal women, emphasizing the importance of identifying factors throughout the life cycle that could potentially influence this indicator.

Age at natural menopause is an important risk factor for morbidity and mortality. Women with early menopause are more likely to develop osteoporosis, obesity, metabolic syndrome, and cardiovascular disease. According to the Framingham Study, the risk of cardiovascular disease and its complications in women falls on the period of 40-55 years, which is the age characteristic of the onset of perimenopause. In the future, cardiovascular diseases are observed in more than half of the female population of the older age group. A number of studies have provided conflicting data on the effects of income, occupation, marital status, menarche age, smoking, and stress on reproductive ability and menopausal age. It has been proven that receptors for female sex hormones are present not only in the heart and blood vessels, but also in the brain; changes in the level of these hormones through imbalance of neurotransmitters contribute to the development of neuropsychiatric disorders.

A Korean study of 3,176 women aged 40 to 70 examined the effect of stress on the age of natural menopause. It was shown that women with a high level of stress in everyday life had a lower average age of menopause than women with a low level of stress (50. 17±3.7 and 50.58±3.5 years, respectively, p<0, 05). This correlation was maintained after adjusting for age, BMI, menstrual regularity, and income of individuals.

According to the definition of G. Selye, stress is a stress reaction that occurs as a non-specific response of the body to the action of extreme and unfavorable environmental factors (stressors). Stressors (physiological or psychological) activate the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Thus, secretion of corticotropin-releasing factor from the hypothalamus is noted, which stimulates the anterior pituitary gland, where adrenocorticotropic hormone begins to be intensively synthesized. The latter stimulates the release of corticosteroids (cortisol) from the adrenal cortex.

Corticotropin-releasing factor is a neurotransmitter involved in the coordination of endocrine, autonomic, behavioral and immune responses to stress, its administration causes stress-like conditions. The purpose of this process is the adaptation of the body to environmental conditions. However, an intense and prolonged stress response can develop from an adaptive to a pathogenic basis for various diseases. Thus, excessive stress in everyday life can lead to the development of diabetes mellitus, arterial hypertension, hyperlipidemia, cardiovascular diseases, cognitive impairment, depression, digestive diseases and chronic fatigue.

It is assumed that the development and progression of these diseases is promoted by hyperactivity of the hypothalamic-pituitary-adrenal axis in response to stress and elevated levels of stress hormones (corticosteroids and catecholamines). In addition, elevated levels of stress hormones can lead to gynecological conditions such as amenorrhea or early menopause.

References are in the editorial office.

Continued in the next issue.

Thematic issue “Gynecology, Obstetrics, Reproductology” No. 3 (23), Zhovten 2016

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• Thematic issue “Gynecology, Obstetrics, Reproductology” No. 3 (23), June 2016

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How to support the body during menopause?

The onset of menopause is a special period in the life of every woman. It is accompanied by hormonal changes and the cessation of regular menstruation. Menopause should not be taken as a tragedy, because there are still many years of active life ahead. Find out how to support the body during menopause.

The average age of menopause is 47-52 years. However, menopause can occur at 35 or 60 years old, because the body of every woman is unique. Irritability, hot flashes, fatigue and other symptoms of menopause are manifested as a result of certain processes occurring in the body:

• decrease in the production of the most important hormones – estrogen and estradiol;
• increasing the concentration of FSH and LH;
• reduction of intrasecretory activity;
• cessation of the normal formation of follicles and maturation of eggs.

With the onset of menopause, not only well-being suffers, but also appearance: the skin becomes dry and less elastic, hair and nails become brittle and dull. These changes occur due to impaired absorption of nutrients. To replenish the balance of useful elements, it is important to know how to support the female body during menopause.

Vitamins for menopause at the age of 50 are necessary for a woman all year round. To maintain health and improve well-being, it is important to ensure sufficient intake of elements A, group B, C, D, E. They allow:

• normalize the functioning of the nervous and endocrine systems,
• improve mineral absorption and collagen synthesis,
• strengthen immune defenses,
• reduce the risk of developing osteoporosis,
• slow down the aging process.

Most of the nutrients can be obtained from food. To do this, women need to include in their daily diet:

• whole grain cereals,
• eggs,
• liver,
• lean meats and sea fish,
• natural unrefined vegetable oils,
• legumes,
• vegetables, fruits and herbs,
• dairy products.

If it is not possible to eat a balanced diet, you can support the body during menopause and ensure the supply of nutrients in sufficient quantities with the help of pharmacy products. When choosing biocomplexes, it is important to take into account the composition, form of release, storage conditions, safety and efficacy.

Biocomplexes for women from PharmaMed meet high quality and safety standards:

• Lady’s formula Menopause Enhanced formula – effectively eliminates the unpleasant symptoms of menopause, prevents complications of menopause, prevents weight gain, moisturizes the vaginal mucosa;
• Lady’s formula Menopause Day-Night – eliminates psycho-emotional problems, increases energy, performance, restores normal sleep with quick falling asleep without frequent awakenings at night.

The complexes include all the necessary vitamins, minerals and valuable plant extracts in optimal dosages. One package is enough for a full course of treatment.