The Menopause Plan: A Guide to Aging Gracefully and Retaining Sexual Vibrancy.

Dr. Tracey Fein M.D.

Board Certified Obstetrics-Gynecology

Senior Attending Physician, Lenox Hill Hospital, NYC

The Subtle Loss of Sexual Vibrancy

Women frequently make an appointment to see me because they are suffering from various symptoms that are troublesome and do not resolve on their own. Sometimes they will say that they think it might be a yeast infection, others will complain of vaginal dryness or difficulty in having sex, perhaps that sexual desire and the ability to reach orgasm have faded over time. As we talk about when these changes to their bodies were first noticed they recall that they saw glimmers of change, too subtle to care much about for quite some time, years perhaps. The common thread that I’ve detected after speaking with thousands of women about these types of problems is that they are describing the experience of menopause as tissues that line the vagina change with declining estrogen levels and it is those affects that they are noticing.

Treating menopause has largely been done in relation to the symptoms that a woman experiences as she goes through its three stages pre-menopause, menopause and post-menopause. Some symptoms like hot flashes, skipped periods, sleeplessness and so forth can be easily helped with various treatments. The main affect of menopause though is the one least talked about; vaginal atrophy due to declining estrogen levels. This is a process that once begun does not stop by itself. It continues until all the tissues lining the vaginal wall have atrophied, by that time sexual activity has most likely ceased due to discomfort coupled with lack of desire.

Preserving sexual vibrancy depends on a healthy vagina. When a woman’s vagina becomes estrogen depleted, the tissues that line the vaginal walls become dry and eventually atrophy. This is true in all women. Therefore, treating vaginal atrophy needs to be the main concern in treating menopause. Hot flashes, etc. may come and go, increase in their intensity, disappear and then re-appear. But vaginal atrophy is a continual process that begins in the forties and continues through post-menopause. Taking steps to maintain a healthy vagina should begin at the earliest signs of menopause because the later effects of vaginal dryness and painful sex can be avoided entirely. As a woman enters her senior years vaginal health remains important to maintain and should be treated in a similar way to the manner we use to maintain dental health over our lifetimes; a continuum of care over decades of time.

Keeping and preserving a healthy vagina should be the foundation of a plan for managing menopause effectively. The treatments for this cover a broad range from herbals to lotions, creams, pills, non-hormone therapies, bio-identicals, synthetics, HRT and laser rejuvenation with each being appropriate and effective at different stages of menopause. Every woman is unique and her experience of menopause is unique as well. It’s highly variable as to when a woman will start to see symptoms. Some women experience menopause in a gentle manner; some women experience it as a time of great discomfort with unpredictable mood swings and other undesirable affects. But all women will suffer vaginal atrophy regardless of their other experiences of menopause. It is a slow, silent progression of change that has the most undesirable of consequences if left untreated, loss of sexual vibrancy.

Painful sex, vaginal dryness, inability to experience sexual pleasure and low libido are the eventual outcome of vaginal atrophy due to declining estrogen production. The inevitability of this outcome is well known but what is less well known is that all of the above symptoms are avoidable. Care and treatment for preserving vaginal health needs to begin early, be maintained regularly and continue through post-menopause.

Thinking of menopause in this manner represents a paradigm shift. It is not so much about chasing symptoms like insomnia as they arise but about a coordinated plan from pre-menopause through post-menopause with different treatments being appropriate at different times. The central experience of menopause however with the longest lasting most deleterious affects are those associated with vaginal atrophy. Those affects should be addressed early and treated continuously, it is the best way to preserve sexual vibrancy in women undergoing menopause and also to preserve vaginal health through the senior years.

The North American Menopause Society (NAMS) has a list of certified menopause specialists that can help women make a plan for effective treatment of menopausal symptoms. Or ask your regular doctor for a referral.

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