Women generally spend the last third of their lifetime in menopause. But most women face this life change alone.
“So, are you still having sex?” the nurse asks me, her hands poised over her laptop.
“Still?” I think.
I’m 55 years old and at my annual OB-GYN visit. In our country, women fall into a black hole of medical attention in the years leading up to and during menopause.
“Yes, I’m having wild up-against-the-wall sex, how about you?” I imagine responding.
But should I be having sex at all at my age? And how should I be feeling around these menopausal years?
An increasing number of women are hitting menopause than ever before. Each day, an estimated 6,000 U.S. women reach menopause at an average age of 51 years. This fact, combined with women living longer, means that women generally spend the last third of their lifetime in menopause.
But most women face this life change alone. Gynecologists in the U.S. receive little formal education about menopausal health, how to reduce symptoms, and the fear around those symptoms. As a result, women and their partners often have misconceptions about how these normal hormonal changes will affect them.
I am a researcher who has focused her career on women’s health and, even for a public health professional like myself, it’s been hard to find guidance.
That very odd feeling that the world is going to end accompanied by a sudden surge of hunger—who knew that this is a perfectly normal pre-onset hot flash symptom called an “aura”?
Smelling petrol or smoke when no one else does? This is also a symptom, although not well-researched, of menopause.
I worried about these symptoms. Were they signs of thyroid cancer, a brain tumor?
Would I have felt scared or reassured to know about these and other symptoms in advance? Likely both, but it is my right to have this information. Perimenopause can begin five to 10 years before the occurrence of actual menopause and comes with a range of normal, but typically new, symptoms for four out of five women. On top of all of this are racial and ethnic variability in the prevalence of menopausal symptoms.
Women can try online resources, which have been proliferating, but are spotty in their quality (no pun intended!). There are books such as The Menopause Manifesto but many women in midlife are too busy taking care of their elderly parents and launching their children into adulthood to crack open such tomes.
So let’s help women out.
We already have a tried-and-true technique for children. At every well-care visit from infancy, toddlerhood and into adolescence, parents and guardians are showered with handouts with such titles as “Bright Futures” or “Help Your Child Grow and Thrive.” They are published by the American Academy of Pediatrics and others and list developmental milestones, checklists of items to watch for, and tips to help parents navigate their child’s health care needs.
How about a set of handouts for menopause?
Instead of “What to Expect When Your Child Turns Two,” how about: “What to Expect at Your 40-Year-Old Gynecologic Visit”? Instead of “This might be a good time to invest in booster seats,” how about, “This may be a good time to invest in a cleavage cooler”?
To date, the American College of Obstetricians and Gynecologists has not created a patient-friendly set of handouts although research shows that such materials improve health outcomes. Just as importantly, health care providers don’t systematically provide this information to premenopausal women at well-care visits.
Let’s make it easier for them! Here’s an example handout.
You’re Entering Your Prime: 45-Year Gynecologic Visit
At this visit, we will talk about:
- Symptoms that are totally normal but to start watching for – for example, depressed mood and hot flushes can begin early in the menopause transition, well before menstrual irregularities occur.
- The type of bleeding that is normal and what might not be normal.
- Changes to birth control that you may want to consider. For example, if you have an IUD, let’s discuss the best time to remove it.
- Possible options for medications/treatments including the risks and benefits of hormone replacement therapy as well as alternative strategies.
What you may be experiencing now:
- Hot flashes may start with an eerie quiet just before a feeling of unease, a drop in the stomach, flash of nausea, and a weak feeling followed by heat. These are called ‘auras’.
- It’s natural that your vagina will not get as lubricated during sexual arousal as it did before – this is not due to you or your partner.
- The decrease in vaginal mucous will make you more susceptible to vaginal infections.
This may be a good time to invest in:
- A handheld fan for your purse. Just a quick couple of breezes early in the hot flush cascade might be enough to prevent a full-blown flash. As you wave your fan about you can say, ‘No worries, I’m just having a power surge.”
- A desktop electric fan—one for the kitchen counter and one for your office.
- Cooling pillows for nighttime.
- Selecting a vaginal moisturizer to make sex more comfortable.
Strategies and tips:
- Try avoiding classic hot flash triggers such as hot beverages, spicy foods, and red wine.
- Keep the bedroom cool at night, especially during the first four hours of sleep.
What to look forward to:
- No more investment in pads/tampons!
- No more worries about unplanned pregnancies or getting your period unexpectedly.
What we will discuss in your next visit:
- Your support system to help you deal with stressors as you enter this next phase.
Here’s how it would play out: At each well-care visit, pap smear and mammogram screen, you would receive an attractive handout. There is no lack of topics: anxiety, lower libido, memory lapses, weight changes, vaginal itching, burning, urinary incontinence and frequency, headaches, skin changes, clumsiness, fatigue, chills, anxiety and palpitations.
To be sure, women could proactively ask their physicians about their symptoms, but it is common for women to feel embarrassed. Recent studies also indicate that many women believe that physicians do not have the time to discuss sexual issues.
Let’s welcome women into this next phase of life by arming them with a tool-box of strategies that normalize this very normal process. Menopausal women have the opportunity to feel liberated, energized and able to take on the world—and, yes, still have sex!