MiddlesexMD

Q: Does having sex delay menopause?

The article you saw was mistaken: Having regular sex doesn’t affect hormone production. At 55, you’re still within the range of “normal” for reaching natural menopause, which is defined as a year without menstruation. While the average is 52, the actual age is generally from 40 to 60.

What is true is that having regular sex will counter one of the most common results of menopause, which is vaginal dryness and painful intercourse. Having intercourse increases blood circulation, which keeps tissues healthy. That’s where the “use it or lose it” adage comes from: Maintaining blood supply can delay the onset of these symptoms, and lessen their severity as hormone levels continue to decline.

I’m glad you and your partner are sharing regular intimacy! And be aware there’s some research suggesting benefits from late menopause. 

Q: What do you recommend to replace Neogyn?

We were disappointed to see Neogyn discontinued, since it filled a very specific niche in vulvar care--addressing itchy or uncomfortable vulvar tissue. We're happy to note the introduction of EpiGyn Intimate Calming Cream, which is specially formulated for that same niche. 

Check out the

 product page to see the conditions for which it may be helpful.

In Pursuit of a Good Night’s Sleep

Many of us in perimenopause or postmenopause struggle to get a solid night’s sleep. There are lots of possible causes, from night sweats (nocturnal hot flashes) to stress associated with events in our lives. One possible cause that’s often discounted by women—because it’s more common among men—is sleep apnea.

Sleep apnea is a disorder defined by disrupted breathing while you sleep. There are a couple of types: “obstructive” apnea is the more common variety, when your muscles relax and block your breathing; there’s another type that involves the brain not sending the right signals to regulate breathing; and sometimes there’s a combination of the two. What’s happening in obstructive sleep apnea is that your airway is obstructed (hence the name) when muscles in your throat relax. When your oxygen is reduced, your brain wakes you up—usually so briefly you’re not conscious of it—so you’ll open the airway, which you do—again, usually unconsciously—by shifting your position or tightening the relaxed muscles.

If you sleep with a partner, they might note that you’re snoring; they might also hear gasps or “snorts” at that moment when you rouse. 

As I said, this is typically a bigger issue for men than women—two or three times as likely. But women after menopause increase their risk, with weight gain as a likely factor. Other factors that may come into play are consumption of alcohol or certain medications (sedatives) that relax throat muscles, congestion from allergies or other causes, and smoking. And sleep apnea is not just an obstacle to a good night’s sleep. It’s also been linked to increased risk of heart disease, Type 2 diabetes, metabolic syndrome, and liver function issues. A few of those may strike you as cyclical—that is, metabolic syndrome can lead to weight gain, which can lead to sleep apnea; and sleep apnea can lead to metabolic syndrome. Frustrating, yes, and accurate. 

Sleep apnea needs to be diagnosed by your health care provider for the complete range of treatments. They may suggest lifestyle changes, like losing weight, or treatment for an underlying cause of congestion. If those steps don’t solve the problem, there are further options, like the use of a CPAP (continuous positive airway pressure) machine or, in extreme cases, surgery. But the first step is that diagnosis.

If you’d like to eliminate other possible causes for restless nights, start with evaluating and improving your “sleep hygiene,” which I’ve described in detail in an earlier blog post. But if you (or your partner) suspects sleep apnea based on the sounds you make in the night, don’t hesitate to see your health care provider! A good night’s sleep is worth it.

Q: Are these change in my periods concerning?

You’re in your mid-50s, and while you’ve always had light and regular periods, you’re now menstruating every three weeks with a quite heavy flow, including some clots. You’re wondering whether you should be concerned.

These are very typical changes in periods in perimenopause. Classically periods will get closer and heavier, and eventually they will get lighter and further apart—and ultimately stop! Unpredictability is the norm for perimenopause.The periods reflect the relative production of ovarian hormones of estrogen and progesterone.  

Fortunately, most healthy women can tolerate intermittent blood loss and have no ill effects. If lessening the bleeding is required, it can be done with simple options like Ibuprofen (800 mg every 8 hours), which, when started right away at the onset of the period can reduce blood loss by up to 30 percent. Usually, within two or three days the bleeding is less and you can discontinue the Ibuprofen. 

When the bleeding is excessive and prolonged, contributing to anemia, we look to options to lessen the bleeding. We have prescription options that are very effective at reducing blood loss; tranexamic acid (Lysteda) works very well. Insertion of an IUD (e.g., Mirena IUD) or oral contraceptives are also options; surgery is rarely needed.

Clots per se are not worrisome, reflecting that there is heavier bleeding at that time. Your body is doing what it is well designed to do, and clotting is important.

Take care of yourself as you navigate this transition! 

Q: How do I prepare for wanting more than a long passionate kiss?

You say you haven’t been sexually active for more than 20 years, because of your own surgery, your husband’s impotence, and then being widowed. I’m touched to hear you’ve reconnected with a high school friend and hope the relationship develops exactly as it should!

Based on your history, it is likely intercourse wouldn’t be possible without some work in advance “getting things ready.” With menopause, it’s normal to expect vaginal dryness and some atrophy, which means the tissues shrink and become less elastic.

The products that would be necessary are vaginal moisturizers, which restore some moisture to the vagina and then dilators, the use of which gently stretches the tissues. Most women successfully regain sexual function with consistent use of dilators. 

A pelvic exam with your provider may be helpful as well to make sure there aren’t any other factors to consider.

Enjoy this new relationship, wherever it leads!

Q: Is there a nonprescription alternative to Premarin?

You note that the Premarin you’re using several times each week is expensive, and wonder about a nonprescription alternative. It’s the estrogen contained in that treatment that makes it both a successful treatment and available by prescription. The tissues of the vulva and vagina are very receptive to the healing effects of estrogen, and nothing else is equally effective.

Vaginal moisturizers offer benefit to retain moisture especially when the vulva and vagina are healthy; they aren’t able to reverse the atrophy that occurs in menopause. If you’d like to try a vaginal moisturizer, be sure to use it very consistently, two to three times a week. 

You can experiment with a moisturizer to see whether it helps to maintain comfort. 

Exploring the Role of Estrogen and Progesterone in Fighting COVID-19

Doctors and scientists are working with urgency to understand the coronavirus, and making new observations as more data becomes available. Perhaps you’ve seen some of these observations in the news, including that COVID-19 has been hitting men harder than women, and that pregnant women who contract the virus seem to have milder cases.

This has led to a hypothesis that the female sex hormones estrogen and progesterone may play a role in fending off the virus or minimizing the damage it does. We do know that, generally speaking, women have a stronger immune system than men and that sex hormones can affect different steps in the immune system. 

To learn more, Cedars-Sinai Medical Center and the Renaissance School of Medicine at Stony Brook University are both conducting trials. Stony Brook will be giving half of the 110 COVID-19 positive (or presumed positive) participants in its study an estrogen patch for a week; the other half will receive standard care. 

Meanwhile, Cedars-Sinai will give the 40 participants in their trial progesterone, which affects inflammation. The hope is that progesterone will minimize or prevent an overreaction of the immune system (a cytokine storm). 

Hormones are just one possible explanation that COVID-19 is worse for men than women. As we all know, correlation is not causation. But it will be interesting to see what the researchers learn.

Why the Onset of Menopause Might Take Your Breath Away

From weight gain and mood swings to vaginal dryness and thinning hair, many of the symptoms of menopause can be attributed, at least in part, to the body’s dramatic decrease in production of estrogen and progesterone. 

The drop in estrogen may also affect your breathing. While the research isn’t conclusive, it shows that the onset of menopause was associated with a higher chance of developing asthma compared with before menopause. Starting periods early (before age 11) and having irregular periods were also associated with a higher rate of asthma. So hormones seem to play a role, but it’s unclear exactly what that role is.

Women who haven’t experienced breathing problems earlier in life, especially those who view themselves as fit and healthy, may ignore the symptoms, which include a tightness in the chest and wheezing, or convince themselves that it’s just allergies. If your breathing has changed, talk to your doctor. There isn’t a cure, but with treatment, asthma can be controlled. And as with other medical conditions, the early you start treatment, the easier it is to control.

Also, asthma is another factor you should take into consideration when you’re thinking about whether to start hormone therapy (HT). And it’s a complicated factor! Research shows that HT might actually help asthma in women who have it before menopause. But if you’re postmenopausal and haven’t had it, reintroducing estrogen back into the body could increase your chance of developing asthma. 

Again, more research needs to be done on the relationship between hormones and asthma, but talking with your doctor about any breathing issues is important to making the right choice about HT, given your health history and the severity of your menopausal symptoms.

Weight Maintenance in Trying Times

Staying home is the best thing we can do right now. But stress coupled with a lack of routine and constant access to snacks creates a perfect storm for weight gain. Knowing it’s a perfect storm is the first step in weight maintenance.

Now you can make a plan. To address stress, make sure you’re practicing some form of mindfulness and getting some exercise every day. (Here are more tips for managing stress that work during a pandemic or during the holidays!)

Regarding routines, I think the answer is to make a new one. It doesn’t have to mimic the old, but it does have to help you be functional during the day, with designated blocks of time for things that need to get done, whether for work, pleasure, household, or community. Established mealtimes and sleep schedules are also important.

As part of a new routine, you might also establish new healthy habits. For one person I know, the inability to pick up a caramel latte reduces her intake by a couple hundred calories each day. Another has set a daily habit of a salad for lunch. And one more has upped her breakfast game with fresh fruit and granola, which she’s finding sets her up well for a day of intentional eating. 

From the conversations I’ve had, it seems like snacking is the most pervasive eating issue at this time. If that’s true for you, there are a couple of tactics I’d recommend.

• If you’re eating because you’re bored, pick an activity that you’ll do instead, when the urge to snack hits, e.g., arm exercises, cleaning out a drawer, or calling a friend. The urge will pass, I promise.
• If you’re snacking because you’re a little hungry, respect the hunger but choose a low-calorie option. A cup of hot tea will both occupy you in the making and satisfy low-level hunger pangs. Celery or carrot sticks, a handful of nuts, or an apple can satisfy your craving and make you feel virtuous at the same time.

For me, eating and exercise go together. When I’m consciously caring for my body, I make better choices about food. I don’t want my exercise to go to waste! If you haven’t already, design a fitness routine that fits your circumstances, whether solitary hikes, yoga, or online dance class.

Finally, it’s okay to indulge in a favorite comfort food once in a while, even as you work to get yourself back on a more healthful, sustainable path. With some thoughtful consideration, you can make room for that Chunky Monkey ice cream—after your green salad lunch and your afternoon workout.

Spending Time Together

Here we are, another week in our homes. Readers live all over the country (even the world), and we’re not all experiencing the same level of restrictions. I’m among those who are telecommuting, which keeps me occupied (and telemedicine is all new to me!) for much of the day. You may be retired or your job may not translate to remote work, so you may not have a similar focus for your attention. For all of us, whether we’re working or not, the pandemic has meant more alone-time with our significant others, without our usual distractions.

At its best, this can be an opportunity to remember why we fell in love in the first place, or to reinforce the friendship that’s at the core of our relationships. I’ve talked to women who are playing Scrabble or Monopoly or doing jigsaw puzzles with their partners. I’ve heard about a private dance party. One woman told me she’s pulled out photo albums from their early time together. They reminisced (and sometimes their memories varied!) with a glass of wine, and recalled some of what they’d had before kids and careers.  Several women have told me about deep conversations they’ve had, considering how the pandemic might change the way they look at their future together. 

Sometimes those conversations lead to intimacy, and if you’ve read this blog for any time at all, you’ll know I think that’s just lovely. Sometimes those conversations lead to more challenging destinations, in which case you might reread “Why Difficult Conversations Can Be the Best Conversations,” which recounts what I learned from psychotherapist Ann McKnight. Keep in mind that this is a stressful time. You and your partner may not be processing the current reality at the same speed or in the same way, and it’s perfectly okay to set aside a topic for another time.

(Stress can lead to increased domestic violence; we’ve likely all seen news of disturbing trends in this unusual time. If you or your children feel threatened, please take steps to secure your safety.)

We shared a quote in our most recent newsletter that we also heard from Ann McKnight. It resonated with so many of us that I’ll share it again: “Fear makes us lose our sense of connection. Because it often takes the form of numbing ourselves or denial or withdrawal, it makes our [inner] world shrink. When we live in fear, we fall into the delusion of our separateness. We need to widen our circle of compassion. That’s how we liberate ourselves from fear.”

That’s our job right now, widening our circle of compassion. We can start with ourselves and our partners, and see how far we can go.