Struggling With Sex During Menopause? Let’s Fix That.

Transcript:

Jamie Forward: 

So, how can menopause symptoms like night sweats and hot flashes interfere with a woman’s sexual well-being?

Jessica Bell: 

Well, first of all, I would say in perimenopause and menopause, there are a lot of symptoms that come up. There are the hot flashes, night sweats, sleep disturbances.

There’s definitely the sense of, “I just don’t feel like myself anymore,” and it’s more than, “I just don’t feel like myself anymore,” it’s this really deep feeling that we’re now going to start including in some of our randomized control trials as a question of, do you experience this? So, I often say that desire occurs in a space that is high in energy, low in stress, and pleasurable.

And when we are going through perimenopause and menopause, that is often not a high energy, low stress, and pleasurable state. So, there can be an intense fatigue, fatigue just because, kind of similar, I would say, to pregnancy or postpartum. There can be a similar fatigue that occurs. And that can create difficulty in experiencing desire. It can also be more difficult to navigate what life brings at us during this time, too.

So, that stress situation as well. And then the pleasure situation is real. So, if tissues are thin and dry, uncomfortable, if there’s decreased blood flow to the area which has inhibited arousal, climax, then perimenopause and menopause is a low energy, high stress, and not a pleasurable state.

And that is how I would say it can really impact desire, intimacy, those kinds of things. And so, what we can do is use the tools in our toolbox to try and create a higher energy, low stress, pleasurable state, which allows desire to evolve from, and that’s the responsive desire that women typically experience. Women typically experience responsive desire, which again, yeah, high energy, low stress, pleasurable state.

Jamie Forward: 

Okay, and what about the hormonal and non-hormonal treatments for those symptoms?

Jessica Bell: 

Yeah, absolutely. So, there are options, always. I mean, first of all, when I address sex medicine concerns, as I call it, I address it from a bio-psychosocial approach. So, biologically, definitely considering hormonal changes. Also things that come up in our bodies. Some people might have chronic pain, different kinds of medical diagnoses.

Medications and medication side effects, so, those are all biological. And then there’s everything else, society, culture, relationships, religion, past experiences, those kinds of things. And so, I would say from a biological lens, we can look at treating what comes up for us. So, hormonally, oftentimes hormone therapy can be helpful. So, a lot of people really do find a lot of significant improvement in the full consolation of symptoms when they use hormone therapy.

So, that can help relieve those hot flashes, night sweats, sleep disturbances, bring back some energy. Again, hormones applied to the tissue level can increase blood flow, allow for physiological arousal, allow for climax, allow for pleasure as well.

I would also say that the mood changes or the difficulty navigating stress is definitely real during this time, and oftentimes, people do find that hormone therapy can help create kind of a more even-keeled space to navigate life stressors through, or that it provides the energy, I would say, to maybe sometimes synthesize the healthy habits that they have already as well.

A lot of the times, women are very educated in what they need to do for their body, the nutrition, the physical activity, all of these things. Sometimes it can feel like a lot, you know? How much protein, how much weight lifting, how much cardio situation, and sometimes with these hormonal changes, it’s difficult to have the energy to kind of put all of those pieces together.

So, I would find that sometimes people see that when they use hormone therapy, they’re able to kind of synthesize those healthy habits, to make the healthy meal that they went grocery shopping for at the weekend, or do that evening walk that they’ve been promising themselves that they’re going to do as well. And then there are also all sorts of non-hormonal options.

Not everybody is going to choose to use hormones on their journey, and that is totally fine. So, I would say there are pharmaceutical, non-hormonal options that a person might discuss with their provider. But one of the things that I discuss with my patients, whether they’re using hormone therapy or not, is all of the other things that we do in our lives to, yeah, create a space, again, to navigate life through. So, some people use acupuncture as a non-hormonal tool. They might find that that really helps decrease hot flashes, night sweats, or some of those vasomotor symptoms.

It can also provide a relaxation and a reset that can help with energy for them as well. So, some people might use those kinds of modalities too, in their journey. Also, all of the – we say this a lot, but it’s really true, and if we could put exercise in a pill, we would. It would be a million dollars or free, hopefully.

But you know, really trying, if possible, to get very intentional and purposeful about taking time for oneself to do the physical activity can be helpful, and that’s an evidence-based recommendation, a non-hormonal, evidence-based recommendation. Mindfulness. Lori Brotto is a brilliant researcher on mindfulness. She wrote the book Better Sex Through Mindfulness, actually.

And she really speaks truth to how that is helpful during our midlife transition, and also, if there’s sex medicine concerns, I would say, that come up for people as well.