Find Dr. Cullins' Answers to Common Sexual Health Questions
Q&A with Dr. Cullins
When a woman reaches middle age, usually in her 40s or 50s, her periods begin to change. When they stop completely, it is called menopause. The period of gradual change before menopause is called perimenopause. During perimenopause and menopause, a woman may experience many hormonal changes, and may have some mild to serious menopause symptoms.
Whether you are approaching menopause, are dealing with menopause symptoms, or are a concerned partner, friend, or family member, you may have many questions. Here are the answers to some questions people commonly ask about menopause and perimenopause.
Menopause is the time when a woman has her last period. This happens when her ovaries stop releasing eggs. For some women, it happens all at once. But for many women, it is a gradual process.
If you have your ovaries removed through surgery, you may go into "induced menopause," and experience sudden menopause symptoms without gradual change. Medical treatments like chemotherapy and radiation can also trigger early menopause.
If you have not had a period in more than a year, are not pregnant, or do not have another illness, you have most likely reached menopause. Typically, a woman reaches menopause in her 50s.
The gradual change leading up to menopause is called perimenopause. Perimenopause usually happens around ages 45 to 55, but can begin as early as 40. It usually starts about two years earlier for women who smoke than for those who don't. Perimenopause is a stop-start process that can take a few months or up to 12 years.
As we grow older, our bodies begin making less of the hormones estrogen and progesterone. In perimenopause, a woman's hormone levels change as they did during puberty, before menstruation started. You may feel these changes even more intensely than you did during puberty.
Pregnancy and Perimenopause
Your period may not be regular during perimenopause, but you can still get pregnant. If you don't want to get pregnant while you're in perimenopause, discuss your birth control needs with your health care provider — whether or not you have had a period recently.
As you approach menopause, your menstrual periods start to change. The time between periods can be shorter or longer, and this may vary from month to month.
As your periods change, you may experience other symptoms, too. Women may worry about their menopause symptoms if they don't know what they are.
Common menopause symptoms include
You may have one, some, or none of these menopause symptoms.
For most women, common menopause symptoms such as mood changes and hot flashes are temporary and last only 3–5 years. But some women may have a long and difficult perimenopause, up to 10–12 years.
A few common menopause symptoms — vaginal dryness and changes in sex drive — may continue or even get worse after menopause. There are treatments available for these symptoms.
The cause of hot flashes and night sweats is not completely understood. It could be caused by the changing hormone levels in your body during perimenopause and menopause.
During a hot flash, your fingers may tingle or your heart may beat faster. Your skin temperature can heat up and/or your face gets flushed. You might break out into a sweat. Night sweats are severe hot flashes women may have while asleep. They can be so severe that they soak through the bed sheets.
Hot flashes are common:
To relieve hot flashes during perimenopause, you can try
Some women keep a diary of when they have hot flashes in order to figure out what might trigger a hot flash and how to avoid it.
Yes, it can. Women often feel less sexual desire when they're having symptoms during perimenopause. For many women, sexual desire returns when menopause symptoms stop. Some women find their sexual desire is heightened because they are no longer worried about unintended pregnancy. But about 3 out of 10 women don't have the same level of desire after they are finished having menopause symptoms.
One common reason that women do not enjoy sex during perimenopause and after menopause is vaginal dryness. Symptoms of vaginal dryness include
Over-the-counter, water-soluble lubricants can help with vaginal dryness. Your health care provider may also prescribe estrogen creams, tablets, or rings. These products can make masturbation and sex play with a partner more enjoyable during perimenopause and after menopause.
STDs After Menopause
Remember that menopause does not protect against sexually transmitted diseases. Latex or female condoms can reduce the risk of infection.
Many life changes often occur at the same time as perimenopause and menopause. They can increase the intensity of the symptoms of menopause. These changes include
If you are facing these kinds of issues or life changes, it may be helpful to talk to a friend, partner, or a licensed counselor about your thoughts and feelings. More and more women are forming self-help groups to help deal with the changes that menopause brings — psychological, emotional, spiritual, social, and physical.
There are many types of hormone therapy to treat your menopause symptoms. These include pills, patches, implants, rings, and vaginal creams. These treatments work by replacing the hormones — estrogen and progesterone — that your body stops making during perimenopause and menopause. Some women take both hormones for therapy — hormone therapy (HT). Others take estrogen only — estrogen therapy (ET).
POSSIBLE BENEFITS OF HORMONE THERAPY
POSSIBLE RISKS OF HORMONE THERAPY
POSSIBLE SIDE EFFECTS OF HORMONE THERAPY
These side effects usually clear up after about three months.
If you're considering hormone therapy, discuss your personal risks and family medical history with your health care provider. Your provider can help you weigh the possible benefits against the risks. To relieve symptoms and reduce the risk of hormone therapy, hormones should be used at the lowest effective dose and for the shortest period of time.
HT is not recommended to treat or prevent heart disease. Use of HT to treat other symptoms within 10 years of menopause does not seem to increase risk of heart disease. Discuss your heart health history as well as your family's when you discuss HT with your health care provider.
Some women concerned about the risks of hormone therapy choose alternative therapies, including homeopathy, herbal treatments, and Chinese medicine. These therapies may also have undesirable effects. While research has not proven their effectiveness or safety, some women may find them helpful. Consult a skilled, experienced practitioner to determine the remedy, dose, and treatment schedule for whatever therapy is chosen.
Women can also make lifestyle changes to help minimize menopause symptoms:
Many Planned Parenthood health centers offer midlife services. Staff at your local Planned Parenthood health center may be able to give you these services or put you in contact with the resources you need.
You can also contact the North American Menopause Society.
Q&A with Dr. Cullins