For our mothers, pregnancy was the workplace unmentionable. Once a married woman began to “show,” she was expected to leave her job and begin her new life as a stay-at-home wife and mother. Now, our daughters often have family leave time, breastfeeding rooms at work, sometimes even on-site daycare.
Still, we have a long way to go. Despite progress on many fronts, menopause remains the workplace unmentionable. It makes people uncomfortable. It can be embarrassing; it isn’t well-understood; it is the butt of stereotypes and jokes; it is inevitably linked to being old, infertile and irrational. Heck, too often, we don’t even understand it ourselves.
In the workplace, the universal approach to menopause seems to be “don’t ask; don’t tell.” If you can’t see it, it ain’t happening.
There are, however, a few problems with this approach.
In our mother’s time, women over 50 were a rarity in the workplace. Our mothers didn’t talk about menopause. They didn’t discuss it with their doctors, spouses, or with us, by and large. There weren’t many options for treatment, anyway.
Now, however, while menopause is still in the closet, a lot of valuable employees at the peak of their careers are going through it. Now, most (75 to 80 percent) of women of menopausal age are working. If menopausal symptoms affect job performance and satisfaction, and if many of these problems could be addressed with more flexible policies and a supportive environment, then why isn’t it happening? Why are so many women struggling through the workday when fairly simple solutions could be implemented?
Menopause is prolonged and unpredictable. There is no handbook; it isn’t over in nine months—it can, in fact, last anywhere from four to eight years! Some women sail through without missing a beat while others struggle mightily with emotional swings, sleep issues, brutal hot flashes and night sweats, and a severe hit to self-confidence. Most of us fall somewhere in the middle, and most of us would appreciate a little understanding on the job.
Because we are numerous and at the peak of our career, one would think that accommodation, or at least conversation, would be happening in the workplace. But alas, in the US we are far behind our Western counterparts overseas. In Europe, awareness may be in its infancy, but at least it’s on the radar.
For example, a poll of just over 1,000 women between 50 and 60 conducted by BBC Radio in Great Britain found that over 70 percent of women didn’t discuss their menopausal symptoms with their employer and about 33 percent hadn’t talked about it with their doctor, either. Half of the women surveyed said that menopausal symptoms had affected their mental health and one-quarter said that it made them want to stay home.
"It was such a waste of all that talent and experience that these women had in serving the public,” said Sue Fish, the former police chief who established the force’s first menopause policies in this article. "I was horrified to find out women were leaving early because of the severity of their symptoms. Some had been rebuffed by line managers or they'd chosen not to talk about what they were going through.”
It’s a touchy issue, to be sure. Most of us wouldn’t want to be singled out for special treatment, and most of our colleagues and bosses wouldn’t want to draw attention to our difficulty or make suggestions about fixing it. Yet, competent, productive women still struggle through work situations that could be made bearable with some awareness and a few, simple adjustments.
A web entrepreneur says in this article, “I have friends in senior roles who have had to attend meetings with closed windows where they were almost expiring from heat and drenched in perspiration, fearing that wet patches might appear – but this does not prevent them from continuing to work effectively.”
So, what’s the balance, and how do we begin to move the needle so our daughters don’t have to sweat it out (pun intended) in an oblivious workplace?
The Faculty of Occupational Medicine (FOM), the educational body of the Royal College of Physicians in the UK, has put together some fairly commonsensical suggestions in its “Guidance on Menopause in the Workplace” that were adapted from the European Menopause and Andropause Society.
The guidelines are addressed to both employers and to menopausal-aged female employees, since both sides share ownership of a solution. Guidance for employers emphasizes an atmosphere of openness and dialog, along with training for management. It also suggests that employers provide some access to ventilation and temperature control, some flexibility in work hours, choice in types of fabrics and the ability to layer clothing when a uniform is required, and some ability to move around for sedentary workers.
Menopausal employees are encouraged to learn about this transition and to reach out to their doctors for help and information, to develop techniques, such as note-taking and using a calendar, to compensate for memory lapses, to reach out to colleagues, sympathetic managers and HR personnel for help and camaraderie when possible rather than trying to suffer in silence. The guidelines also suggest using mindfulness techniques to reduce stress and to consider lifestyle changes that are known to ease symptoms: weight loss, not smoking, reducing alcohol use, and exercise.
Working toward a workplace that is accepting and open to menopause is a worthy goal, and now, given our numbers, is an opportune time to crack that resistance. We did it before, and for our daughters’ sake, we can to do it again.
You describe your experience as “incredible pressure and pain,” and “deep aching pain.” You also said that you’ve had some varicose veins in your legs and have had some removed. Your research led you to vulvar varicosities, which does sound like a possible answer. These are varicose veins in the vulva, which are not all that common but do occur (often during pregnancy).
There are two options I’d like you to consider: The first is a good pelvic floor physical therapist. She or he can assess structurally whether there is evidence of a source for your pain. A great therapist can work magic! Really, they can.
The second option is a vein specialist. They can do an ultrasound assessment of vein function, even in the vulva, and try to help understand if that is what might be causing your discomfort.
Good luck on your journey!
One of the benefits of my work with MiddlesexMD is the networking that makes it more likely that I’ll run into medical information, over-the-counter products, articles and books that could be helpful to my patients, and, of course, the interesting conversations that turned into our podcast, The Fullness of Life.
I received an advance copy of Love Worth Making: How to Have Ridiculously Great Sex in a Long-Lasting Relationship, by Stephen Snyder, MD, a month or so ago. Steve is a couples therapist, psychiatrist, and writer, as well as associate clinical professor of Psychiatry at the Icahn School of Medicine at Mt. Sinai in New York City. While I’ve met him—so far—only via email and his written words, I know we share some perspectives: that intimacy remains important to us no matter what our age, that men and women do have some differences in their approaches to love-making, and that there’s nothing wrong—and lots that’s right—about seeking tools that help us!
I think it’s useful to hear men’s perspective on sexuality, too, so when Steve offered to contribute to this blog, I accepted! Read on for more from Stephen Snyder, “sex therapist in the ‘hood.”
Several years ago, a merchant in my neighborhood learned that I was both an MD and a sex therapist. The next time I was in his shop, he asked me if I could get him some Viagra.
“How long have you had erection problems?” I asked.
“I don’t,” he answered. “But my wife and I have been married for 30 years. To tell you the truth, sometimes I’m too tired or preoccupied to get hard without the Viagra.”
What was this man’s problem, exactly? He wanted to have sex with his wife, even though he wasn’t feeling that strongly turned on. Evidently there were other reasons he wanted to do it.
Sound familiar? Of course: He wanted to make love like a woman.
Women can have sex with their partners any time they want. They don’t have to be very excited. Sure, some lubricant might be required, especially over 50. But the absence of peak excitement isn’t necessarily a deal-breaker.
A woman can make love for other reasons besides strong desire. To feel close or emotionally connected to her partner. To promote loving feelings. Or just for the simple pleasure of the experience. Even occasionally to keep a partner happy, even though she might be too tired or preoccupied to be really into it. A useful book on the subject calls it “good-enough sex.”
One wouldn’t want all one’s sex experiences to be like this. But once in a while it’s okay. Especially if the alternative is not to make love at all. If there’s one thing that sex research repeatedly shows about successful long-term couples, it’s that they keep having sex even when if the sex isn’t always earth-shaking. The ritual itself is important.
Men traditionally haven’t been able to do sex very easily under conditions of lower arousal. Especially over 50, when it ordinarily takes more stimulation to stay hard than it did at 20. If a man, for whatever reason, hasn’t been strongly turned on, conventional sex hasn’t usually been an option for him.
Viagra changed all that. Since the blue pill came on the market in 1998, a man can take Viagra and have sex even if he’s tired or preoccupied and just wants some loving and affirmation but isn’t feeling peak excitement. In fact, just having a good erection can help a man feel more in the mood.
There is often strong partner resistance to a man’s boosting his erection through chemistry, though. Women especially are used to the affirmation that occurs when a man gets hard (as Mae West famously put it) simply because he’s “happy to see her.” It’s worth it for a man to communicate that he needs sex for closeness and affirmation and pleasure as well. Just like she does. And that worrying about his erection just gets in the way.
Some couples worry whether taking Viagra under such conditions is a wholesome or natural thing to do. If it just takes more sexual stimulation now to keep him hard, wouldn’t it be more natural to simply intensify the excitement?
Maybe, but not necessarily. Intensifying excitement sounds like a great idea. But in practice, having to do things to get the man hard enough can be a bit of a burden. And it can take time, sometimes so much time that the moment is lost.
Sound familiar? Of course. It’s the same predicament that women find themselves in when they can’t get lubricated or can’t climax. Deliberate efforts to manufacture excitement often backfire. They usually aren’t very erotic.
My advice? It depends on the couple and the situation. But sometimes Eros is best served by taking the Viagra. Then a man can stop worrying about his erection, and get back to making love.
Sometimes it’s best for a man once in awhile to make love like a woman.
Sounds like you’ve been doing a number of the right things: You’ve been using dilators, a vibrator, lubricant, and vaginal moisturizer. It sounds like you’re at a point where localized estrogen, Osphena, or Intrarosa would be helpful for you to achieve your desired outcome.
Any of these prescription drugs will provide elasticity, a critical factor for getting the “stretch” needed with the dilators. Take your dilators in to your health care provider and have this conversation, too. He or she can help you determine whether you can get further capacity with the methods you’re using or whether, as I suspect, you need to take the next step and add a prescription to your routine to restore health to the vaginal tissues.
It’s hard to get to the final goal without that option--and that final goal is definitely one worth working for! Good luck.
The loss of hormones (estrogen and testosterone) with a hysterectomy and bilateral salpigoophorectomy (removal of ovaries) is definitely a “hit” to sexual function for women (I assume based on your message that your ovaries were removed). The genitals are, as we say in medicine, abundant with hormone receptors. In other words, hormones play a big role in the health and function—both urinary and sexual—of the genitals. So now, moving on without those hormones, what to do?
For most women, it’s direct stimulation of the clitoris that leads to experiencing orgasm. In the absence of estrogen, there is less blood supply, and, in turn, loss of sensation and ability to arouse or orgasm.
This can also be a time to consider treating the genitals with prescription treatments such as localized estrogen or the non-estrogen options, Osphena or Intrarosa. Using testosterone off-label can help women with arousal and orgasm as well.
I’d encourage a conversation with your healthcare provider to see if there are options that may be helpful for you.
Good luck! I’m glad to hear that your husband is supportive in addressing this frustration for both of you!
I’m so sorry that you’re experiencing this loss in your relationship. Both depression and the medications used to treat it can be culprits in a loss of desire, and given the relatively short time frame in which you noted the change (one or two weeks), the antidepressant is the likely explanation for your husband.
The situation that you describe is probably best addressed with the help of a therapist; someone who does sex therapy would be most helpful (you can find one certified by the American Association of Sexuality Educators, Counselors, and Therapists through their website).
As you’ve begun to experience, the longer this dynamic goes on, the more anger and resentment builds. Having a therapist to help you navigate the conversations is extremely helpful. And your suggestion of a therapist sends your partner the clear message that intimacy is really, really important for you and your relationship.
There’s some evidence that Stronvivo, a nutritional supplement for cardiovascular health, can improve both libido and function in both men and women; that could be a consideration as well.
As we’ve said (many times) before, our sexual responses are complicated and unpredictable. And this becomes especially true once we’ve embarked upon this menopausal transition. That doesn’t mean we can’t respond sexually anymore, just that we respond differently from men and differently even from the way we did before.
Way back in the 1960s, Masters and Johnson, the groundbreaking sexologists, developed a graph of the sexual response cycle. It was a simple, linear depiction that purported to track both men and women from arousal to afterglow in four stages—arousal, plateau, orgasm, and resolution. Sort of like a visual depiction of the wham-bam-thank-you-ma’am version of sex that women used to think was normal.
It did not contain a lot of room for nuance.
Fortunately, concepts about how we respond sexually have evolved over the years. Lately, Rosemary Basson, professor of psychiatry at the University of British Columbia, proposed another model of how women, specifically, experience sex. Guess what? It’s different from men. Her graph is circular. It includes elements that previously weren’t linked to sex, like relationship satisfaction and self-image, and our previous sexual experiences. It leaves room for skipped steps and a non-linear response to sex. This woman gets us.
Take feeling desire, for example. Basson’s model doesn’t get all hung up on desire. You may not feel spontaneous desire—the old “horny” thing—the way you used to. Or maybe you’ve never felt horny. According to a 1999 study from the University of Chicago, fully one-third of women never feel desire. “[Women] may move from sexual arousal to orgasm and satisfaction without experiencing sexual desire, or they can experience desire, arousal, and satisfaction but not orgasm,” according to this article.
You may not feel desire until you’ve begun to have sex; you might not feel desire even then. You might not feel desire even if you orgasm.
Likewise, for a lot of us, sexual satisfaction doesn’t even depend on having an orgasm, necessarily. We may have lovely, satisfying sex because it satisfies our partner and affirms the relationship and enhances our feeling of intimacy. Or, we may engage in sex for negative reasons, such as not wanting to lose a partner or avoiding the unpleasantness of turning him down.
Basically, Basson’s work tells us that however we experience sex that works for us and our partner is good sex. We may not “feel like” sex (experience desire), but once we get into it, desire might come tripping along like a puppy on a leash. Or, it might not, but the sex might be good anyway.
According to the literature, the sex that seems to work best for most couples is light-hearted, flirty, playful sex. It isn’t rushed. It has nothing to prove. It’s a mature, evolved celebration of the fact we’re still here, still loving each other. It’s the kind of sex worth working for.
So, let’s give ourselves a break. If we’ve been honest with ourselves, our sexual response very often depends on stimuli that has little to do with sex—how safe and happy we are in our relationship; how long we’ve been in the relationship; how we feel about ourselves (confident, sexy, desirable; or fatigued, stressed, distracted); whether sex has been painful (it’s hard to look forward to an experience that’s associated with pain).
The most important thing that’s necessary for sexual satisfaction in your relationship is the willingness to pursue it in whatever way works for you.
Oh, and the more sex you have, the more you want it. There are lots of ways to make sex comfortable after menopause: That’s what this website is all about; lube up and laissez le bons temps rouler.
What you describe—pain during intercourse and tissues that your doctor says are thinning and pale—sounds like vulvovaginal atrophy, also called genitourinary syndrome of menopause (GSM). Since your hysterectomy (if it included your ovaries) or whenever your ovaries stopped producing estrogen, your vaginal tissues have become more fragile and can actually tear. GSM is what we call chronic and progressive, meaning it will continue to get worse over time as a natural consequence of the loss of hormones. If you want to have comfortable intercourse, you’ll need to maintain a treatment plan.
The most likely effective treatment is localized estrogen (in creams, ring, or tablet) or Osphena, a non-estrogen oral medication, or Intrarosa, a non-estrogen vaginal insert. Those are all prescription therapies. If you don’t have access to prescription medications, or in addition to them, vaginal moisturizers can be of some benefit; I’d recommend PrevaLeaf Oasis.
You say that your partner is sometimes away from home for weeks or months at a time for military service. That can also pose some challenges for you. At this point in our lives, we face a “use it or lose it” challenge with our vaginal tissues, circulation, and muscle tone. That means treating your GSM can’t be an off-and-on pattern; you need continuous maintenance. I published an article shortly after MiddlesexMD launched called “Vaginal Patency for Single Women.” While you’re not single, you might follow some of its advice, including the use of a vibrator during those “dry spells” when you’re home alone.
Best of luck in regaining not only comfort but pleasure! Intimacy is an important part of our relationships and our lives.
In the last post, we examined where we are right now in life in order to identify where we might want to be in the future: the health of our bodies, our spirits, and our relationships as well as the dreams or passions we have not yet pursued (or maybe even identified).
With this in hand, let’s move on:
Step #2. Same drill. Quiet place; journal in hand. Read through your initial entry. Anything to add or edit? Does it still feel honest?
What leaps out at you from your work? Do you notice any patterns—boredom and overeating; stress and impatience; lack of self-assertion and a feeling of victimhood?
Did you identify something you always wanted to pursue or to learn? Are there disappointments you uncovered? Are some elements of your life story simply incomprehensible to you—how did you end up here, you ask?
Sit with these for a minute. What tugs at your heart? What calls to you? What sounds absolutely awful or completely thrilling? What needs a closer look?
Also read over your assessment of your primary relationships. Any action plan needed here? Fences that need mending or habits that need adjusting?
You aren’t writing anything, necessarily. You’re just noticing habits, patterns, ways of thinking, and how yesterday’s work makes you feel today.
Now. Begin creating your reinvention plan. This is the eulogy moment. What do you want people to say about you after you die? How do you want to feel about your one and only life? Begin to articulate the big, sine qua non items. The ones you cannot die without having accomplished. Make a list of them. Not an overwhelming list—the top three or four. The big ones.
Choose one. This is your project for this year. And maybe for next year. If it’s that important, you may work on it for the rest of your life. Break this goal down into manageable steps that you can start doing tomorrow. What’s the first step, then the second? Travel to Africa? You’ll start by researching your options with the goal of having a plan in place this year. Lose 35 pounds permanently? Research your options with a goal of having identified a realistic, lifelong approach this week that you can begin practicing next week. Learn how to play the flute? You’ll need to find an instrument and a teacher…
Next, review those primary relationships—kids, extended family, spouse. Have you identified tendencies to work on? Habits to develop or break? Relationships that need attention? Relationships that need special nourishment or a new approach?
Don’t overlook the one relationship that is most critical to your longevity and quality of life. “If you’re in a happy marriage, you will tend to live longer. That’s perhaps as important as not smoking, which is to say: huge,” says Lyle Ungar, one of the researchers of that data-driven longevity calculator I mentioned in the first post. Knowing that someone in the world knows you intimately, loves you, and has your back adds measurably to quality of life. It makes sense, then, to focus especially on this relationship in your life review—to test its soundness and ponder how it might be strengthened.
List one or two specific steps you can take immediately that will make any of these relationships stronger. Also write down one or two habits or personality traits that impede them—that you should work to change.
With a path identified (for the year, at least) and the initial steps delineated, you’re ready to begin. Let me just add the wisdom of a few professionals and life-reinventers who have walked this path before.
Practice gratitude. Every day. “…allow yourself to be grateful for the things you…have. Anger is never inspirational but gratitude is,” writes the best-selling albeit hyperactive author, James Altucher.
Goals, such as those you just articulated are important because “if you don't have long-term goals, you run the risk of doing lots of little things every day—cleaning the house, sending emails, catching up on TV—without ever making a contribution to your future,” says Art Markman, psychology professor and author in this article.
Stay flexible. Change is never static. Reinvention is an ongoing process. You’ll have to rinse and repeat again next year (or next month) to make sure the goals you set today are still relevant and important and that your progress is unfolding according to plan. “Too often, we give up just when we need to push harder, and persist when we actually should quit,” writes one author.
Change is never easy. Expect setbacks; anticipate resistance. Anything really challenging and worthwhile will take time to accomplish, so if it’s really important, don’t shortchange yourself. Persevere through the tough spots. “The most successful self-reinventors are those who understand that they have time and are willing to use it to invest in their own skills and education,” writes this author.
Declutter. Yes, you read that right. Downsizing, clearing out, cleaning up can feel both psychologically freeing and is also metaphorically linked to ridding your life of things that hold you back—mental clutter, too many commitments and obligations, relationships that are buzz-kills or worse, according to Margaret Manning, blogger and creator of sixtyandme.
There. You did it. I hope you feel empowered or at least optimistic. You should now have a roadmap for the months ahead. I’d love to hear how the project is working for you and if you have suggestions to refine it.
Need inspiration? Some of our “The Fullness of Midlife” podcasts are on topic: Lesley Jane Seymour on reinvention, Kate Convissor on overcoming fears, Deborah Robinson on appreciating our own bodies and treating them wellI, Joan Vernikos on how movement keeps us capable.
I had a shock the other day.
In an unguarded moment, I ran across one of those life expectancy calculators. You know, the kind that will tell you how many years you have left on earth after 10 minutes of softball questions.
Basically, I believe that predicting how long you’ll live is a fool’s errand—any of us could get hit by alien laser rays or a schoolbus tomorrow. But my data-driven heart was sucked in by this calculator, which was developed by professors at the University of Pennsylvania Wharton School and based on 400,000 data samples collected by the National Institutes of Health and the AARP.
Now, I know that I fall in a healthy category for weight, activity level, and absence of chronic disease. But, still, the results shocked me.
Ninety-six. My estimated life expectancy is 96.
This is enough time to live a second adult life. This is enough time to start another career or follow a dream or pursue a passion. This is not enough time to waste.
So, that’s the challenge I put before you (and myself) this January: the macro view; the life-reinvention perspective. Because no matter how much time we have (or think we have), why squander it in self-defeating, fearful ways? Or simply by drifting through a handful of years without direction?
Reinvention isn’t a quick-fix project; it isn’t a lose-five-pounds resolution. It’s a project we could (and should) work on for the rest of our lives, periodically reviewing and adjusting our goals to see if they still fit.
Now—today—is a good time to start. So I put before you the proprietary MiddlesexMD Reinvention Project. Ready?
Step #1. Take stock. No shortcuts here. Sit yourself down somewhere quiet. Open to the first page of the Reinvention journal that you bought for this occasion. (You did get one, didn’t you?) Today’s task is to examine the important aspects of your life. As realistically and objectively as possible. You can’t envision a new you without a solid understanding of who you are now, right?
How’s your health? (Obviously my first question.) Are you content with how you feel? How do you feel about your eating/exercising habits? Your weight? Your overall mobility? Your blood pressure and cholesterol levels? Your mental acuity? Do not indulge in guilt or leap to quick, feel-good resolutions, just assess your physical self realistically.
How’s your spirit? Do you feel lonely? Optimistic? Afraid? Content? Discontent? Restless? Do a full-spirit wellness scan. Are the physical and spiritual linked in some way—being overweight and depressed, for example? Are you handicapped by free-floating fears or anxieties? Does stress nibble at the corners of your life—or maybe devour the whole enchilada? Do you feel unsettled and discontent or grateful and happy?
What is the source of your greatest joy or satisfaction? What are you good at? What are you happiest doing? Where does your passion—or your pleasure or your interest—lie? What have you always wanted to attempt? Do you have dreams that you decided had passed you by or that you are too afraid to try? Is there anything you would regret not having done before you die?
Examine the health of your most important relationships. Our closest relationships are the sources of our greatest joy and satisfaction as well as our greatest heartbreak and frustration. We expend a lot of energy repressing, denying, or making excuses for broken relationships, whether with family, lovers, or friends. Does this sound true for you?
Are you keeping up with friends and loved ones, or have you let important relationship wither on the vine? We also sometimes endure relationships that kill our spirits, that are toxic to our psyche and sometimes our bodies. Resolve now to examine them with a clear eye. You don’t have to do anything today except be honest with yourself.
Write it all down in the journal. This is the first day of your new you.
Okay. Take a deep breath. You’re done for today.