NO LONGER INTERESTED IN SEX AND THE DREADED DRY VAGINA

Dear Crabby,

My husband and I have been married for over 10 years and we’ve always enjoyed an active, healthy sex life. Lately, I have been losing sleep because I am no longer interested in sex. When we do make love, my vagina is completely dry and it makes intercourse almost impossible. My sex drive is completely gone. My husband has become very “Crabby”, and I have completely shut down physically.

I am 46 years old, and my periods have become irregular. I suspect that I may be perimenopausal. It has been almost six months since our last sexual encounter and I’m afraid my husband will start looking somewhere else for it. I feel guilty of not “pleasing” him anymore, but even more guilty of not even “wanting” to. Once a woman’s period stops, is it normal to not want sex because we are no longer “baby makers”? Am I “guilty” of losing interest in sex and not pleasing my husband?

GUILTY IN SEATTLE

DEAR GUILTY IN SEATTLE:

The only thing you may be “guilty” of is not having all the facts so you can continue to have a healthy sex life.

Vaginal dryness is a common menopause symptom. Intercourse can be painful if you are experiencing vaginal dryness. When estrogen levels drop, vaginal dryness can occur. Your vagina can tear more easily from friction, and the vagina tissues can lose their elasticity. Estrogen plumps up the cells in the vaginal wall so they produce more lubrication.

It is important to discuss this with your doctor to confirm that you are not suffering from a vaginal infection. Not only does the physical act of intercourse become a challenge with vaginal dryness, the emotional dialogue that goes on in your head when you no longer lubricate naturally, makes the whole encounter stressful. You ask yourself, “Why am I not turned on? He’s doing all the things I like.” Then you think, “What must HE be thinking? Does he think HE doesn’t turn me on?” Next you suspect, “It’s me, what’s wrong with me?” Your only option is to say, “I have a headache”, then roll over and cry yourself to sleep. No wonder you are sleepless and no longer interested in sex.

There is good news. Option #1: Low dose hormone therapy may bring relief. Option #2: A bioadhesive lubricant, such as AstroGlide that can be purchased over-the-counter, may bring instant relief. Option #3: If vaginal dryness is your only menopause symptom, you may consider using an estrogen cream applied vaginally.

The loss of libido is another common symptom of perimenopause straight through post menopause. The loss of libido can also result from fluctuating hormone levels. Don’t let a decrease in hormone levels blow the flame of desire out of your love life, visit your doctor, take the appropriate tests and discuss treatment options.

Certain medications may also contribute to a declining libido: blood pressure, depression, heart disease, or diabetes medications.

If you need to treat your relationship, visit a counselor.

Besides the effects of menopause, it is also normal for your libido to decline with age. Between the ages of 55 and 65 sexual activity slows for men and women.

A healthy sex life is possible during and after menopause.

If buying lubrication, getting blood tests, and discussing hormones with your doctor seem like an effort, check out the amazing benefits of sex:

-Sex burns about 200 calories during 30 minutes of active sex.
-Regular sex promotes circulation and lubrication!
-Having sex three times a week can make you look and feel ten years younger, thus boosting self esteem.
-Sex is the safest sport you’ll ever enjoy.
-Sex releases endorphins into the bloodstream producing a sense of euphoria, that can reduce depression.
-Sex is a stress reliever. It is ten times more effective than Valium.
-Sex can relieve headaches by releasing the tension that restricts blood vessels in the brain.
-Sex is a natural antihistamine that can help with asthma and hay fever.
-Sex can lower your cholesterol by tipping the HDL/LSL (good kind/bad kind) cholesterol balance towards the HDL (good) side.
-Regular sex can boost estrogen levels. Estrogen keeps your hair shinny, skin smooth; helps reduce the chances of getting dermatitis, and rashes.
-The actual sex act triggers the release of oxytocin that promotes more good feelings.
-Sex can help you sleep better because the levels of oxytocin, a sleep-inducing hormone, can be 5 times higher than normal during love making.

Now, let’s chat about your “guilt”. Women get joy out of pleasing the people we love, especially our wonderful partners. Of the two species, women are usually the “pleasers”. When something changes and we can’t please everyone as we used to, it is common to feel guilty. During perimenopause, menopause and post menopause our bodies are going through natural changes. This is nothing to feel guilty over. Just as our bodies go through a transition during puberty, our bodies also go through a transition as we end our childbearing years. This is a time when we need to pamper ourselves. We may have a little less time to give to others as we devote time to ourselves during this menopausal transition. This is a good time to find other friends going through the same thing, share information, lend support and compare experiences. Talking about “it” can make you feel better. It is a perfect time to build strong communication skills with your partner. The more your partner understands your menopausal journey the more supported you may feel regarding your insecurities.

Purchase a bioadhesive lubricant (Astroglide), visit your practitioner and discuss treatment options, take time for pampering, and being sleepless should only happen because you are making love to your Prince Charming.

Signed,
Less Crabby and More Loving

PS. A note to menopausal women who are in the dating world with more than one partner…. practice safe sex. You may be able to get pregnant and you want to avoid getting a sexually transmitted disease or AIDS.

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

STRESSED OUT AND NOT IN THE HOLIDAY TO-DO MOOD

Dear Crabby,

It’s been a rough year suffering from miserable menopause symptoms. I have gained a lot of weight, I am always cranky, my skin has started to drastically age, my hot flashes hit me every few hours, and I feel like no one understands what I am going through. I am not in the “giving” mood this year, freaking out that I won’t get through my holiday “to-do” list, and feeling stressed out.
Bah, Humbug from Minnesota

Dear Bah Humbug,

The responsibilities during the holidays can be difficult with 99 percent of all women experiencing stress and panic attacks this time of year. Throw in one of the biggest transitions of your life, menopause, and it is no surprise you are freaking out, not in the “giving” mood, and feeling stressed out.

First, let’s address your physical menopause symptoms. Weight gain, irritability, skin changes and hot flashes are all symptoms of fluctuating hormones. Make an appointment with your doctor to discuss your symptoms and possible treatments. Once you decide on a program to treat your symptoms, you will hopefully start to feel better. Going through physical changes can be stressful.

Second, menopause usually happens as the natural aging process kicks in. If you’ve practiced a lifetime of poor eating choices and lack of exercise, it’s unforgiving during menopause. Now is the time to start eating nutritiously, exercising regularly, and dedicating time to pampering.

Regarding your skin, treat yourself to a holiday makeover. Visit your favorite make-up counter. A new cleansing/moisturizing program may restore your radiant complexion.

Visit your practitioner to discuss symptoms. Start eating a healthy diet and exercising. Make time to pamper yourself.

If you practice a few of these Stress-Free Holiday Tips you may just survive your “to-do” list and the holiday season.

10 Tips for a Stress-Free Holiday
1. Keep expectations reasonable. Planning parties and decorating are stressful tasks. Instead of planning a big holiday party, plan a day to celebrate the holiday at the spa with your closet friends. Keep your schedule open to attend a few parties, not give them. Instead of decorating your home and a Christmas tree, put a lovely wreath on the front door, place a small-planted evergreen in the living room and enjoy red candles around the home.
2. Communicate with your loved ones. Let them know you are going through changes, and that you plan to get some rest this holiday and would appreciate their support.
3. Limit your alcohol intake. Holiday parties are often centered on drinking. Try to “nurse” one glass of wine for the evening. Remember alcohol is loaded with extra calories. I ask for “water on the rocks with a twist” – it is fun, always gets a reaction, is calorie free and keeps you hydrated.
4. Quiet time. Plan a half hour a day to sit quietly. Find a spot in your home in a comfy chair. Close your eyes, and take long deep breathes. Breathe in thinking of good health and happiness and breathe out stress and frustration.
5. Eat a healthy diet. Eat more vegetables, whole grains, fruits and low-fat foods. You will have more energy.
6. Start exercising. Take a 30-minute walk. Not only will you burn calories, you will feel more relaxed.
7. Manage your time. Cut your to-do list in half this year.
8. Send e-cards this year. It is fast, easy, free and fun. This will save you time, money, paper and postage.
9. Have a sense of humor. Dealing with relatives over the holidays can be stressful. If relatives are visiting you for the holiday, ask them to book a hotel for their stay. Keeping your home a sanctuary during your menopause transition is important. If a relative is driving you crazy, try to be cheerful and laugh it off.
10. Keep a budget. Dealing with extra holiday expenses is also extremely stressful. To buffer this a bit, try making homemade gifts or let your loved ones know that this year the gift theme is ‘to spend less than $20 per person per gift’. Don’t forget, shopping on-line will save time and frustration at the malls.

Remember menopause is a natural transition. The holidays can be a joyful time if you embrace your changes and make a few holiday stress-free adjustments to your agenda. The greatest gift you can give…. is to take care of yourself, and when you do, you will want to give to others.

Signed,
A less stressed Dear Crabby wishing you a Happy Holiday!

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

Hot Flash 101

The most common and often the most irritating symptom associated with menopause is the hot flash. As many as 75 percent of women going through menopause in the United States experience hot flashes with 10% to 15% of women having severe or frequent hot flashes. I had miserable hot flashes that heated up at the most inconvenient times and sometimes flaring up every few hours. I tried every trick in the book to eliminate this miserable symptom – from herbs, to teas, to exercise, to diet, to praying hourly that they would disappear – but they persisted.

With confusing and conflicting information online and in best-selling books, I teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on alternative, complementary and medical options to relieve hot flashes.

Understanding available hot flash options will give you the opportunity to discuss menopause management with your clinician. This interview with Dr. Klein is the first in a series that addresses the various menopause symptoms.

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Hot Flash Interview

Staness: Dr. Klein, what exactly is a hot flash?

Dr. Klein: A hot flash is a sensation of extreme heat in the head and upper body generally associated with sweating.

We know from studying women that the internal core temperature does increase. You can a put a sensor on the skin and before a woman experiences a hot flash she will be able to tell you, “I am going to have a hot flash.” And sure enough, there will be an increase in internal core temperature followed by profuse sweating which is very uncomfortable. As you know, the purpose of sweating is to cool the body so there is often a reflex of sort of chill that follows the hot flash. It is a very uncomfortable and distracting sensation. It can occur at any time of the day. It can occur with tremendous variability, it can happen many times an hour or only just once or twice a day. Some women have one or two hot flashes a day, and get through menopause with no problems while other women have fifteen or twenty a day. We are all different.

Staness: What causes a hot flash?

Dr. Klein: We are still trying to understand exactly what causes hot flashes. We know that they are related to the hypothalamus, which is in the center of the brain and acts like the thermostat for the body. What we don’t understand is why some women are so troubled by them and others are not.

Certain women seem to have triggers. An alcoholic beverage may bring on a hot flash, or a change in external temperature can cause a hot flash for some women. In general, the hormonal flux or variation in hormone levels seems to be related to this sensation in some women.

Staness: Are there other causes?

Dr. Klein: We know that smoking is associated with hot flashes. Women who smoke have a higher risk of troublesome hot flashes, so obviously you should not smoke.

Also certain medicines can cause hot flashes such as certain antidepressants SSRI, Selective Serotonin Reuptake Inhibitors, are common antidepressants that can actually cause an increase in hot flashes. Yet, for some women, a very low dose can actually alleviate hot flashes, making antidepressants an alternative to hormone therapy.

Illnesses and fever can cause hot flashes, as can malignancies, and tuberculosis – many illnesses can cause hot flashes.

Increased BMI, Body Mass Index, has been associated with hot flashes. We used to think that women who were heavy had excess estrogen, and therefore fewer hot flashes. Now from the major study that was done in the SWAN, Study of Women Across the Nation, we know that women who are heavy, who have abnormally high body mass index, are at increased risk for hot flashes.

Staness: What’s a menopausal gal to do if she suffers from hot flashes?

Dr. Klein: The real issue is how troubled are you. Some women find that they can manage their hot flashes with simple lifestyle changes, such as wearing layered clothing, lowering the thermostat, carrying a fan, drinking cool beverages, avoiding triggers like caffeine and alcohol. Some women can have a few hot flashes a day and over time, seventy-five to eighty percent of cases the hot flashes will diminish and disappear. Then there is a subset of women for whom hot flashes are really troubling and don’t go away. Lots of women have recurring hot flashes waking them up over and over again and they can’t go back to sleep. They are not getting enough rest; they wake up grouchy, tired, and sweaty. If it is really a problem, there are hormonal therapies that will alleviate these symptoms. As you know hormone therapy can have side effects, so you must always weigh the benefit versus the risk. There are very low dose hormone therapies that are now available that can be extremely useful for alleviating hot flashes.

There are some other options to consider such as soy and black cohosh. The studies regarding soy are mixed, with some showing that soy can be helpful; while there are other studies that show soy may help with mild symptoms. Soy is benign and easily available and may be worth trying. Black cohosh is another herb and has been used in Europe widely, but you have to be careful because there have been reports of toxicity with high doses. Used in limited amounts in standardized doses black cohosh supplements may help some women with hot flashes. Again, there have been mixed studies, so whatever you do, and with anything you take, you should always discuss with your clinician.

You can also try lifestyle changes – wearing layered clothing, practice deep breathing, meditation and yoga, exercising – all of these things that can be really helpful in learning to live with the symptoms if they are moderate.

Another option to treat hot flashes is gabapentin. This is a drug that was originally developed as an antiseizure medicine. Gabapentin is widely used for pain relief, because it was discovered that with patients in whom it was used for seizures, it helped with pain. It was then found that it helped with hot flashes. Gabapentin is a reasonable alternative to discuss with your clinician if you do not want to or if you cannot take hormone therapy.

Staness: I was on birth control pills for years and had no idea I was perimenopausal until I stopped them, then the hot flashes started erupting. Are birth control pills a good option for hot flashes?

Dr. Klein: Birth control pills are a form of hormone therapy. They are a higher dose than standard menopausal therapy, but there is estrogen in most birth control pills and that keeps hot flashes away. If you are in the perimenopausal phase, birth control pills can also be useful for regulating your periods, plus they keep hot flashes away.

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Understanding the causes and solutions for hot flashes is the first step to managing your menopause. If you suffer from hot flashes, discuss your treatment options (alternative, complementary and medical) with your healthcare provider.