Menopause is a normal condition that all women experience as they age. Women can experience a wide range of symptoms including hot flashes, night sweats, insomnia, fatigue, memory loss, low sex drive, dyspareunia (painful intercourse) depression and more. For some women these symptoms are transient and barely noticeable. However, for other women these symptoms may be severe and interfere with quality of life. The good news is that there are several treatment options available to help relieve these symptoms. Our caring staff stays up-to-date with the most current research and can explain the best options based on your individual needs.
Menopausal symptoms vary from woman to woman. Some women find that they have severe symptoms, others that their symptoms are barely noticeable. Generally symptoms include some of the following:
- Hot flashes or flushes
- Night Sweats
- Difficulty sleeping or staying asleep
- Memory loss or mental fogginess
- Decreased interest in sex
- Difficulty getting aroused or having an orgasm
- Dry or painful vagina
- Weight gain
The most common treatment for menopausal symptoms is HRT (hormonal replacement therapy). HRT medications include estrogen and progesterone. Women who have had a hysterectomy (had their uterus removed) can use estrogen alone, but women who still have a uterus need to take progesterone in addition to estrogen. Progesterone protects the lining of the uterus from estrogen induced overgrowth which can increase the risk for uterine cancer.
HRT or systemic estrogen can come in a variety of forms: skin patches, gels, creams, vaginal rings and tablets. The dosing can range from small amounts to greater amounts depending on your symptoms and what dosages are needed to control them. Our medical practitioners can help you decide which modality is best for you but all the products we use are bioidentical.
In some cases, menopausal symptoms will suggest the use of testosterone treatment as well. In cases where there seems to be significant problems in sexual functioning, lack of desire, problems with arousal or orgasm, our practitioners might suggest the use of testosterone in addition to estrogen. In these cases testosterone can be administered through creams, gels, or pellets.
Hormone replacement therapy should be started within 5-7 years of a woman’s last period. In 2002 the Women’s Health Initiative (WHI) released findings of a long term study on estrogen and progestin. The investigators found that the associated health risks of the combination hormone therapy outweighed the benefits and it was thought that women were being put at risk for cardiovascular incidents or strokes only if women started HRT 10 years after.
There are no clear rules about when to start using testosterone or how long it can be used, as long-term use has not been studied. Many women are afraid of hormones and cancer. To date there is no direct link between testosterone supplementation and cancer and several studies show testosterone to be breast-protective.
No. Women should not use HRT if they:
- Have problems with vaginal bleeding
- Have had certain kinds of cancers, such as breast and uterine cancer
- Have had a stroke or heart attack
- Have had blood clots or a bleeding disorder
- Have liver disease
Testosterone treatment is less limited in its use and you should discuss with your practitioner whether testosterone is appropriate and safe for you.
There are non-hormonal FDA approved medications that can help with vaginal dryness and hot flashes; these include Osphena (ospemiphene) for vaginal dryness and Brisdelle (paroxetine) for hot flashes. Vaginal moisturizers and lubricants are available over the counter that can help with vaginal dryness as well. The newest treatment method which is loved and recommended by patients and physicians alike, is a laser treatment called MonaLisa Touch. It’s fast, painless and does not involve the use of hormones.
There are also supplements that may help. Supplements containing soy or herbs, such as black cohash, can help as they act like estrogens. However research is limited and has yielded conflicting results on efficacy.
Lifestyle changes can offer some relief from hot flashes and other menopausal symptoms, especially those that are mild to moderately bothersome. For example, wearing light layers of clothing to avoid becoming too warm, engaging in physical activity to help reduce stress, and dietary changes including limiting spicy foods, alcohol and caffeine.
For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, and breast cancer. Our medical providers will perform a complete physical examination, including a breast and pelvic exam as well as blood work. Blood work will be monitored throughout treatment. Before initiating hormone therapy, an up to date mammogram is required.
Some studies suggest that hormones should be used at the lowest dose that helps relieve symptoms for the shortest time. However, every woman’s needs are different and some women do choose to remain on HRT for an extended period of time.
In A Patients Own Words:
It has been three months since my initial visit and I no longer experience painful intercourse. I have my sex life back!
I was experiencing painful intercourse for about a year and with proper treatment I got my sex life back in a short period of time.
My husband is a patient of Dr. Werner’s. I went with him to an appointment one day and I saw a pamphlet in the waiting room explaining how many women experience painful intercourse post menopause. After reading the pamphlet I immediately decided to make an appointment.
My first appointment was a very pleasant experience. I had a consultation with Tara Ford and Bat Sheva Marcus and they both made me feel very comfortable. I was able to speak freely about my sex life and what I was experiencing with painful intercourse. The next thing was the physical examination. Tara described each part of the exam to me prior to it being done. I was relaxed during the exam as I knew what to expect. My reaction did not change, but just reinforced my decision to seek treatment.
My treatment included medication first and then dilation. I began to see results within the first month and my condition kept getting better with every week that went by.
Women should know that they are not alone. There are many women experiencing the same problem. If you are experiencing post-menopausal painful intercourse like I was, don’t wait to seek treatment. Make an appointment right away. You too can get your sex life back.
– MC, Age 51 –
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