Getting Intimate After Menopause: A Candid Consult

Entering your mid-life phase can be an incredibly rewarding time, as you are in tune with your body and are feeling confident in your own skin. Unfortunately, for many women, menopause can also bring an onslaught of frustrating symptoms that can make navigating the transition a very challenging time.

In this edition of Candid Consult, we’re exploring how sexual function can change after menopause and what women can do to take back control of their health. Dr. Joann Richichi of Axia’s Revita’ Life care center shares her personal menopause experience and offers insights into the work she’s doing to help women reset the clock.

1. After practicing OB/GYN care for many years, you chose to shift your focus to specialize in helping women through the menopausal years. Why is that?

When I was 47 years old, I had an emergent hysterectomy that sent me into early menopause. While I had treated many menopausal women before, I became acutely aware of just how debilitating the symptoms of menopause could be when I became menopausal myself. For me, conventional therapy did not offer much relief from my overwhelming hot flashes, mood swings, weight gain, and insomnia. I researched alternatives modalities. Once I found out how overwhelmingly positive they can be for a patient’s overall well-being, I then made it my mission to not only heal myself but to help my patients by sharing what I learned. I am excited to bring alternative approaches like bioidentical hormone therapy to my patients, which can have an incredible impact, especially for women who had failed on prior therapies. My goal is to help women regulate their hormones and get back to feeling like they did in their 30s or 40s.

2. So, what exactly is happening inside our bodies during menopause, and how does that impact our vaginal health?

Many of the symptoms women experience during the menopausal transition are due to a fluctuation in hormone levels. In particular, a drop in the hormone estrogen is what contributes to vaginal atrophy, hot flashes, insomnia, and mood swings. Vaginal atrophy means that the tissue of the vagina becomes drier and more fragile, and less pliable with less lubrication. Vaginal atrophy can also include a shortening and thinning of the vaginal canal. Prior to menopause, women also experience a drop in testosterone, which is a hormone involved in regulating libido, enhancing energy, stamina, focus, and muscle building. While we often think of testosterone as the male hormone, it’s important for women to have the right balance of both testosterone and estrogen.

3. Are there other health issues that may make intercourse more uncomfortable during the menopausal years?

Feeling hot, sweaty, and irritable no doubt can contribute to a decreased libido. Urinary incontinence, or unexpected leaking, is also common during menopause. Just as a drop in estrogen can cause a shortening of the vaginal canal, it can also cause a shortening of the urethra and a weakening of the pelvic floor muscles, and this can contribute to leaking. The weakening of the pelvic floor also can cause uterine or vaginal prolapse. Of course, this can cause distress and embarrassment and make it difficult to relax and enjoy intimacy.

4. Thank you for the background. Now, let’s shift to focus on what women can do to address these symptoms?

Fortunately, we’ve come a long way in developing safe, effective treatments for women that address a variety of these problems associated with menopause.

Dependent on severity, many of these concerns can be addressed by a woman’s primary gynecologist. For women experiencing vaginal atrophy, vaginal estrogen can be prescribed and there are several different over-the-counter lubricants or natural supplements like coconut oil that can help to restore lubrication and enhance sexual pleasure.

Other forms of therapy like pelvic floor physical therapy can help with issues like urinary incontinence and prolapse by helping to strengthen and retrain the muscles.

In my practice, I’ve found incredible results with bioidentical hormone therapy, a form of plant-based hormones that are like those that your body naturally produces when you are younger. While conventional hormone replacement therapy (HRT) has its place, it can carry health risks for some, especially after prolonged use and if started many years after becoming menopausal. Many of the women I treat did not have the positive results they hoped for with traditional HRT and were left thinking they had no other alternatives. For patients whose symptoms cannot be treated with other therapies, bioidentical hormone therapy can be an excellent resource.

5. Why is it important to still practice safe sex during this period?

Menopause is a transition, it’s not a simple “off” switch. In perimenopause (the years preceding menopause) your hormones are fluctuating greatly, which can last anywhere from 2-8 years. Despite a decline in fertility during this stage, there can be the possibility of getting pregnant. I check certain hormone levels to determine the likelihood of conception. For those people who I feel may benefit from hormone replacement and who may have a risk for conception, I will work with them to recommend an appropriate form of birth control (i.e., tubal ligation, an Intrauterine Device, or possibly a vasectomy for the male partner.) While most of my patients are in committed relationships, it’s important to remember menopause does not prevent you from contracting a sexually transmitted disease, and therefore safe sex is still important to practice.

Menopause doesn’t have to stop you from enjoying aspects of your life, including intimacy! If you can’t find relief for your menopausal symptoms, don’t give up hope. Talk to your Axia Women’s Health provider to learn about the variety of treatment options available. Remember, you are too young to get old!