I am a menopausal woman, have been for about 10 years. I just couldn't help it, it came with aflash,, it surprised me with the heat it generated. The dysregulated temperature of feeling so cold and within hours throwing off night covers and seeking fresh air, even in the middle of winter. As a therapist I depend on my memory as one of the essential tools of my trade. Suddenly I found myself digging in my mind for the name of an artist or a piece of music. I felt sluggish, could not dance as fast and sexual feelings were as lost as my memory. My body and mind became foreign to me. Kind of frightening experience.
I was one of those women who really believed I was going to escape this scourge. Who wants to have such a definitive marker of ageing such as menopause. Ageing is presented as a weakness, asexual, loss of body shape, health, attractiveness and productivity. One is presented as lesser than, I reckoned if I could avoid menopause I would avoid ageing. I as a trained sexual medicine consultant was ignorant and had bought into a societal construct that prejudices against ageing women. Listen to any news report: " an elderly woman/granny in her 60's was robbed". Ag shame!
Tell me about the shame you feel . Talk about the confusion you experience. I want to know why you hold silence about menopause. Why do you not visit a health care provider to discuss your menopausal symptoms? Are you terrified of hormone therapy? And what has happened to your sexuality?
One in ten women describes the common physical, psychosocial, sexual symptoms as "intolerable", negatively affecting their quality of life. Suddenly you are sweating, peeing when you run, jump or want to pee all the time, you feel anxious, depressed, have achy joints, insomnia. Your partner describes you as unpredictable and questions his/her love for this raging angry woman. You don't love yourself as much, watching your hair fall out and thin, your skin dries out, and your waist expands as your hourglass figure disappears into the shape of an apple. No wonder your interest in sexual activity is pretty depleted.
And that's before you factor in the direct impact of the draining out of oestrogen and testosterone, which essentially controls your sexual desire. The loss of these two vital hormones can lead to changes in a woman's body and sexual drive. Here are some of the sexual symptoms that happen in menopause and can lead to less interest in being sexual:
- Not as easily aroused.
- Less sensitive to touching and stroking.
- Drop in blood supply to the vagina leaving the vagina dry.
- Endothelium lining (inner lining of the vagina) thins out making penetration painful.
- Vagina without oestrogen shrinks = painful penetration.
- Vaginal atrophy happens if there is no oestrogen replacement.
- Relationships become strained which diminishes sexual interest and arousal.
- Slower time to orgasm, with less intense orgasms, may diminish interest in being sexual.
- Less opportunity for penetration. Women may be divorced, single, living in sexless marriages in which case their vaginas are getting a little exercise.
- Change in body shape and fat redistribution inhibits interest in being sexual.
If you are a male partner of a menopausal women, I'm curious to know how your sexuality has changed in response to her changes. Have you had an affair? Left her for a younger woman? Find her less attractive? Disappear when she's crabby? Perhaps you're suffering with your own male menopause and have lost all interest in sexuality?
There is a solution in the form of Hormone Therapy (HT). However controversial interpretation of the research on HT, from the Women's health Initiative 2002, got women to stop using it and slink back into hot flashes, painful penetration, silence and shame.
Fact: Hormone therapy with oestrogens is highly effective but it has possible long-term safety question marks that deter many women using them. Because of misgivings about safety more than half of all women resort to alternative or complementary medicines for relief. The evidence that these methods actually work in relieving menopausal symptoms is at best poor and probably non-existent if one takes into account the placebo effect. Apart from a lack of efficacy, the active substances these remedies contain are unregulated, unquantified, potentially harmful and cross reactions with legitimate drugs are common. In plain English, avoid these compounds, creams and potions.
The South African Menopause Society (SAMS) revised consensus position statement on menopausal hormone therapy (HT) 2014 emphasises that commencing HT during the 'therapeutic window of opportunity' maximises the benefit-to-risk profile of therapy in symptomatic menopausal women. That means forget your shyness and get to your health care provider asap. The sooner you begin HT the quicker your symptoms are managed and your risks for increased breast cancer or cardiovascular events are lowered significantly.
By the year 2025 there will be one and half billion menopausal women globally. You are going to live longer, you are going to be interested in being sexual. You may be single or sexless, but do not allow menopause to steal away half your life. Find your voice and visit a gynaecologist to discuss your individualised options for managing menopause.