Understanding Menopause and HRT

1. Menopause and HRT

2. 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.

3. 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 don’t seek help for them or discuss them with Research shows most patients (both men and healthcare providers. This can be because of shame or women) want to be asked about genital and sexual embarrassment for both women and doctors. Most doctors and symptoms. Doctors and patients often collude in nurses haven’t had training on discussing sexual difficulties, and ignoring sexual difficulties despite them having a big therefore both patients and doctors can feel uncomfortable talking impact on people’s lives and long-term health. At the about sex in medical consultations. Leger Clinic, we understand how important it is to have a doctor who is comfortable and skilled in dealing with sexual difficulties.

4. The Menopause and Sexual Function As women go through the perimenopause (the years in the lead up to a woman’s 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 These changes can lead to symptoms including: flow to the vagina, vulva and breasts. The vaginal lining • vulval itching (mucosa) becomes significantly thinner. The clitoris • vaginal dryness and reduced lubrication shrinks and becomes less sensitive. As well as • reduced sensation & sensitivity from sex affecting the vulva and vagina, oestrogen is also • pain during sex important for bladder health. As oestrogen levels fall, • reduced sexual desire the bladder thins with weakening of the muscles which • urinary problems such as needing to go to the toilet control the bladder. frequently, urinary incontinence and frequent urinary infections

5. 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 doesn’t 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. It’s important to put things into this wider context when thinking about medication as oestrogen and testosterone won’t 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.

6. 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 we’re willing to ask for.

7. Now for the good news – what treatment is available? It can seem like it’s 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 “what’s 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.

8. Thanks