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!

doctor in a white coat holding a green medicine bottle, sitting across from a patient

It’s been 18 years since the landmark Women’s Health Initiative (WHI) initial hormone therapy (HT) results. They gained worldwide attention by throwing HT “under the bus,” alleging the risks outweighed the benefits. I didn’t, and still don’t, endorse that conclusion, because estrogen therapy reduces the risks for heart disease, Alzheimer’s disease, and osteoporotic fractures among other benefits. Regardless of one’s point of view, almost 80% of women abruptly went off their HT.1 Here, I want to talk about the latest “potential” benefit of estrogen therapy… prevention of COVID-19 infection, and reduction in disease severity. Yes, you heard me, I can’t make this “stuff” up!2,3

The basics are these:

  • The severity of coronavirus infection appears to be greater in men than in women.
  • Estrogen reduces both influenza virus growth (replication) and the inflammation it causes.
  • These benefits of estrogen (replication and inflammation) are eliminated in animals when they lose ovarian function, like menopause, and are restored if those animals receive estrogen.
  • Pregnant women have high levels of reproductive hormones, including estrogen. 92% of pregnant Chinese women from Wuhan with COVID-19 had mild symptoms, and the other 8% all recovered from their disease. There were no deaths in pregnant women.

Taken together, estrogen seems to be protective against COVID-19, both the prevention of infection, and reduction in disease severity. So much so that clinicians and scientists from Stony Brook University Hospital in New York have launched a clinical trial using menopausal estrogen patches for the reduction of COVID-19 severity in both women and MEN!4,5 Yes, we are now giving menopausal estrogens to MEN. So, before you throw away your menopausal hormone therapy, think twice, it may be helpful in this COVID-19 pandemic.

 

  1. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol. 2012;120(3):595‐603. doi:10.1097/AOG.0b013e318265df42
  2. Suba Z. Prevention and therapy of COVID-19 via exogenous estrogen treatment for both male and female patients. J Pharm Pharm Sci. 2020;23(1):75‐85. doi:10.18433/jpps31069
  3. https://www.healio.com/endocrinology/hormone-therapy/news/online/%7B334d4dd8-cc70-4672-952f-735440eef7da%7D/study-investigates-estrogen-patch-use-to-lessen-covid-19-complications
  4. https://clinicaltrials.gov/ct2/show/NCT04359329
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!

an open bottle lying on its side with golden capsules emerging and on the table beside it

Sex supplements are everywhere and easy to access, but do they actually work?

Studies have shown that even Viagra, an FDA-approved prescription drug, has a placebo effect of over 30%, which tells me that if you believe Viagra or a sex supplement will work, it just might. But is it worth the negative effects that sex supplements can have?

Most sex supplements include ingredients that have not been tested or studied and may not be safe at all to take. Several common ingredients in sex supplements, including ginseng, yohimbe, tribulus, and ginkgo biloba, can have adverse side effects from headaches to seizures. It is just not worth it!

There are several FDA-approved options for you that are both safe and effective, such as Addyi for women or Viagra and several similar medications for men. Addyi helps women who have HSDD, or Hypoactive Sexual Desire Disorder, which is the most common form of sexual dysfunction in women. HSDD by definition is lowered sexual desire. If you’re unsatisfied with your current level of sexual desire, or feel as if you had a higher desire for sex before, you might have HSDD, and Addyi could help! Viagra and several similar medications are common treatments for erectile dysfunction or ED, which can even effect men in their 20s. It’s not just for seniors! In fact, 50% of men in their 50’s, 60% of men in their 60’s and 70% of men in their 70’s have ED.

We also specialize in hormone replacement therapy, which can be used to treat a myriad of symptoms, including low libido and low testosterone. Hormone replacement therapy is safe to use, and we will create a cocktail of hormones specific to your body’s needs. Sometimes we can even package it up in a pellet, which we would then insert under your skin in a quick and relatively painless office procedure, so you can forget about it and get on with enjoying your life!

In addition, we will work with you to find out the root of your sexual problems, not just treat the symptoms. Just getting enough sleep or making small changes to your diet and exercise can improve sexual function, and make you feel a whole lot better. Maybe seeing a sex therapist will help you and your partner uncover what is holding you back. There are a number of effective ways to treat sexual dysfunction, but taking sex supplements is not one of them!

I understand the appeal to buying “over-the-counter” sex supplements instead of talking to a doctor about your sexual problems. It can feel embarrassing to talk about, and it’s been documented that many primary care physicians are equally awkward and embarrassed when the topic is breached, which is why seeing a sexual medicine specialist is a way to go. Sex is our bread and butter. We welcome the awkward questions!

Make an appointment to see one of our experts by calling 202-293-1000. Leave the sex supplements behind and get a tailored treatment plan that will actually work for 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

closeup of a doctor with a stethoscope in his pocket and a sexual health pin on his lapel

We are pleased to share a recent article in Washingtonian Magazine featuring an interview with our own Dr. James Simon, “The Menopause Whisperer.” In the article, Dr. Simon discusses female sexual dysfunction, the state of sexual healthcare for women, and his hopes for the future.

Read the full article “Sexual Dysfunction in Women Has Long Been Taboo. Washington’s Menopause Whisperer Is Here to Help” in Washingtonian Magazine.

Here is an excerpt from the article about one of Dr. Simon’s patients who consented to share her experience:

Palim stumbled on a Washington Post article that mentioned [IntimMedicine Specialists; Dr. Simon] put [Palim] on testosterone, and her condition rapidly improved. But if she hadn’t happened upon that story, “that might have just been the end for me of a part of my life and of my relationship with my husband that was meaningful and fun—and why? Why should I have had to give that up just because nobody bothered to tell me about it?”

If you or someone you know might benefit from seeing Dr. Simon or one of our sexual medicine experts at IntimMedicine Specialists, please share this post or give us a call at 202-293-1000 to make an appointment.

Pellet Hormone Replacement FAQ

We know that Hormone Replacement Therapy is essential for managing severe menopause (or “manopause!”) symptoms, and hopefully there is an easy way to deliver it, right? Fortunately, there is! IntimMedicine offers an easy outpatient procedure to place a bioidentical hormone pellet under the skin. Outta sight, outta mind, and you get to start living your life again!

What is it?

Pellets are compounded bioidentical hormones for women (our team of experts will determine exactly what’s right for you – the right amount can help you regain your hormonal balance). Pellet therapy is actually FDA approved for men, as well. Pellets are typically naturally occurring hormones that are pressed into a solid, little insert, about the size of a grain of rice.

How does it work?

Your pellet will release a small amount of your hormonal regimen straight into your bloodstream, similar to what your ovaries or testes would normally have produced in your younger years. Research shows that pellets are able to deliver a consistent level of hormones to your body, unlike some creams, gels, or pills which are also compounded. Pellets also reduce the risk of blood clots (venous thrombosis) associated with oral hormone replacement therapy because the hormones released from pellets enter the bloodstream directly and do not cause changes in blood clotting factors made in the liver the way oral medications can. It’s a win-win!

How is it used?

Hormone Replacement Pellets are used like any other Hormone Replacement Therapy to help our bodies regain some of its hormonal balance, which will improve everything from the emotional roller coaster to hot flashes. The pellet is just a convenient delivery method! It’s not for everyone, but getting your hormones “just right” no matter the method is critical.

How long does the procedure take?

It is a quick and painless (with numbing medication) outpatient office procedure. We will insert the HRT pellet right into your hip, abdomen or buttock area, and you’ll be on your way and back to your life!

How long till I see results?

It will only take 7-10 days for you to notice your HRT Pellet working on your symptoms.

How long will my pellet last?

HRT Pellets typically last 3-6 months for men and women.

How can I make an appointment? Call us at 202.293.1000 or email us to set up a consultation appointment with one of our specialists here in Washington, DC. Don’t wait to get back to living your normal life – call us today!

man and woman in bed, separated, unhappy

Study Shows that Deep Dyspareunia can Improve with Interdisciplinary Treatment

There is good news for women who are suffering from Deep Dyspareunia! Dyspareunia is the fancy medical term for painful sex, and can be categorized two ways: superficial (affecting just the entrance of the vagina or vulva), or deep (pain during deep penetration).

In a recent study published in the Journal of Sexual Medicine, researchers had 278 women self-report pain scores related to their Dyspareunia symptoms on an 11-point scale. The women and their physicians decided which treatment options to pursue, including “minimally invasive surgery, hormone therapy, pain education, physiotherapy, or psychological therapy” (ISSM). This is what is considered an “interdisciplinary approach,” since treatments were not limited to one course of action.

After a year, researchers followed up with the women who participated in the study and found that the 28% of women who had reported absent or mild pain had increased to 45% of women, the 17% who rated their pain as moderate increased to 25%, and the 55% of women who said they were experiencing severe pain decreased to 30% of women. These are great results and should give hope to women who are still experiencing painful sex!

It should be noted that having depression and being at a younger age were considered predictors for having continuing deep dyspareunia after a year, because depression can also “affect the sexual response cycle, pelvic floor function, relationships with partners, and emotional aspects of pain” (ISSM). More research needs to be done about how depression can affect deep dyspareunia, but the authors of the study recommend treating your depression first and foremost should you be suffering from it, as your other symptoms can improve with that treatment.
Because the women and their doctors chose different plans of action to treat the symptoms, we can’t be sure exactly which treatments were most effective, but the bottom line is that after only a year your symptoms can improve if you are able to attack the problem holistically. That’s where we come in. IntimMedicine Specialists are well-known for our holistic, tailored approach towards treating our patients. If you are experiencing painful sex, give us a call, or e-mail us! Our experts here in Washington, DC would love to discuss which options to try with you to start treating your pain and improve your sex life and beyond!

Dr. Rachel Rubin of IntimMedicine Specialists

Dr. Rubin at Planned Parenthood DC’s “I Like It” Event

“Nobody taught us about the clitoris in medical school, and doctors rarely ask women if they can orgasm…but they should!”

That’s what our very own Dr. Rachel Rubin told the audience at a local Planned Parenthood “I Like It” a fundraising event held at George Washington University earlier this year. 

The discussion followed a screening of “The Female Orgasm,” an episode of the Netflix Original Series Explained. Dr. Rubin, joined on the panel by a sex therapist and sex educators, discussed the “orgasm gap,” what happens to the body during female orgasm, and ways to talk about what feels good. You can watch highlights of the discussion here.

panel members at "I Like It" at Planned Parenthood DC

Dr. Rubin is a board-certified urologist with fellowship training in sexual medicine. She believes in a multidisciplinary and individualized approach to care for men, women, and couples, with the first step being an in-depth consultation with enough time to truly understand her patients’ concerns.

Follow Dr. Rubin and follow IntimMedicine on Twitter to find out about future events where you can hear Dr. Rubin and our other experts speak.

 

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