Understanding Menopause and HRT

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Menopause and HRT
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Menopause, Sexual Pleasure and HRT
Are you struggling with symptoms of the menopause?
Is this impacting on your relationship, your
experience of sex, on your work or family life?
Please be reassured you are not alone. The good
news is treatment is available which will be
tailored to meet your needs.
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There has been much recent publicity about the
perimenopause, menopause and hormone replacement
therapy. While for some women menopause can be
freeing, for many women it is accompanied by
difficult symptoms hot flushes, night sweats,
mood changes, sleep disturbance and brain fog to
name just a few.
Many women also experience genital symptoms and
sexual difficulties but often dont seek help for
them or discuss them with healthcare providers.
This can be because of shame or embarrassment for
both women and doctors. Most doctors and nurses
havent had training on discussing sexual
difficulties, and therefore both patients and
doctors can feel uncomfortable talking about sex
in medical consultations.
Research shows most patients (both men and women)
want to be asked about genital and sexual
symptoms. Doctors and patients often collude in
ignoring sexual difficulties despite them having
a big impact on peoples lives and long-term
health. At the Leger Clinic, we understand how
important it is to have a doctor who is
comfortable and skilled in dealing with sexual
difficulties.
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The Menopause and Sexual Function
As women go through the perimenopause (the years
in the lead up to a womans final period),
hormone levels vary enormously. By the time of
menopause, the amount of oestrogen in the body
has reduced significantly. Testosterone decreases
by about 25 between the ages of 30 and 50. The
reduced oestrogen and testosterone leads to
decrease blood flow to the vagina, vulva and
breasts. The vaginal lining (mucosa) becomes
significantly thinner. The clitoris shrinks and
becomes less sensitive. As well as affecting the
vulva and vagina, oestrogen is also important for
bladder health. As oestrogen levels fall, the
bladder thins with weakening of the muscles which
control the bladder.
These changes can lead to symptoms including

• vulval itching

• vaginal dryness and reduced lubrication

• reduced sensation sensitivity from sex

• pain during sex

• reduced sexual desire

• urinary problems such as needing to go to the
  toilet frequently, urinary incontinence and
  frequent urinary infections

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What might be the cause of my low sex drive? Is
it hormonal?
Hormones are obviously an important factor. The
changes described above can mean sex is less
pleasurable or even painful, which leads to an
anticipation of pain and discomfort, which
reduces the desire for sex. Know everything about
HRT for Women and Checkout our website for
detailed study of how they are related.
However, hormones are not the only factor. There
can be many other factors at play. Some examples
include

• relationship difficulties differences in sexual
  desire within couples

• how we feel about our bodies as we age

• anxiety about sex and sexual arousal

• sex not being very rewarding, having sex which
  doesnt meet our sexual needs

• cultural and social norms about what is normal

• our understanding of how desire and sex drive
  should be

• illness including cancer and medical treatment

• childbirth fertility issues

• wider mental health issues such as anxiety and
  stress

• medication, including antidepressants, hormonal
  contraceptives, medications for bladder issues

These are just some examples. Its important to
put things into this wider context when thinking
about medication as oestrogen and testosterone
wont address many of these wider factors.
Working through some of these factors with a sex
and relationship therapist can be helpful to
untangle what might be going on for you. You can
find a list of therapists on our website HERE
insert link.
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Hypoactive Sexual Desire Disorder
Hypoactive sexual desire is the formal diagnosis
for absent or very reduced desire or motivation
to engage in sex, which has happened over a
period of several months and is causing
significant distress. Despite it being common, a
smaller number of women are distressed by low
sexual desire and only some of those seek help
for it. However cultural norms around
expectations, what is normal and allowed play a
big part in what we expect of our bodies and the
help were willing to ask for.
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Now for the good news what treatment is
available?
It can seem like its all very difficult and
overwhelming but there is hope. There are lots of
things which can help, getting you back to
feeling yourself again as well as improve your
experience of sex.
Firstly, just by noticing and asking questions
such as whats happened to my sex drive?! you
can become more aware of what is going on in your
body, mind, relationship, and sex life and find a
way forward. Usually an approach which addresses
different aspects of your current experience at
once is the most helpful. Exploring with a
psychosexual therapist, or through books, apps
and websites as well as ensuring biological
aspects are treated is often helpful.
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Thanks