In this article, I will be talking to you about women’s physiological changes with aging. And I do want to start out with showing a graph that shows you men and women – in this case, women are the blue categories and men are the red. Over here we have ages 45-59, and here’s ages 60-74, and this group is age 75 and older. And these people said that a satisfying sexual relationship is still important to my quality of life. And as you can see, it drops a little bit here as you get older, but between 40% and 50% of the age group of 75 and older said that sex was still an important part of their life. So I want to just show that to kind of set the tone for this particular presentation.
Now one of the major things that happens with women as they age is they will go through menopause. And menopause, the term menopause, we use that after a woman has had no period for one entire year. That’s when she has reached menopause. The time up to that is called perimenopause. And it can last up to ten years. And the natural menopause usually happens between age 45 and 55. It can be earlier or later, but that’s usually when the natural menopause happens. We call it premature menopause if a woman in her 30’s completes menopause by the time she is 40. And then there’s another type of menopause called artificial menopause, and that’s either if a woman has had surgery, radiation, chemotherapy, or certain other drugs can cause artificial menopause. Now of all of the symptoms of perimenopause, the time before a woman reaches menopause, it’s really mainly related to the drop in both progesterone and the estrogen level. These are important hormones, and as we get older they slowly start dropping and women experience different symptoms. And I’m going to go through some of them, and these are all normal changes as a woman gets older. And it can start as early as in her late 30’s. And the first and most noticeable symptom is irregular or otherwise abnormal periods. Usually a lot of times increased bleeding is very common. Women feel more bloated – more water retention, they feel more swollen when it comes close to their period. And there can be lots of breast swelling and tenderness – they can be extremely tender, much more than it used to be when they were younger. Mood swings – being more irritable or depressed is very common. Hot flashes – everyone has heard about hot flashes. That’s one of the things that can be most bothersome for a lot of women as they get closer to menopause. Insomnia – having a hard time sleeping, is not uncommon. Weight gain, especially around the abdomen and the hips – it just comes with age, and it’s one of the things that happens as a lot of women get closer to menopause. Cold hands and feet is something that some women experience. Headaches, more than usual, and sometimes especially just before you have your period. And decreased sex drive. I want to point out this picture to you, because sex drive does not always decrease as someone gets older. This is a figure of women who were under 55 but they were already postmenopausal, and it shows the changes in sexual activity since menopause. This big column here, these were all the women who experienced a decrease in sexual activity. And this group had no change – and I do want to point out that there was a small group here that had an increase in sexual activity. And I want to make sure to mention this, that some women feel better after they have gone through menopause. Maybe they have more time, maybe their children are out of the house and there are more opportunities to have sex, but it doesn’t necessarily decrease – it does increase for some women, sexual frequency.
Now what are the normal changes with aging? And again, it’s related to the fact that the hormone levels drop. And one of the things is that women after a few years will sometimes notice is vaginal elasticity is reduced, so the tissue in the vagina is not as elastic as it used to be. Reduced lubrication is a very, very common thing that happens, and it’s a simple consequence of the low hormone levels. And that can actually sometimes cause a little bit of irritation if you don’t use any lubricant. I’m going to show lubricants in a little bit. It can cause irritation and actually even minor injury and infection. Also the whole tissue of the vaginal wall is not as thick anymore, it gets much more frail and it thins out. This is another normal thing. Less engorgement during sexual arousal is normal. Some women, not all of them, experience less sensation with orgasm. And then also, simply because of the reduced hormones, the size of the vagina and the uterus shrink. So these are all completely normal changes with aging. Now in some cases we have a condition called atrophic vaginitis, when there is an inflammation in the vaginal tissue. It causes infection and intercourse becomes extremely painful. It can cause vaginal itching, burning, frequent urination, and vaginal discharge. This can definitely be treated – there are several ways of treating it. It’s very important, if you have any of these symptoms, you need to see your physician because there are several things that can be done. And one of them is the person might prescribe estrogen, just a topical cream or maybe even tablets that you insert into the vagina. The other option is to have something called an estring – it’s a small ring that releases hormone and that is inserted for a three months at a time. Your prescribing health provided might prescribe oral estrogen, hormone replacement therapy. Vaginal lubricants – I’ve brought a few samples here, Astroglide, K-Y, K-Y Silk and Vagisil – you can get these over the counter and it’s important to use these during sexual activity. I always tell people don’t just apply it in the bathroom, but take it with you wherever you are and it needs to be reapplied all the time because it tends to dry up after a while. The other thing that is very good is called Replens. And this is something you can also get over the counter – you basically apply it every so many days, there is an applicator in the box. You would break this part off and insert it in your vagina and press and the lubricants will be inside your vagina and moisturize it. So you can use this independent of sexual activity. People find their own schedule – some people use it every two to three days, but you need to reapply it all the time.
Also, some people say that having sexual activity can help the vagina stay healthy because use helps to increase blood flow. So more or less, what we say – “use it or lose it” – the more sexual you are the better, actually, because it increases the blood flow to the genitals.
Now if someone has experienced menopause a few years ago and has not had any hormone replacement therapy, it’s very tricky these days. People like to only prescribe hormone replacement therapy for very short periods because of safety issues. And you need to discuss this with your own health provider and see whether hormone replacement therapy is an option for you. But if people have low hormone levels for a long time what’s not uncommon is that not only do they get vaginal discomfort but also bladder discomfort and even heart disease and osteoporosis, which is bone loss. So it can be very helpful to have hormone replacement, at least for a brief time period. But it’s something that each person is different, each person has a different family history, and it’s something you need to address with your own health provider, and they can give you the appropriate recommendations. There are also a lot of natural products out there. There is one book I really like that is called “The Wisdom of Menopause” by Christiane Northrup. This book is wonderful – she lists a lot of natural products that people can use to alleviate some of the symptoms of perimenopause and menopause. Some of them are soy products, Dong Quai, Chaste Berry, Black Cohosh – this is something that has been used for hundreds of years in different cultures, I know it’s been used in Europe for many hundreds of years. Native Americans have used it, it’s a popular Chinese herb. And also licorice root. So those are some of the more typical products that people use during menopause and perimenopause. What I usually suggest to my clients is go to your local health store – if you’re interested and if you want to read up you can get this book – but go to your local health food store and those people are very often quite knowledgeable about what the natural products are that can be helpful. Again, I don’t recommend to overdoing it because some of these natural products, just because they’re called natural doesn’t mean that they are safe, so you have to stay within the guidelines that are either written on the boxes or that they can tell you at the health food store. But there are many many options that are worthwhile exploring.
Finally, I want to cite one of my favorite books, called “Women’s Sexualities” by Dr. Ellison. And she has a definition of what it means to her to be sexually successful, and I think in this presentation that is about normal aging changes I want to be sure to read this definition. And what she says is this: “I think of a couple as sexually successful when they create mutual erotic pleasure, to whatever level and in whatever form they desire, on any particular occasion, so that each ends up feeling good about herself or himself and the other, experiencing a good time and enhancing their relationship.” And as I stated, both men and women, when it comes to aging, instead of thinking about your particular performance and how maybe you reach orgasm and how you perform, I try to help them embrace pleasure and focus more on pleasure and not just on how they perform.
With this I want to finish and just show you some of the resources that are out there. I already showed you Women’s Sexualities – that is not specifically about menopause, but it’s about women’s sexuality in general. There’s another very good book by Lonnie Barbach called “The Pause” about menopause. And I will be listing all of these on the website. And then Sandra Leiblum has written a book, “Getting the Sex You Want” – a very nice book also for women as they age. And another one is by Dr. Judith Daniluk, it’s called “Women’s Sexualities Across The Life Span,” also very good. And then finally I recommend this book by Dr. Landau, Dr. Cyr and Dr. Moulton, and it’s called “The Complete Book of Menopause.” So these are all wonderful books where you can read up and maybe get some more suggestions in addition to what I have been telling you today.