Sex and menopause

I've experienced the beauty and power of sexual activity for decades. From the wonderful sexual relationship I have with my husband I experienced a beautiful bond that has grown more lovely over the years. From our love for one another we created our dear, sweet, children. We have been fortunate to have the blessing of being able to express our love for one another both verbally and sexually.

Unfortunately, all too soon that changed. In my early 40's, as my ovaries began to fail, my ability to respond sexually began to fail as well. At first I wasn't too worried because I had read in magazines and newspapers that this change in response was temporary and soon I would be myself again. Needless to say, my wait did not seem to have an end. I began looking for reasons why my sexual response was not returning. I read articles from important sources like the National Institute of Aging (NIA) which stated very clearly that if I was not functioning sexually it was more a problem with my relationship than any influence from my failing ovaries. (i)

I began to question whether I had fallen out of love with my husband. I was married a long time and maybe, like a switch, I could no longer respond to him sexually because I had changed in some way. The more I thought about this the more it did not make sense. How could it be our relationship and not something physically wrong? After all, aren't I a sum of my parts and if I was losing one of my parts, wouldn't that be something I would notice?

Contrary to what I had been reading I felt that it must be the change in my ovaries, not my relationship, that was the problem. The idea that ovarian failure (menopause) had little or no effect on sexual functioning defies logic. So I began to probe medical texts and I found the answers I was looking for.

I learned the loss of sexual function was due to a 'perfect storm' of events. The first part of the 'storm' I found in a medical textbook which stated the explanation for the loss of sexual function quite clearly:

"The majority of sexual problems that surface in perimenopausal and menopausal women can be linked to the changes in gonadal steroid status." (ii)

A change in gonadal steroid status! A change in the ovary means a change in sexual function. Finally, a link between the ovaries and sexual function!

The next hurdle I had to clear was whether the loss of sexual function could be restored. After all, many articles referred to the loss of sexual function as a normal part of aging and therefore not fixable. Like putting on glasses, giving the body what it needs to function may be all that is necessary. If I believed the popular media I would have given up the search for an answer. Giving up was the next part of the 'perfect storm'.

In this same medical text I found the answer on why I should not give up.

"It is clear that most of the sexual response changes are directly impacted by changes in the endocrine system, because the greatest percentage of menopausal sexual dysfunctions are directly or indirectly related to changes in circulating estrogen and androgen levels."(ii)

I had my answer, improve my circulating estrogen and androgen levels.

I was extremely fortunate to have a doctor who was willing to work with me to find the right levels. The problem was no one knows the right levels. The National Institutes of Aging (NIA) still believes menopause does not impact sexual functioning. The last 66 years of research have been wasted on Premarin because it does not restore sexual function and any effective treatment for ovarian failure must include restoring sexual function! I wasn't going to give up even though the NIA has.

I was now two steps closer to getting my sexual function back. Now I had two more steps to go, which hormones to take and how much.

I was almost there.

The last two hurdles I had to clear were the recognition that very few products were made for replacement purposes, and that there was very little direction in how to use them. The pre-packaged products like the patches would come off and the gels were just too low dosage. Oral pills were out because they do more harm than good when creams and patches are available. There are no pre-packaged testosterone products available and only 1 pre-packaged progesterone product. My physician, a very smart and well meaning doctor, did not know how to monitor my treatment because there are no protocols to follow. Through trial and error we came up with a replacement regimen that closely resembled my menstrual cycle.

I began replacement, and I did regain most of my sexual function. I know that with better replacement options I would get a better response, more like when my ovaries were still working.

There are ways you can combat the 'perfect storm':

1) Ask your doctor to treat hypogonadism in women, not just men

2) Ask your doctor for replacement dosages of all of your gonadal hormones, uterus or not! Men don't have a uterus and their level of estradiol and progesterone after ovarian failure are many fold higher than a woman's!

3) Monitor your levels, > 50 pg/ml estradiol, > 40 ng/dl testosterone, progesterone > 3,000 pg/ml and consider adding dhea 10-25 mg.

4) Realize these products were not made for easy use or even for replacement and you may not get the results you want.

We can change the future for the better.

We can call menopause by its real name, hypogonadism.

We can tell our friends and our doctors that ovarian failure does impact sexual function.

We can be determined not to give up and go to multiple doctors if we have to.

We can make replacement options more available if we change our expectations of ourselves and of our doctors. The pharmaceutical companies will follow through if they see that women are interested in buying their products.

Just look at the progress that has been made in the treatment of diabetes over the last 50 years. That progress was made because untreated diabetes is very unhealthy. Look at the increased quality of life and health now compared to 50 years ago of diabetics. The difference is night and day.

Let's make the same thing happen for the treatment of hypogonadism in women.





(i) Can Menopause Change Your Sex Life?, National Institutes of Aging, http://www.nia.nih.gov/NewsAndEvents/PressReleases/PR20001013CanMenopause.htm

(ii) Lobo, RA, Kelsey, J, Marcus, R, 2000, Menopause, Biology and Pathobiology, Academic Press