How Sex Changes After Menopause
Chris Kraft, Ph.D.
With no need to worry about getting your period, becoming pregnant or being walked in on by your kids, your postmenopausal sex life should be stellar, right? It can be good, but dont expect it to be the same type of sex you were having in your 20s, says Chris Kraft, Ph.D., director of clinical services at the Sex and Gender Clinic in the department of psychiatry at Johns Hopkins Medicine.
While you may have greater freedom at home, this is also a stage of life with a lot of changes that can affect your intimacy, he says. Youre redefining your roles and your relationship as the kids go off to college and your careers wind down. And youre also physically changing.
Should I Continue Using Birth Control During The Transition To Menopause
Yes. You can still get pregnant during perimenopause, the transition to menopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months.
But it is impossible to know for sure when you will ovulate. If you dont want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs. Learn more about different .
You cant get pregnant after menopause, but anyone who has sex can get . If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or correctly every time you have vaginal, oral, or anal sex. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sex, exposing you to STIs.
How Often Should I Get A Pap Smear Now That I Am Menopausal
You can get a Pap test every three years if both of these are true for you:
Women who have a higher risk of cancer may need a Pap test more often. Your doctor can recommend what is best for you.
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Woman’s Day: Bleeding After Menopause
As the Womans Day story details, transitioning out of menopause comes with uncomfortable yet common side effects like hot flashes, mood swings and weight gain. But, if your body is suddenly experiencing period-like bleeding after menopause, its time to call your doctor’s office and make an appointment.
Menopause is considered official when a women does not have a menstrual period for one year. Typically, women enter menopause around 51 years of age, but it can range from as young as 40 to 58 years old. And before menopause begins, most women experience changes in their menstrual cycle.
During this transitionary time, your bleeding pattern may start to change due to some wild fluctuations in your hormone levels, Chan told Womans Day. At first, you usually have a shortening of the cycle. Then you may have a change in bleeding pattern. It can be lighter. Then theres a lengthening of the cycle. You may skip some periods before you stop altogether.
But If bleeding occurs after menopause, doctors need to rule out other conditions. Post-menopausal bleeding can be a symptom of endometerial cancer — also called uterine cancer. About 10% of postmenopausal bleeding experience is due to cancer, the Woman’s Day article states.
Read the complete story here.
Theres Nothing Wrong With Needing Help In The Lubrication Department
Whether you decide to opt for extra hormones or not, using vaginal moisturizers like Replens and regular ol lube can help ease vaginal discomfort. In fact, Tami Rowen, M.D. an obstetrician and gynecologist specializing in sexual health at the University of California San Francisco, highly recommends using a lubricant to help make sex more enjoyable if you experience vaginal dryness. If youre new to lube, its important to know that there are several types: silicone-based, oil-based, water-based, and hybrids. Generally, water-based lubes that dont contain glycerin are a good choice because theyre suitable for people with sensitive skin. Further, Dr. Rowen suggests buying a lube that mimics the natural pH of your vagina. Changes to its natural state can cause an overgrowth of bacteria and lead to infections like bacterial vaginosis, according to the Cleveland Clinic. . Before heading to the store, you can do research online to find a product that fits within this scale. Dr. Rowen recommends lubes like Almost Naked by Good Clean Love . This one falls between 4.2 – 4.7 on the pH scale, according to the manufacturers website.
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Missed Periods Intermittent Spotting Heavy Bleeding And Flooding
Changes in periods vary widely as hormones adjust. As mentioned in other parts of this site this is a time to really tune into your body and trust your instincts. As you can see from this list it’s hard to define what perimenopause periods are like:
Periods can disappear for a year and then return.
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How Is It Diagnosed
To find the cause of your bleeding, the doctor will do a physical exam and review your medical history. You may need one or more of the following tests:
Transvaginal ultrasound: This image helps your doctor check for growths and look at the thickness of your endometrium. Theyâll place a small probe into your vagina. It sends off sound waves to create a picture of the inside of your body.
Endometrial biopsy: The doctor uses a thin tube to take a small sample of the tissue that lines your uterus. Theyâll send it to a lab where scientists will look for anything unusual, like an infection or cancerous cells.
Sonohysterography: Your doctor may use this test to measure the size of a polyp. Theyâll put a saltwater solution inside your uterus to create a clearer ultrasound image.
Hysteroscopy: When the doctor needs to look inside your uterus, theyâll use a hysteroscope. This thin, lighted tube has a camera on one end.
D& C : During this procedure, the doctor opens your cervix. They use a thin tool to scrape or suck a sample of the uterus lining. They send this to a lab that will check for polyps, cancer, or a thickening of the uterine lining .
Ultrasound and biopsy are usually done in your doctorâs office. Hysteroscopy and D& C require anesthesia on one part of or your whole body. Youâll either go to a hospital or an outpatient surgical center.
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Treating Post Menopause Bleeding
If you have postmenopausal bleeding it is important to have it investigated.
You will most likely be referred to a gynaecologist who may:
- ask you questions about the history of your health
- examine you
- do a blood test
- look at the inside of your vagina and cervix using special tongs . At the same time, they may take a tiny sample of your cervix for testing .
The kind of treatment you have will depend on what is causing the bleeding.
- Atrophic vaginitis and thinning of the endometrium are usually treated with drugs that work like the hormone oestrogen. These can come as a tablet, vaginal gel or creams, skin patches, or a soft flexible ring which is put inside your vagina and slowly releases the medication.
- Polyps are usually removed with surgery. Depending on their size and location, they may be removed in a day clinic using a local anaesthetic or you may need to go to hospital to have a general anaesthetic.
- Thickening of the endometrium is usually treated with medications that work like the hormone progesterone and/or surgery to remove the thickening.
Before treatment there are a number of tests and investigations your gynaecologist may recommend.
All treatments should be discussed with you so that you know why a particular treatment or test is being done over another.
Is Hrt A Good Option
HRT is very effective at treating hot flushes. It protects against osteoporosis, too, although the benefit depends on how long you take it for and drops off once you stop. Taking HRT slightly increases your risk of getting breast cancer while youâre taking it, but this depends on how long you take HRT for, and the risk goes down when you stop treatment.
The risk of deep vein thrombosis and pulmonary embolism is increased by some forms of HRT but not others. Your GP can advise on the specifics of risks and benefits for you, depending on your medical history.
There are lots of lifestyle tips to cut the impact of hot flushes and sweats too, including avoiding woolly jumpers and polo necks cutting out alcohol and caffeine switching to a thinner duvet and wearing several thin layers you can take on and off. Increasing the amount of soya you eat and drink may also relieve flushing, as can herbal remedies like MenoherbÂ® or red clover.
With thanks to âMy Weeklyâ where this article was originally published.
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Can Stress Cause Postmenopausal Bleeding
As we women age, our bodies go through some drastic and remarkable changes. After the childbearing years, the 40s and the 50s, the female body begins to change away from procreation as the production of reproductive hormones naturally begins to decline. This phase of a womans life is called menopause and is signaled by 12 continuous months since the last menstrual cycle.
The average age in the United States for women to start menopause is around 51 years of age. There are three phases of menopause that women typically go through and they are perimenopause , menopause, and then postmenopause .
Many questions surround this phase of female life, and for the purpose of this article, we are going to look at the postmenopause phase and a common question that arises often.
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Things To Know About Postmenopausal Bleeding
Spotting or light bleeding after menopause might not seem like a serious problem, but you should never ignore it or wait to bring it up with your doctor. After a womans periods have stopped, vaginal bleeding could be a sign of a health issueincluding endometrial cancer. Heres what every postmenopausal woman should know.
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When Do Periods Stop At Menopause
There can be gaps of up to 12 months between periods. You could go for 3-4 months without a period and the have a regular period for a few months
When having sex it is well advised to use contraception for up to 24 months after our last period. If you are having intermittent periods then you are most likely still ovulating and could become pregnant.
Changes in the monthly cycle are an indication that you are in perimenopause. There is no typical pattern of change – each woman can experience a combination of different symptoms.
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And Keep In Mind That You Can Still Get Pregnant Even After The Menopause Process Starts
Because menopause is defined by not having a period for 12 months straight, when you’re perimenopausal, or transitioning towards menopause, your period may go MIA but then make a comeback at some point. Some people have breakthrough bleeding or periods in between, according to The American College of Obstetricians and Gynecologists. And while that doesnt necessarily mean that youve ovulated, it could mean that you have. And that means you could potentially get pregnant.
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So What Kind Of Symptoms Are You Likely To Get
Most women will find their symptoms to be very similar to the ones they had before they started menopause. But, sometimes, they can be exaggerated and they can even be worse than they were before, which is not a nice situation to be in.
So, you might find that you get cramping, which tends to be the most common symptom. You can get the bloating. You can get the sugar cravings. You can get the breast tenderness, the irritability, the bad mood, the anger.
You might find that you get constipated, and you might find that you just feel really uncomfortable and heavy in this particular area.
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The Significance Of Bleeding After Menopause
Bleeding after menopause or “postmenopausal bleeding” can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40’s, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness.
Bleeding after menopause or “postmenopausal bleeding” can be defined as the resumption of vaginal bleeding at least 6 months after a woman experiences her last menstrual period. This assumes of course that she is indeed menopausal ie. in her late 40’s, perhaps having hot flashes and night sweats, mood swings, insomnia, perhaps experiencing some vaginal dryness. The bleeding pattern most women experience as they approach menopause is one where the periods become lighter, shorter in duration, and the interval between periods changes so that the periods are either somewhat closer together or intervals greater than her customary 28 days. Cycles may be missed entirely for a couple of months.
Polyps and fibroids are common benign growths that develop in the uterine cavity. The former is most often associated with irregular light spotting, staining or actual light bleeding. The latter may also present this way, but in fact may be associated with much heavier bleeding.
Cancer obviously requires a much more aggressive surgery, namely hysterectomy.
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Vaginal And Vulvar Atrophy
Postmenopausal atrophic vaginitis, or vaginal and vulvar atrophy , is the thinning of the walls of the vagina caused by decreased estrogen levels during menopause. As a result, the lining of the vagina may be more likely to bleed.
Vaginal and vulvar atrophy is caused by cellular changes during menopause. Changes in estrogen levels also cause a decrease in blood flow to the vaginal area, which further contributes to vaginal dryness and discomfort. Spotting during and after intercourse is a common symptom of VVA.
At least half of those who enter menopause have signs and symptoms of VVA, but only 20% to 25% seek medical attention from their doctor.
Menopause Can Have Mental And Emotional Effects Too
Most people dont like their period, but when it goes away you feel your age, Dr. Rowen tells SELF. For some people, the idea of losing their period can be psychologically distressing.And as we mentioned, your hormones, specifically estrogen and progesterone, change during menopause. And this change may cause feelings of anxiety and depression. Lower estrogen can also trigger hot flashes that make it difficult to sleep, leading to mood swings and anxiety. Coupled with any emotional distress from losing your period, and you understandably may not be in the mood to have sex. If you feel down for more than two weeks, you may be depressed and want to speak with a therapist, the Cleveland Clinic recommends. However, finding a therapist can be a long, and often stressful, process. . Generally, you will want to start by asking your insurance company for a list of providers. If you dont have insurance, websites like Open Path include therapists who offer reduced-fee sessions.
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What Is The Most Common Cause Of Postmenopausal Spotting
Having a period after menopause can be alarming, but theres not one most common cause. Theres a range of causes of postmenopausal spotting not all of them serious but all requiring a check-in with your doctor.
Causes of postmenopausal bleeding include:
Polyps these are non-cancerous tissue growths that can form anywhere in your cervix, uterus, or cervical canal.
Endometrial Hyperplasia This is the thickening of your uterine lining caused by an imbalance of hormones, specifically too much estrogen and not enough progesterone. Cells in the uterine lining can become abnormal, and can sometimes lead to cancer.
Endometrial Atrophy This is the thinning of the uterine lining, caused by very low hormone levels.
Vaginal atrophy This is the thinning of the vaginal walls, again, caused by low hormone levels experienced after menopause. The lining of the vaginal walls can become dry and inflamed, especially after sex.
Cancer Postmenopausal bleeding is the most common symptom of certain types of cancers, including endometrial, uterine, cervical, and vaginal cancers. Although serious, only around 9% of postmenopausal women who sought medical advice for vaginal bleeding were diagnosed with cancer. So you dont have to assume the worst.
HRT treatment spotting can be a common side effect of Hormone Replacement Therapy which can be a common cause in itself for endometrial hyperplasia.
Other factors including STIs, medications, and vaginal infections.