If you’re wearing a Fitbit to bed, like a patient I saw last week, you might be seeing pretty colored charts that confirm just exactly how poorly you slept last night. And if you’re like her, it may only be increasing your stress about what you already know: You’re tired! You’d like to sleep through the night!
Yes, as you’re likely tired of hearing, it’s hormones. Estrogen and progesterone are in decline, and the mix of hormones (add cortisol, the “stress hormone” to the cocktail, too) may be less friendly to sleep than it once was. Hot flashes, which can happen day or night, come with a surge of adrenaline, from which you need to recover before you can settle back to sleep.
A few of the people I’ve talked to for The Fullness of Midlife, our podcast, have had some light to shed on our sleeplessness. Joan Vernikos, a retired NASA health science researcher, says sleep is “like a cleaning service in an office. ...The cleaning service starts out by emptying the garbage cans, by tidying up, picking up—and that’s what happens with the brain during sleep in the various cycles. If you wake up and you don’t sleep well, not only are you going to make mistakes the next day, but you’re not going to detox your brain.”
Menopause can sometimes bring its own befuddlement, right? Memory lapses. Foggy thinking. Well, add in some sleep deprivation and a brain in desperate need of a “detox,” and you can imagine a day that you’d rather forget.
Another podcast guest, Dr. Pamela Peeke, gave us a pep talk about making “sleep hygiene” a priority. She points out the relationship between sleep and diet: We’re much better able to be in control of our appetite—not because we lack self-discipline but because of busy hormones at work in our bodies—when we’re well-rested.
Make “sleep hygiene” a priority? Well, it sounds good. And there’s plenty of reason to do it, from easier healthy eating to clear-headed days. Here’s what it takes:
A perhaps unexpected side effect? Since stress and fatigue are two of the three most common obstacles to sex (the third is lack of privacy), you just might find yourself with a little more romance in your life.
Makes “sleep hygiene” sound a little sexy.
As I mentioned in the last post on this topic, even after you’ve decided to have a hysterectomy, a few critical questions remain. Time for a sit-down with your surgeon to hash them out.
First: How will he or she perform the procedure. There are three basic surgical options. The type of procedure your doctor chooses will affect the speed of your recovery, how long you’ll be in the hospital, and how much pain you’ll experience.
You should discuss what procedure your surgeon recommends and why. The quality and speed of your recovery rests in his or her hands.
The second topic to thoroughly discuss with your doctor is what, exactly, he or she is taking out. Here are the three umbrella categories of hysterectomy.
Hysterectomy is the removal of your uterus and the cervix, which is the organ at the top of the vagina. A lot of discussion and very few facts surrounds the pros and cons of leaving the cervix intact. Unless there’s a problem with the cervix itself, there’s no biological need to take it out—or to leave it in. The preponderance of evidence suggests that the cervix has little to do with sex, and removing it doesn’t seem to change sensation or to affect orgasm.
Removing the cervix, however, can change the vagina: It can become shorter, although rarely enough to compromise sex; some nerves might also be affected, which could make the top of your vagina more sensitive, and not in a good way. But the vagina, as we know, is a very stretchy and forgiving organ, so with the use of dilators (and gentle, consistent sex) the situation can be remedied.
Often, the cervix is removed prophylactically, to avoid a small but real cancer risk. Without a cervix, there’s no longer a risk, ergo, no more pap tests. That’s one point in its favor.
In the supracervical hysterectomy procedure, only the uterus is removed, leaving the cervix, fallopian tubes, and ovaries intact. In this case, you probably won’t experience much difference in your sexual activity unless you were accustomed to deep-muscle uterine contractions with orgasm. No uterus; no more muscular contractions. You might notice other changes, however, that we’ll discuss in the next post in this series.
Hysterectomy with bi- (or uni-) lateral salpingo-oopherectomy. Yes, it’s unpronounceable. This is the removal of one or both ovaries and the fallopian tubes along with the uterus. Unless you’re well into menopause, this procedure can put a woman in a hormonal tailspin.
The ovaries are the seat of much of testosterone production (it’s also produced by adrenals) and estrogen production—all the good stuff that keeps the sexual apparatus and our moods humming nicely along. Removing them while they’re still functioning puts a woman into immediate and sometimes intense menopause. It’s called “surgically induced menopause.” For that reason, ovaries are left intact, if possible, especially in younger women.
The decision can be complicated, however. The ovaries themselves can be diseased. Also, some women carry a genetic trait called the BRCA mutation. They are at a much higher risk for breast and ovarian cancer. While breast cancers are often identified at early stages, no screening or early-stage detection exists for ovarian cancer. It’s usually discovered later, when it’s very hard to treat. For women without that genetic trait, the risk of ovarian cancer is low, but not zero.
When menopause is surgically induced, your sex life (among other things) is likely to be seriously impacted just as it is in menopause. You should prepare for low libido, a possible decrease in arousal, dry vagina—all the issues we cover so repeatedly here.
I’d strongly advise you to line up resources ahead of time. Make an appointment with a gynecologist who specializes in menopausal issues. You might be a good candidate for estrogen and/or testosterone therapy. Stock up on lubes and moisturizers. Fire up the vibrator. The hormonal transition could be rocky, but with support and medical oversight, you’ll get through it. Sex (and life) will be good again. Promise.
A lot of issues and options are involved with the decision to have a hysterectomy (beginning with the question of having one at all). Believe me, you want to understand the process, your options, and the possible outcomes. When it comes to this part of your body and your being, you want to know what’s going to happen and to minimize the surprise factor.
Recently I had the privilege of interviewing Dr. Joan Vernikos for my podcast series “Fullness of Midlife,” which are conversations with interesting people about health, love, life, and meaning. Dr. Joan was director of Life Sciences at NASA until 2000 when she “retired” to write and speak (some retirement!) about some of the groundbreaking research she had conducted from her special perch at NASA.
You can listen to the entire interview here, but I wanted to also distill the pertinent bits for MiddlesexMD readers.
As you might imagine, the effect of gravity, or lack thereof, is a fundamental concern for scientists at NASA. Astronauts are exposed to low-gravity environments, sometimes for months at a time, which has wide-ranging and deleterious effects on bones and organs, blood and cardiovascular systems. During her time at NASA, Dr. Joan specialized in the effects of gravity on the human system.
But here’s the thing: Dr. Joan came to understand that gravity operates on earthbound humans in similar ways! When we are upright and moving around, we are subject to the full effects of gravity pulling us to the center of the earth vertically. But when we are horizontal, lying in bed, for example, gravity’s pull is spread evenly throughout our bodies and is much less intense—similar to the experience of astronauts. “…The changes that accompanied lying in bed… 24 hours a day… are very similar to those we see in astronauts. Granted, maybe a little less intense,” said Dr. Joan.
Interestingly, these metabolic changes don’t happen when we sleep at night. Normal sleep appears to have a restorative, “detoxing” effect on the body and the brain, which is also important to good health.
Since the few astronauts who actually spent time living in micro-gravity were harder to find than subjects willing to lie in bed, Dr. Joan began studying the effects of long stretches of time spent horizontally. She found, for example, that after about four days “very significant changes” began to happen in the way her subjects metabolized fluids, in the cardiovascular system, and in stress responses. Of course, as with astronauts, these changes mostly were reversed when the test subjects got up and walked around or the astronauts came back to earth, and gravity took over.
Then, Dr. Joan visited a friend’s elderly mother who was bedridden, and she realized the low-gravity changes she’d been studying looked a lot like aging. Was there a link between our increasingly sedentary culture and the symptoms of early aging? Dr. Joan feels that the chronic diseases of the elderly—diabetes, cardiovascular problems, obesity, bone loss and muscle wasting—are happening at younger ages, even in childhood, because we no longer allow gravity to do its work. We sit too much and move too little.
Dr. Joan hypothesized that the body is meant to move all day long, and in the not-so-distant past, that happened pretty naturally. Our grandparents “…bent over and reached up and made beds and cleaned and washed and gardened. And went and bought groceries and walked home or rode a bicycle, or whatever.”
Following several studies, Dr. Joan feels that simply standing up is “fundamental” to countering the effects of inactivity. Simply standing up and then moving around reverses the micro-gravity effects of lying in bed—or of aging. Trouble is, we don’t live like our grandparents. More likely, we sit for hours in front of one screen or another in the office and at home. Then, if we’re disciplined, we might exercise a few times a week.
Exercising, while good in itself, isn’t enough to counteract the effect of sitting around for hours every day. Our bodies are designed to move, to work against gravity. That, not sitting, is our normal state, the result of eons of evolution.
After her 2011 book, “Sitting Kills, Moving Heals,” was published, a slew of new research supported the hypothesis she’d developed from her work at NASA: Long periods of inactivity have deleterious health effects. “…sitting makes worse absolutely everything. Whether you’re talking about cancer—prostate, breast cancer, cardiovascular conditions, stroke, metabolic conditions, diabetes, obesity—you name it, it makes it worse,” said Dr. Joan. (Here, for example, is NPR’s report on recent studies of aging subjects. The conclusion? If you don’t walk now, you might not be able to later.)
So, what should we do, especially if we’re still working and chained to a desk all day—but even if we’re retired and reading or knitting? Fortunately, the solution is simple. “Stand up!” says Dr. Joan. Go to the watercooler, the bathroom, just take a break every 30 minutes or so. You don’t need to hop on a treadmill or take a 30-minute walk, just stand up and move for a few minutes. You won’t lose weight or tone your muscles with this regimen; it isn’t meant to take the place of exercise and a healthy diet, but it’s a good habit to develop if you regularly sit for hours every day.
Gravity is your friend, says Dr. Joan. Embrace it!
As if the hot flashes, mood swings, night sweats, and sexual challenges weren’t enough, now you can add weight gain to the menopausal whammy.
That’s right. In case you hadn’t noticed (fat chance!), women tend to gain about 10-15 pounds on average—from 3 to 30 pounds is the typical range—during and after menopause. And because our entire metabolic mechanism is different now, that weight is blessedly hard to take off.
“I feel like my body has betrayed me,” said one of my patients.
“Prior to menopause I was able to maintain a weight loss of 70 pounds. I see that 25 pounds have come back and nothing I seem to do is helping,” said another woman.
Weight gain during menopause isn’t totally related to “the change.” Lifestyle, genetics, and, yes, hormonal fluctuation all play their respective roles, for better or for worse. But the weight goes on, and the way that happens is different from weight gain in previous years.
So, if you’re accustomed to losing weight easily—or not gaining it in the first place—this development may come as a puzzling and unpleasant surprise. And if you struggle with your weight, be forewarned: The deck is about to be reshuffled, and that struggle may become harder yet. The single bright spot is that you’re in a very big boat with a lot of other menopausal gals—up to 90 percent of us gain weight during this transition, according to this article.
Menopausal weight gain is different because:
In order to effectively tackle this unsettling turn of events and to grasp why the things you did before aren’t working now, it helps to understand the underlying mechanism.
For one thing, muscle mass, which is an efficient burner of calories, slowly decreases with age. Now, even your resting metabolism (when you aren’t active) is lower. Adding insult to injury, loss of estrogen compounds this effect. Studies of lab animals suggest that estrogen has a regulating effect on appetite and weight gain. Animals with lower estrogen levels ate more and moved less.
When the ovaries stop producing estrogen, fat cells tend to take over. Ovaries produce estradiol, a “premium” estrogen; fat cells produce estrone, which is a weak, inefficient estrogen. This hormonal change increases the body’s efficiency at depositing fat, especially, we find, around the abdomen.
A recent study confirmed that certain proteins and enzymes that enable cells to store more fat and to burn it less become more active in post-menopausal women. “Taken together, these changes in bodily processes may be more than a little surprising—and upsetting—for women who previously had little trouble managing their weight,” comments Sylvia Santosa, assistant professor in Concordia University’s Department of Exercise Science in this article.
You got that right, sister.
Menopause packs a couple more weight-inducing changes: insomnia and stress. When you don’t sleep well (and who does, what with night sweats and cratering mood swings?), levels of ghrelin, known as the “hunger hormone,” rise and levels of the “fullness hormone” leptin drop. That’s why you get the nighttime munchies. A study of over 1,000 volunteers (The Wisconsin Sleep Cohort Study) found that those who slept less had higher ghrelin levels and lower leptin levels—and also had a higher body mass index (BMI), i.e. they weighed more.
And we all know what stress eating does to our waistline.
So, what’s a stressed-out, sleep-deprived, menopausal woman to do? It’s a challenge, without doubt. However, when we understand the mechanism—what’s happening to our bodies on a biological level—then we realize that doing what we did before isn’t going to work. We need to change up the paradigm if we want to control our weight and maintain a healthy, active post-menopausal lifestyle.
This paradigm shift involves a different approach to both diet (Note: I did not say dieting!) and exercise. No magic pharma pill or painless regimen. Still, we can regain control of the bathroom scales despite the slings and arrows of our slowing metabolism and estrogen-storing fat cells. And honestly, we might end up with better health habits than we ever had before.
Regular or decaf. White wine or red. Chocolate or vanilla.
Choices abound. Some are inconsequential—the whim of the moment. Others matter, like your choice of health care provider. I’d like to make the case that, although you may be well past childbearing years, you haven’t outgrown being a woman. Ergo, you still have very unique and specific needs that are best served by a specialist with training and experience in all things feminine.
Most gynecologists see an abrupt migration of their older patients to internal medicine or family practice providers. “…between ages 45 and 55, you start to see a very sharp decline in the number of encounters between women and their ob/gyn--and a mirror-image rise in visits to internal medicine,” says Dr. Michael Zinaman, director of reproductive endocrinology at Loyola University Medical Center in this article.
Not for one moment am I suggesting that this is a bad thing. General practitioners take a broad and thorough approach to patient care. In a typical exam on an older woman, an internist would screen for diabetes, colon and other common cancers, osteoporosis, high blood pressure and cholesterol, anemia and other blood disorders—basically, the whole enchilada. Since heart disease is the #1 killer for women, it’s a good idea to have this type of broad screening every year.
Internists also counsel with patients about lifestyle issues, such as smoking or weight control, diet or exercise (which I also do regularly). And they might refer and coordinate a patient’s care with various specialists.
So, why might a woman who no longer needs reproductive care and who may or may not even have her reproductive organs continue to see a gynecologist? Well, for all the stuff we talk about on this website, for starters.
Older women have specific needs and vulnerabilities for which gynecologists have deep and specific training and experience. The incidence of breast and ovarian cancers increase with age, for example. And although internists may do pelvic exams (and note that “may”; even when, after age 65, we no longer need a pap smear, we still need regular pelvic exams) and order mammograms, gynecologist have years of practice in detection and treatment.
Then, there are all those everyday annoyances of menopause and an aging reproductive system—pelvic organ prolapse, incontinence, hormonal disruption, and all those vexing sexual changes we address here on MiddlesexMD. When it comes to treating these quotidian challenges to health and well-being, gynecologists are simply the specialist. We’re more likely to know about new treatments and medications; we’re more likely to catch anomalies; we’re very attuned to kinds of changes that can signal something serious.
But the bottom line? This isn’t one of those either/or decisions. You can choose between a chocolate sundae and a frozen yogurt, but the choice isn’t between a gynecologist and a general practitioner.
You need both. And both healthcare providers need to be working together for you. “A collaborative approach would be very good,” said Dr. C. Anderson Hedberg, head of general internal medicine at Rush-Presbyterian-St. Luke’s Medical Center.
In one study comparing the type of screenings women tended to receive from primary care doctors as opposed to gynecologists, researchers found that gynecologists were more likely to screen for cervical and breast cancers, and osteoporosis, while primary care doctors were more likely to test for colon cancer, high cholesterol, and diabetes.
I’m thinking you wouldn’t want to miss out on any of this fun stuff, and you sure want to know early on about issues or warning signs. But in the end, you make the judgment calls about your health. You decide what doctor to see and how often and whether or not to follow medical advice. That’s as it should be.
Having the right medical team on your side simply gives you the ability to make the best, most informed choices.
For this last of our January resolutions series, we’ll break from our discussion of underappreciated body parts but remain totally in keeping with MiddlesexMD’s tradition of confronting embarrassing issues head-on and unfiltered. Specifically, those we avoid talking about with our doctors.
Admit it, most of us don’t like to discuss topics having to do with sex, elimination, mental health, gender orientation, obesity. Often these topics are surrounded by social ambivalence or downright discrimination. We want to be healthy and normal. We don’t want to have problems, and we sure don’t want to air them with a semi-stranger.
The doctor/patient relationship can be clumsy, strained, uncomfortable or superficial. Some providers are simply more skilled at coaxing out and straightforwardly addressing your intimate questions. If you find that your doctor is abrupt or unapproachable, or if you just don’t have good chemistry, you ought to—and have every right to—change doctors. Along with your dentist and auto mechanic, this is one individual you have to trust.
I want to assure you that doctors have heard it all. Not only that, we want—and need—to know what’s bothering you emotionally or physically. That’s our job, and we can’t do it effectively if you decide to soldier on. Often, that embarrassing secret can be easily treated; sometimes, it’s a symptom of something more serious that needs further testing.
Too often, however, patients wait until the “doorknob moment.” The exam is all wrapped up, and the doctor is literally almost out the door when the real question tumbles out: Oh, and I have noticed blood in my stool a few times recently; or, is it normal to have pain with sex?
If you don’t mention it, you doctor can’t address it. And if you wait until the doorknob moment, you may have to schedule a second visit so your provider can adequately assess the problem.
Here are examples of some of the questions that are either quirky or hard to bring up. Feel free to add your own in the comment section—or email me for a personal reply. While I can give you my best response, this in no way lets you off the hook from getting in-depth, personalized information from your own doctor.
Pick up your courage and a pencil and do yourself a favor: Write down all the questions, sexual, messy, and embarrassing as they may be, to ask at your next physical. You can also answer the questions in this quick and easy Menopause Map to begin framing the questions.
“In the end, we all just have to become comfortable with the fact that sex involves the genitals and the genitals are down there. It’s a big, messy thing—but it’s worth it!” says Dr. Debby Herbenick, in this article.
This is the tough one, ladies, but it’s also the most important. Cardiovascular disease (heart attack and stroke) is the #1 killer of women today. One in 3 women die from it. By comparison, 1 in 8 women die from breast cancer.
The news gets worse: about 44 million women in the US are affected by cardiovascular disease right now. Ninety percent of us have at least one risk factor, such as high blood pressure, diabetes, smoking, or being overweight. We are less likely than men to survive our first heart attack.
But the really good news is that 80 percent of cardiovascular problems can be prevented by knowledge and lifestyle change, according to the American Heart Association (AHA). The other bright spot is that improving heart health also improves our brain health, because good brain function relies on good cardiovascular function. And we know that as we age, we are at higher risk for various dementias.
It’s important to honestly tackle those lifestyle changes right now because as we age, our risk factors for heart disease increase: cholesterol and blood pressure tend to rise; we tend to gain weight; sleep may be more difficult. So time, very literally, is of the essence.
Unfortunately, lifestyle change of the type required for good cardiovascular health is hard. Honest, systemic lifestyle change demands consistency, and self-discipline, and this is hard. Few among us achieve perfection when it comes to an overall health care regimen.
Fortunately, perfection isn’t required. Getting started and sticking to it is.
To get started, assess your current baseline. These are the most important numbers:
Second: discuss your numbers with your doctor to get your marching orders: hash out what to focus on; what is possible, and how best to begin, especially regarding an exercise regimen.
And third: Get started! Every one of those important numbers measuring cholesterol levels, blood pressure, blood sugar levels, and weight can be moderated or controlled through diet and exercise. That’s it. A clean, heart-healthy diet and regular moderate activity could extend your life and help you to avoid the serious consequences of heart disease. Plus, you’ll feel better, experience less pain, and be more flexible.
This is a once-in-a-lifetime deal.
A heart-healthy diet for a woman over 50 should rely heavily on fresh fruits and vegetables, lean meat and lots of fish, whole grains, and unsaturated fat, such as olive oil. Cut way back on salt, sugars of all sorts, saturated and trans-fats.
Cook your own food so you know what’s in it. Processed foods are full of sodium and unpronounceable additives. Make eating out a rare treat.
Both Weight Watchers and the Mediterranean diet get high marks from nutritionists as being heart-healthy, not too restrictive, and easy to follow—thus good candidates for a successful lifelong change.
Drink lots of water (we lose the tendency to feel thirsty as we age) and take your multi-vitamins and supplements, such as calcium and vitamin D, as advised by your doctor. Here’s a ton more diet information from the AHA’s Go Red for Women campaign.
Exercise is the second leg of cardiovascular good health. It’s hard to overestimate the benefits of regular, moderate activity—it regulates blood pressure, strengthens your heart and other muscles, increases bone density, and improves your mood.
The trick with exercise is to get started and to keep going because you will use every distraction in the book to procrastinate. It doesn’t have to be hard or expensive. A brisk, 30-minute walk 5 times a week—that’s all! Start with 10 minutes if you’ve been sedentary, but keep challenging yourself.
If you live in an area with cold winters, you can walk in the mall or do cardio workouts at home with some of the very good fitness videos available online. Here’s a beginner workout from the inimitable Jane Fonda, who imparts salty health advice along with encouragement. Here’s a no-nonsense and very comprehensive set of workout programs to explore once you’ve built up some stamina. Stick with low-impact workouts, warm up thoroughly, and don’t overdo. Steady, consistent progress is better—and safer—than a jackrabbit start.
Finally, stop smoking. Not negotiable. Smoking adds incredible risk to your health. Do whatever it takes to eliminate nicotine from your life.
It’s January. This is a good time to seriously take charge of your health. Imagine how incredible you'll feel after spending the entire year working out and eating clean. Imagine actually witnessing the change in those numbers. Buckle up for a life-changing year.
Bladder health may be far from the most riveting of conversations, but trust me, a bladder that behaves itself will make your life a whole lot more enjoyable, and that includes your sex life, as well.
As we discussed in the last post, bladder misbehavior in the form of incontinence and urinary tract infections (UTIs) is a common female complaint, and it tends to become more common and more troublesome as we age. This is because decreasing estrogen affects genital tissue and muscles in unhelpful ways.
You don’t need to check out adult diapers just yet, however. Not only are treatment options available, depending on the type of incontinence you have, but you can develop some common-sense bladder health habits that will tune up that tired organ and may even roll back some of the age-related changes.
Despite your attention to good bladder health, you may still experience bothersome levels of incontinence and UTIs. The next step is to talk with your doctor. Studies show that most women avoid this conversation because, well, it’s embarrassing. Let me assure you that we’ve heard it all, and incontinence is an incredibly common female issue. This isn’t something you should endure. Treatments are available, and they do work.
Depending on the type of incontinence you have, (urge and stress incontinence are the two major sub-types), treatment options could be very simple. With bladder training, for example, you set a timer and wait for increasingly longer periods before urinating to “retrain” the bladder (and yourself). This method coupled with Kegel exercises can cut urge incontinence problems in half, according to the National Institutes of Health.
There are a number of medications, including some new ones, that are very effective in treating urge incontinence. Your health care provider can help you weigh the options.
Since stress incontinence is more commonly caused by wear and tear on the pelvic floor (by childbirth, for example) as well as by normal aging and hormonal loss, medications are less effective in treating it. Topical estrogen, however, is a good option for rejuvenating tissue in the entire genital area, urethra included. It isn’t absorbed systemically, so it’s a good option for those who want to avoid extra hormonal exposure
A common and minimally invasive surgical procedure involves inserting a tiny mesh sling to support the urethra. This procedure is effective in over 85 percent of cases.
For most of us, some level of incontinence is an annoying fact of life. But it shouldn’t compromise our quality of life or cause undue embarrassment or anxiety. If you find this to be the case, it’s time for a talk with your doctor.
And what, you ask, does my bladder have to do with sex?
Good question, but here’s the thing: When you think about it, all our sexual bits are tucked in a very tight space with all the “other” bits we use for elimination. They all cohabit the same anatomical real estate and pass through the same muscular sling (pelvic floor). If you question the wisdom of our anatomy, pity the poor hyena, who copulates, urinates, and gives birth—with great difficulty—through the same tube.
Since all those organs are clustered in one anatomical region, they are also all sensitive to any change of flora or pH balance or hormones that might happen in that space. In fact, what we now refer to as the genitourinary symptoms of menopause (GSM) is an umbrella term for the hormonal changes which affect the whole enchilada—pelvic floor, bladder, vagina, and all the associated tubes and musculature. (The bowels aren’t included, but they can also be affected by age and hormonal change.)
So, as vaginal tissue becomes more fragile due to loss of estrogen during menopause, so does the labia and the urethra (the tube from the bladder through which we urinate). Specifically with regard to the bladder, GSM exacerbates two extremely common female complaints: urinary incontinence and urinary tract infections (UTIs).
If you’ve had kids—and maybe if you haven’t—you’ve probably experienced the nearly ubiquitous stress incontinence of the cough-sneeze-pee variety. A second type of incontinence is overactive bladder (OAB) or urge incontinence. This is when you feel the need to pee suddenly, frequently, and urgently. In both cases, small—and sometimes large—leakages may occur.
Both conditions can either commence or worsen with menopause, and either can cause you to urinate a little or a lot during sex, usually with penetration or orgasm, when all the nerves in the area are stimulated.
Which could really dampen the mood.
Research on the effect of incontinence on sex is scarce, and honestly, that effect would seem pretty intuitive. Studies that have been conducted indicate that incontinence has a negative effect on sex (duh!)—and on life in general. The embarrassment and anxiety of constantly having to worry about peeing your pants certainly puts the kibosh on quality of life—and that embarrassment doesn’t stop at the bedroom door.
In one small study, every woman with OAB syndrome all expressed anxiety over its effect on their sex life, whether or not they were actually incontinent during sex (coital incontinence). Just the worry about whether they would pee during an orgasm was enough to create a psychological barrier to sex. The worse their condition, the greater the negative impact on sex.
“Overactive bladder with or without incontinence negatively affects women's sexual health, reducing sexual desire and ability to achieve orgasm,” the study concluded.
Urinary tract infections (UTIs) are the second sucker-punch to libido that accompany and can increase with age and menopause. Again, it’s all part of a syndrome in which loss of hormones makes our genitourinary tissue more fragile and prone to breakdown and, thus, infection. Our female anatomy—short urethra in a warm, moist location near our other orifices—creates an inviting greenhouse for bacterial growth. Ironically, even sex can cause a UTI because it invites the migration of bacteria from one spot to another.
But take heart! As with most things menopausal, prevention techniques and treatment options are available. There are ways to mitigate the effects of GSM on the bladder and ways to prevent them. Not perfectly. Not always. But neither do you have to soldier on alone and in silence. That’s the kind of awareness that Bladder Health Month is all about.
Previously, we examined several herbal remedies that are commonly taken to relieve hormonal symptoms. Plants have been used since time immemorial for treating health conditions, and I have the utmost respect for plant-based medicine.
Except for three caveats: 1) botanical (plant-based) treatments can have side effects and drug interactions just like any other medicine; 2) their use, dosages, and efficacy in treating specific illnesses haven’t been rigorously studied; and 3) the manufacture of these products isn’t held to federal standards for safety or consistency.
So my general approach to botanical therapies has been to proceed with caution. Always tell your doctor what natural remedies you’re taking, buy products from reputable manufacturers, and pay attention to how they’re affecting you.
Except for soybean products. I withdraw most of my qualifiers for soy.
While soy has gotten a bad rap in some quarters, especially since most of the US-grown beans are from GMO seedstock, soy still comes close to being a superfood in my (and others’) playbook.
Another tick in the plus column is that soy has been subjected to numerous rigorous scientific studies. (Not to mention that it’s been consumed for millennia in Asian countries.)
Recently, new studies have shed light on how soy might work to relieve menopausal symptoms, such as hot flashes and even vaginal dryness. Its effects aren’t always straightforward, as in “eat more soy, have fewer hot flashes” (although sometimes, it is just that straightforward), but it does clarify how soy is broken down in our systems and under what circumstances it seems to be effective.
When we consume soy products, such as tofu, soy milk, tempeh, edimame, it’s metabolized in our gut into two main isoflavones: daidzein and genistein. These compounds have phytoestrogenic properties, meaning that they mimic estrogen in some ways. (However, seem to carry less risk than estrogen, related to estrogen, and in fact, some research suggests they may have some protective qualities.)
Some women (about 30-40 percent of North American and Europeans; significantly higher percentages of Asians) carry a gut bacteria that can metabolize daidzein into a substance called S-equol. And this, according to at least one recent study, is the bit that is strongly linked to relieving hot flashes and other good stuff.
Among the women who produce equol, those who ate the most soy and had the highest levels of daidzein, reported far fewer vasomotor symptoms (VMS--or hot flashes in common parlance) than equol producers who ate less soy. “Among equol producers, higher equol availability attributable to higher soy consumption contributes to decreased VMS,” the researchers concluded.
Among women who didn’t naturally produce equol, there was no link between higher levels of daidzein and fewer hot flashes. Either you could produce equol and reap the benefit of soy or you couldn’t. Until recently, the only way to find out, says North America Menopause Society executive director, Margery Gass, was to conduct your own personal experiment: Eat soy foods for 4 to 6 weeks, and if it didn’t help, you probably couldn’t metabolize equol.
You either had the right gut flora or you didn’t.
Recently, however, a Japanese pharmaceutical company, Otsuka (Pharmavite in the US) has developed an S-equol dietary supplement made from fermented soybean germ, so whether you are among equol-producing women or not, you have access to the same VMS-busting possibilities.
Studies are fragmentary and scattered, but the consensus seems to indicate that S-equol, either produced naturally or taken as a supplement, is a viable and safe way to reduce the frequency and severity of hot flashes. It also may have positive effects on skin health, including regeneration and thickening of vaginal tissues without the risks associated with hormonal supplements.
Theoretically, you can take 10-40 mg. of S-equol supplement per day for relief of hot flashes. Since it’s metabolized quickly, you should take it in several 10 mg. doses at different times. S-equol has no negative interactions with drugs or supplements, and its side effects are minimal, although research is contradictory, so women with a history of breast cancer are advised to avoid it.
So there you have it. No guarantees, but with very little risk or expense you can conduct your own naturopathic experiment in taming menopausal symptoms. Let us know how it goes.