Sex life does not stop for many women after 50, this should not be a surprise, nor that the quality of it partly decreases, as menopause seems to reduce its frequency and ultimately stands in the way of the quality of sex life. On average four years after entering menopause, sexual desire returns.
According to the findings of a study from the University of Michigan, 43% of women said they were sexually active, with almost the same number of middle-aged women limiting frequency due to health problems. Another scientific study found that 91% of men and 86% of women remain sexually active in their 50s.
When hearing about menopause, many women become anxious, as this term has been associated with the onset of old age and stereotypical roles that consider women’s sexual expression limited and diminishing over time. These attitudes, accompanied by the hormonal changes that the body undergoes when entering menopause, create anxiety and insecurity in the woman in relation to her image and her sexual life.
Women from 50 onwards, undergoing major hormonal changes, go through various mental and physical stages that progressively change their sexual participation and especially their desire. Hormones and especially estradiol are slowly lost, the vagina becomes drier and stiffer and contact with the partner faces difficulty in penetration and orgasm. However, it is characteristic that women who enter menopause are more vulnerable to sexual dysfunctions since the endocrine changes they experience affect their nature, their body image and their self-esteem.
A recent survey published in 2017 in Health Care for Women International of 282 climacteric women found that: 79.4% experienced some sexual dysfunction, 30.5% decreased sexual desire, 30.5% pain during intercourse, 27.3% difficulty achieving orgasm, 25.2% decreased vaginal discharge, 24.1% difficulty arousal and 9.9% difficulty sexual satisfaction.
Sex after menopause can be just as satisfying as sex before menopause. However, the hormonal and physical changes associated with menopause may require some adjustment. Reduced estrogen levels can affect spontaneous arousal and physical sensitivity for some people. These changes can be upsetting for some women but liberating for others.
What are the hormonal changes in menopause?
As women get older, the ovaries have fewer and fewer eggs over time. They also have fewer follicles, which produce hormones that help regulate menstruation and the functioning of other reproductive organs. Early in perimenopause, the body can compensate for the loss of follicles. However, over time, this becomes less feasible.
During the early stages of menopause, there are sharp fluctuations in estrogen. These fluctuations cause many of the symptoms associated with menopause, such as sleep problems and hot flashes. As menopause progresses and women move into postmenopause, estrogen levels decrease permanently and stabilize at a low level.
Testosterone levels also decrease during and after menopause. However, this decline occurs more slowly than the changes that occur in estrogen levels. Therefore, changes associated with reduced testosterone levels may not be as noticeable.
The decline in estrogen that occurs after menopause affects the structures of the reproductive system. Women often notice problems with vaginal dryness and many also experience vaginal and vulvar atrophy. These changes may be accompanied by symptoms such as pain during intercourse (dysparenia) or discomfort during urination.
Is there a solution to vaginal discomfort?
Vaginal discomfort is treatable. Vaginal moisturizers and lubricants, as well as vaginal estrogen, can be helpful in treating vaginal atrophy and its symptoms. The same treatments that help with vaginal discomfort can also relieve some urinary symptoms. However, if you experience pain during sexual intercourse or even when urinating, it is a good idea to discuss this with your gynecologist so that he can give you an individualized treatment.
How does menopause affect sexual mood?
Certain factors can affect a person’s sex drive or libido. Libido is not affected by menopause in the same way in all women. Although age-related changes in testosterone can affect a person’s sex drive, studies show that loss of libido is actually not that common. One study of 500 women in early and late menopause found that while 12% of the perimenopausal group reported loss of libido, only 3% of the postmenopausal group reported the same.
More sex after menopause?
Not all women will have a decreased libido after menopause. For some women there isn’t much change. Conversely, others actually experience increased sex drive after menopause. Some of the predictors of changes in sex drive after menopause are what happens to the body but also changes in lifestyle factors such as not having children in the home, not having to worry about an unwanted pregnancy or having periods , can be liberating. In general, people who are less stressed and more active after menopause are less likely to experience libido problems. If stress is reduced after menopause, sex drive may increase.
How is vaginal dryness treated?
Hormone replacement therapy can help with vaginal dryness. This often includes topical estrogen to increase the amount of estrogen in the vaginal tissue, which improves blood flow and lubrication. The advantage of using topical estrogen over estrogen pills is that lower doses can be used for the same effect. Topical estrogen forms include rings, creams, and tablets.
Vaginal moisturizers can help in mild cases. They should be used two to three days a week. Vaginal lubricants are also used in addition to moisturizers if needed during intercourse.
Conversely, in severe cases, estrogen is the most effective option. Of course, there are certain categories of women who cannot use estrogen, such as, for example, women with estrogen-dependent breast cancer or a high risk of blood clots.
Beyond the use of estrogen there are some alternative options. These include: Ospemifene: This is a selective estrogen receptor modulator that was approved in 2013 for the treatment of vaginal atrophy. Prasterone (dehydroepiandrosterone, DHEA): This medication can be used orally or vaginally depending on the symptoms that need relief.
Alternatively, those women who do not wish to take medication can try treatment using the ULTRA VERA machine, HIFU technology, which is certified by the strict USA FDA medical devices organization and refers to women who have: Urinary incontinence, vaginal relaxation with or without incontinence, vaginal tenderness-loss of sensation to touch, vaginal dryness and postmenopause. This treatment is a painless and short procedure of 30 minutes performed in the doctor’s office, without the use of anesthesia, without bleeding, without preparation or intense pain, offering great efficiency and improving the lives of many women.
Also, another alternative treatment for women who do not wish to take hormonal preparations is vaginal PRP, a treatment that addresses the inner surface of the vagina and aims to improve and rejuvenate it functionally and aesthetically. Vaginal PRP is used as a therapeutic tool for menopause, dryness and atrophy. As a result, pain, atrophy, dryness and infections in menopause are eliminated, restoring the smooth functioning of the vagina and sexual life.
The continuous development of medicine is able to deal with the diversity of menopausal symptoms, in order not to interfere with the normal life of women.
Stefanos writes Xandakas, MD, MBA, PhD Obstetrician-Gynecologist, Endoscopic Surgeon-Specialist in Assisted Reproduction at the HYGEIA IVF EMBRYOGENESIS Unit, Chairman of the Board of Directors. Mother Hospital, HHG group
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