DID YOU KNOW THAT MENOPAUSE CAN IMPACT YOUR MEMORY?

If your partner is going through menopause, here’s a brief guide for survival.

Menopause isn’t just a challenging time for the person going through it, but it can also be difficult for partners, friends, and children. Hormones are very real, and they have a very real-life impact on our bodies and our relationships.

Dr. James Simon, Medical Director and Founder of IntimMedicine Specialists in Washington, DC, shared his expertise with True Women’s Health on how to best survive menopause as a partner, and we’ve distilled that for you here.

(Note: Not all women have a uterus so not all women go through menopause, and not all people with a uterus are women, so we will be using gender-neutral language throughout this guide.)

Step One: Understand What’s Going On

The first step in understanding what’s going on with your partner is to know exactly what menopause is. Here is a quick guide to help you understand a bit more of what’s happening before, during, and after menopause:

1. Perimenopause—This means “around menopause” and refers to the time when someone with a uterus is making the transition to menopause, usually age 45-50.

What even is perimenopause? Perimenopause means "around menopause."

At this time:

    • Periods become more irregular and/or heavier.
    • Ovaries begin producing less estrogen, and as menopause becomes closer, the drop in estrogen increases, causing symptoms like hot flashes, night sweats, disturbed sleep, lower sex drive, weight gain, and mood swings.

 

It’s important to note that during perimenopause, pregnancy is still possible.

2. Menopause—This is the time when the last spontaneous menstrual period occurs. Once a full year has gone by without having a period, the date of that last period is the moment of menopause. This usually occurs, for most people, around the age of 50.

Your partner might experience the symptoms listed above, as well as other symptoms, like vaginal dryness, pain with sex, and decreased sexual desire.

3. Postmenopause—This is the time after your partner has gone through menopause. In other words, after an entire year without a period, postmenopause has officially begun. For some people, menopausal symptoms, such as those listed above, may become less frequent and less intense. However, sometimes those symptoms can last for many years after the menopause transition.

Step Two: Listen to Your Partner

It can feel really bad when your partner is tired and cranky, and it might even feel like you did something wrong. You might even feel rejected romantically and physically, and that lack of desire and touch can lead to something called skin hunger – where you crave touch, and begin to feel lonely without it. But your partner is also going through all of this. And it is nobody’s fault. You can’t support your partner and your relationship if you don’t really understand what’s going on. And sometimes, your partner won’t understand what’s going on either.

The easiest thing to do is to ask what your partner needs, and what would feel good. And when it comes to sex, it’s about thinking outside of what’s “normal” for you in your relationship.

Dr. Simon has done significant research on the impact of painful sex after menopause, and nearly two-thirds of people experienced painful sex after menopause, causing them to avoid sex and lose interest in sex. This shift in desire can have a large impact on relationships.

First, consider different ways to connect intimately. Perhaps penetrative sex isn’t a viable option right now. What about mutual masturbation? Or oral sex? What kind of touch sounds good to you and your partner? These conversations can be difficult if we aren’t used to having them, but communication is one of the most important aspects of sex.

There are treatments for painful sex, and that will be different for each person, but may include:

  • Vaginal lubricants or moisturizers
  • Vaginal estrogen
  • Vaginal dilators
  • Sex therapy
  • Pelvic floor physical therapy

 

Dr. Simon has found that nearly 60% of couples who went through post-menopause treatment for painful sex felt that their sex life (and their relationship) was significantly better than even before menopause!

Step Three: Count Sheep

Sleep is imperative for all humans, especially for those going through menopause. The constant night sweats cause more than disturbed sleep: weight gain, mood swings, and decreased sex drive are all results of a change in sleep habits.

If you’re in a relationship with someone who is currently experiencing these changes, then you probably know what I’m talking about. If you think it’s difficult for you, just imagine what your partner is going through. And, if you’re concerned about your partner, it’s okay to seek professional help individually or as a couple. Menopause can feel so isolating, especially when dealing with sleep deprivation.

If you see that your partner is isolating by setting up barriers, it will be especially important to work together to create a support plan with professional help. Mood swings, for example, may be related to PMS or heavy bleeding, and taking birth control can actually help lessen these symptoms. There are answers, but your partner may need that extra understanding and a gentle push from you to take the steps to get help.

Step Four: But, What Can I Do?

  • Take Initiative to Learn—There are so many books, articles, and podcasts  with good information on the topic of menopause. This is a great place to begin educating yourself. Asking your partner to do the emotional labor to educate you about menopause generally will be just as exhausting, and you want to help, not hinder. That doesn’t mean that you shouldn’t ask questions about what your partner is going through, how things feel, and what support would look like—questions like these can be really validating.Websites like menopause.org and isswsh.org have so much information that can help people navigate the struggles of menopause. You can also make an appointment with IntimMedicine—we often setup meetings with individuals and couples to better grasp how to handle menopause with a bit more ease. Having basic information before you talk with your partner will convey that you are really trying to understand what’s going on.
  • Have Compassion—This can be a difficult time for everyone, and hormones are fierce. Reminding yourself and one another that no one is at fault can be helpful. Take a beat before responding during heated conversations, and remember that, again, hormones are real and they actually alter the chemical state of the brain. If you’re feeling hurt, confused, or lonely, consider talking with a therapist or journaling about what you’re going through.
  • Use “I” Statements—When discussing your emotions around this whole menopause experience, try to use “I” statements. For example, saying “I feel _(hurt, rejected, sad, lonely)_ when I initiate intimacy with you and you turn away” is much better than saying, “You never want to have sex anymore.” Having an intentional conversation about your experiences of emotions can be really productive.

What’s Next?

Menopause isn’t easy for anyone involved. As a provider who specializes in caring for people who are at this stage of their life, this is Dr. Simon’s best advice: Understand what’s happening with your partner and know why it’s happening. This can help you navigate your way through the challenges of menopause—together. Now that you know more about menopause than perhaps you ever thought you would – use that information like a tool to work together with your partner to foster a healthy, compassionate relationship, even when things feel tough.

And if you and your partner are looking for hormone balancing or menopause treatment options, Dr. Simon and the IntimMedicine staff are ready to help.

Pink background with a mask sitting on top and letters spelling out "Don't Panic"

Back in April 2020, an article in the Journal of Women’s Health prompted me to think about the differences between men and women’s life and death responses to COVID-19. That article illustrated what we’ve heard in the news over, and over, and over again. Namely, that men tend to fare much worse than women if hospitalized with coronavirus (sars-cov-2) related diseases. Since then, we have come to know that, in this context, men are clearly the weaker sex. But even more data has emerged around the why, demonstrating that reproductive hormones are, in fact, an important part of women’s resistance to severe COVID-19 disease and can possibly even prevent death.

For most postmenopausal women, whether currently using menopausal hormone therapy or not, hormone therapy in early menopause (i.e., started in the first 10 years since their last menstrual period) is of significant benefit. Menopause specialists strive to determine the risk-benefit ratio for any woman before starting hormone therapy. It’s now clear that early menopausal women without absolute contraindications should seriously consider utilizing hormone therapy for disease prevention (i.e., heart attack and osteoporosis) and now to help prevent severe COVID-19 infections and even death.

Prevention of severe cases of COVID-19 may not be a good enough single reason to start hormone therapy, particularly as vaccinations are becoming more readily available. However, recent evidence documents that in women who start on hormone therapy for its basic, well-established benefits (treatment of hot flashes and night sweats, vaginal dryness and pain with sexual activity, prevention of osteoporosis etc. etc. etc.), may also benefit from the protection it provides against COVID-19 disease.

So, if you or someone you know wants a consultation to evaluate the benefit/risk ratio of postmenopausal hormone therapy, factoring in the potential benefits against severe COVID-19 infections, make an appointment to talk with us about all the options. All staff at IntimMedicine Specialists are fully vaccinated and we maintain careful CDC precautions, though we are also available for virtual visits. Menopausal hormone therapy may not only be good for you, it may save your life!

hazelnuts and walnuts

I’m frequently asked whether there’s anything to change in one’s diet to improve sexual function. While there’s absolutely nothing dietary that can treat a severe erectile dysfunction, or ED or significant arousal disorder in women (for that visit us at www.IntimMedicine.com) there are number of dietary habits or lifestyle changes which may help. The most important of these is to lose weight. Most of us could shed a few a few pounds and perhaps the best “pro-sexual or sex positive way” to do this is to substitute a plant-based diet for one rich in animal protein and fat. You don’t need to become a vegan overnight, but a dramatic reduction in animal products will help. This approach improves vascular function which is exactly how erections in men and arousal in women happens. It’s all about blood flow! When people lose weight, their blood vessel function improves, ED improves and, as weight is lost testosterone levels rise in men and estrogen concentrations in women increase and menstrual cycles become more regular. Looking for a shorter-term fix to temporarily improve sexual function, that’s nuts! Specifically, walnuts and pistachios.

It turns out that some nuts (remember peanuts aren’t nuts, but legumes), can be very good for sexual function. They improve vascular dilation and lower blood pressure both directly and indirectly by virtue of their positive impact on gut bacteria. Two nuts documented to improve sexual function are walnuts and pistachios. It’s very important that you read the following carefully, because there’s no free lunch. Nuts typically come with both calories and fat. If you’re going to consume a lot of nuts, you’ll need to increase your exercise or decrease your calories from other sources in order to remain weight neutral.

It turns out that about 20-30 walnuts a day for as short as 6 weeks can improve sexual function. However, those 20-30 walnuts/day come with 400 to 650 calories, about 80% of which is fat. This means that your new sex-positive walnut habit is a meal replacement. And while walnuts have been shown to curb appetite, and do so even better than almonds, unless you want to gain a bunch of weight, you will also need to bump up your exercise and/or eat less…a typical meal less.

100 Grams of Pistachios

Pistachios are also a good nut for sex. It turns out that 100 g of pistachios per day for as short as three weeks can improve erectile function. These nuts can also improve blood flow, lower blood pressure, and improve the cholesterol profile (increasing the good cholesterol, HDL, and decreasing both total cholesterol and bad cholesterol, LDL). However, this approach, too, requires a lot of pistachios.100 grams of pistachios, about 3 servings, contain about 560 calories, and 44 grams of fat. Yes, another meal replacement.

All of which raises another question, what do you do with all those shells. Two thoughts: 1) they can be put at the bottom of your potted plants for drainage, or if well-dried, they can serve as kindling for a fire to curl up in front of with your lover. So, lose the weight, and go nuts for sex!

Esposito K, Ciotola M, Giugliano F, Schisano B, Autorino R, Iuliano S, Vietri MT, Cioffi M, De Sio M, Giugliano D. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int J Impot Res. 2007 Sep-Oct;19(5):486-91.

Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Effect of Nut Consumption on Erectile and Sexual Function in Healthy Males: A Secondary Outcome Analysis of the FERTINUTS Randomized Controlled Trial. Salas-Huetos A, Muralidharan J, Galiè S, Salas-Salvadó J, Bulló M. Nutrients. 2019 Jun 19;11(6).

Tindall AM, McLimans CJ, Petersen KS, Kris-Etherton PM, Lamendella R. Walnuts and Vegetable Oils Containing Oleic Acid Differentially Affect the Gut Microbiota and Associations with Cardiovascular Risk Factors: Follow-up of a Randomized, Controlled, Feeding Trial in Adults at Risk for Cardiovascular Disease. J Nutr. 2020 Apr 1;150(4):806-817.

Aldemir M1, Okulu E, Neşelioğlu S, Erel O, Kayıgil O. Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction. Int J Impot Res. 2011 Jan-Feb;23(1):32-8.

smiling woman

Testosterone Therapy

I have been involved in the development of testosterone products for women for many years. My research has been included in the original Princeton Consensus on Testosterone Insufficiency in Women back in 2002, and in the testing of Estratest and Estratest HS for female sexual function (both of which are still on the U.S. market), in the development of the Intrinsa Testosterone Patch for women by Proctor and Gamble, (which was never approved by FDA, but was approved and available for years in Europe), as well as in a testosterone gel for women, Libigel (which also failed to win FDA approval). Some of my additional publications on this topic can be found here

Needless to say, after all of this time, I am grateful to have been part of the International Menopause Society’s global consensus that testosterone treatment for post-menopausal women is viable and useful for female sexual dysfunction. It is time the medical community accepted this so that women can get the help they need and start feeling like themselves again for the second half of their lives.


What are the benefits/risks of testosterone supplementation? 

The primary benefits discussed in the global consensus include increased interest in sex and easier arousal and orgasm, but testosterone also contributes to increased lean muscle mass, increased bone density, and improved energy and sense of well-being. 

There literally are no risks to proper transdermal testosterone therapy if testosterone levels are kept within the normal range. If testosterone exceeds the normal range (and this can easily happen when women use men’s products not approved for use by women) women can sometimes: lose the hair on their heads, develop dark facial hair – even beards – get hairy elsewhere, have their voices change to a lower register, get an enlarged clitoris which can be too sensitive, and possibly increase one’s risk of heart attack or venous blood clots.

When testosterone treatment is taken under a doctor’s supervision and properly monitored, these side effects will typically not occur.

 

What patient population is testosterone treatment indicated for? 

All postmenopausal women may benefit from testosterone treatment, but particularly those with induced menopause (i.e. women who have had their ovaries removed, have had their ovaries radiated [even accidentally] and ovary failure ensued or had chemotherapy and their ovaries failed as a result). 

 

Testosterone and Sex Drive

I recently described a dose-response relationship-specific for testosterone for sex in women and how it is different for testosterone for sex in men. Basically, women can get too much testosterone, and it either does not increase and may actually decrease their interest in sex. As current President of ISSWSH, The International Society for the Study of Women’s Sexual Health we have nearly completed a “how-to” paper on how to use testosterone in women. In the absence of an approved product specifically for women, and the possible negative side effects of inappropriate use at high doses, this publication will be used a practice “bible” for uses of testosterone in menopausal women in the future.

 

If you think you might benefit from testosterone therapy…

Call us and make an appointment at 202-293-1000. We take the time with each of our patients to determine possible causes of complaints and develop a treatment plan that will work for you. Don’t wait to start living your life again, so make that call and let us help you!

Doctor and patient, women

Catching Cancer in Patients with Lynch Syndrome

Does your patient have cancer in their family history? If they have Lynch Syndrome, a simple screening can catch cancer before it’s too late.

It’s easy to merely glance over the obligatory medical history form that new patients fill out, scanning for information pertinent only to their presenting problem. But, as we at IntimMedicine Specialists look over a new patient’s medical history, we are always on the “look out” for a family history of cancer. How about a family history of Colon, Uterine, or Ovarian cancer? These and a number of other cancers could indicate that you and your family has Lynch Syndrome.

Lynch Syndrome is named after Dr. Henry Lynch, who is considered the father of hereditary cancer. He named this syndrome the “Cancer Family Syndrome” in 1966, which was later called “Lynch Syndrome” in 1984 by other authors, after which point Lynch himself began calling it Hereditary Nonpolyposis Colorectal Cancer, or HNPCC. It is now known as HNPCC or Lynch Syndrome, and it is characterized by members of the same family line born with a predisposition to develop ovarian, colorectal, endometrial, or other cancers.

For those of us in the fields of sexual health, we are in a unique position to be able to spot this syndrome and help our patients get the screenings they need to catch these potential cancers early. 1 in 400 people are at risk for Lynch Syndrome. It is projected that up to 1 million people in the United States have Lynch Syndrome, but due to a lack of public education about it, only about 5% of people who have Lynch Syndrome have been diagnosed with it.1 Patients with Lynch Syndrome are at a much higher risk of developing these cancers, and it is recommended that their screenings start at an earlier age and are repeated more frequently than patients without Lynch Syndrome. For example, a patient with a family history of colon cancer starting before age 50 might have Lynch Syndrome, and it is recommended that they begin colonoscopies at age 20-25, rather than wait until it may be too late.

IDENTIFYING LYNCH SYNDROME

  • If a patient has a family history of colon cancer – particularly if a family member developed colon cancer before age 50
  • If a patient has a family history of extracolonic cancers including endometrial, ovarian, small bowel, biliary, renal pelvis, ureter, or glioblastoma (a particular brain cancer)
  • If a female patient has abnormal uterine bleeding and a diagnosis of complex endometrial hyperplasia or endometrial cancer and she is younger than age 50

If any of these criteria are met, it is time to order a hereditary cancer panel. This panel will test for multiple cancer syndromes at once and is now the standard of care.

We are in a unique position to be able to catch cancer before it strikes. Ask your patients more about their family history of cancer. A simple screening process can make all the difference.

The specialists at IntimMedicine are experts in post-cancer sexual health. If you or a loved one is being treated for cancer or has been treated for cancer, talk to us at 202.293.1000, or email us at info@intimmedicine.com.

Learn more about Lynch Syndrome in this article.

1 https://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome

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