Susie L. * is a 52 year old administrator for a suburban school board. Over the past 2 years her menstrual periods became more and more irregular until they recently stopped. She experiences intense hot flashes
which seem worse at night. She often has trouble falling back to sleep after these episodes. She has also noticed herself becoming more edgy and irritable, particularly with her husband and co-workers. At times she feels a little down and her friends have even noticed she is not as upbeat as usual. After years of a satisfying sex life with her husband, Susie has been enjoying sex less because she is finding intercourse to be uncomfortable, sometimes even painful, because she has less vaginal lubrication. Sometimes, she just doesn’t feel like having sex at all!
Susie is like millions of American women who are in the postmenopausal phase of reproductive life. Not all women will experience troubling symptoms as a result of menopause, however. In fact, 20% of women may experience no symptoms at all beyond the ending of their menstrual periods. About 20% may experience severe symptoms related to menopause and the rest of women fall somewhere in between those two groups. Perhaps the most troubling symptoms for some women are those symptoms that particularly affect their relationships, namely the mood changes and sexual difficulties often associated with menopause. These areas are important targets for therapies designed to ease the transition into menopause such as hormone replacement therapy (HRT).
Mood changes of menopause typically involve mood swings, irritability and anxiety. Mood swings involve rapid shifts in mood that are often unpredictable and may leave you bewildered. There is sometimes no obvious trigger for a mood swing from happy to sad to angry and back to happy again. You may have never suffered from this emotional roller coaster in the past, and the experience can be a very uncomfortable and sometimes embarrassing one. Those closest to you are likely to be troubled by your mood swings as well. The irritability of menopause can be described as just feeling more “edgy” or more easily bothered by small annoyances. Everybody and everything may just “bug” you even though you realize these feelings are irrational. Patience may be a quality that you find hard to exercise at these times. The anxiety symptoms of menopause may vary widely from very mild sensations of nervousness to full-blown panic attacks. Some of the other symptoms of menopause such as night sweats and hot flashes may mimic signs and symptoms of anxiety causing potential delays in diagnosis.
The overall effect of menopause for many women is that it causes emotional changes that can adversely affect relationships. What are the causes of these emotional changes? Some argue that the change in hormone levels that occurs at menopause is the cause of the emotional changes that can be seen. Others feel that there are other factors associated with this time of life that cause the changes such as lack of sleep, children leaving home, sense of ending one phase of life and starting the final phase of life, medical illness or fears of becoming ill, becoming a caregiver or dealing with the physical changes of your body. Most likely, the contributions of various stressors combine to cause the emotional changes of menopause. What treatments may be effective for these symptoms of menopause? Although HRT seems a likely candidate, results from the Women’s Health Initiative (WHI) do not support that idea. In fact, in the quality of life part of the study, women who were taking the combination HRT (estrogen plus progestins) did not report a significantly improved view of their mental health, depression, or social functioning. Researchers for the study collected data about quality of life at the beginning of the study, at one year and in a smaller subgroup (about 1500 women) at 3 years. There were no significant changes in perception of emotional quality of life in any of the groups at any time point.
You may find that during menopause you, like Susie in the case described above, experience changes in your sexuality. Changes in sexuality during menopause can involve changes in sexual drive (libido), sexual satisfaction or the ability to achieve orgasms. These sexual changes may have both physical and psychological roots. Physically, after menopause, the vagina undergoes changes that will change your sexual experiences. The vaginal walls become thinner and less elastic and they produce less lubricating fluid. These physical changes can lead to discomfort during intercourse and can change your feelings about having sexual relations. Psychologically, you may feel uncomfortable with all the changes you are undergoing. Your body may not be as pleasing to you because of increased weight and a redistribution of your weight. You may observe more wrinkles in your skin further contributing to your discomfort with your body. You may notice an abrupt drop-off in your interest in sex which can adverse affect your primary relationship. All of these factors may combine to lead to decrease in the overall feeling of satisfaction with sexuality after menopause.
Does HRT positively impact a woman’s sexual health after menopause? Again, from the WHI, the answer appears to be “No.” The estrogen-progestin pills that were given to women in the study did not appear to improve the quality of life measure called “sexual satisfaction” any more than placebo pills. Women after menopause need to rely on treatments other than traditional HRT to improve their overall quality of life.