One of the most frustrating problems women face in menopause is vaginal dryness. Vaginal dryness in very common, almost universal. Vaginal secretions largely come from the blood vessels in the tissue beneath the vaginal wall. These vessels are estrogen receptive, so when estrogen levels drop at menopause, the blood vessels diminish and so do secretions. So, even with sexual excitation, lubrication is much decreased. Many women find that intercourse becomes very painful, and many women stop having vaginal penetration. This is a big loss for many couples, and may adversely affect a relationship.
Women may think this is abnormal, but it is not. Some women do not feel comfortable discussing this with their doctors. Please don’t be shy. You are not alone, and there are many avenues to treat this problem. Many types of vaginal lubricants are available over-the-counter and are used each time a couple has intercourse. Even with lubricants, some women experience a burning type of pain with intercourse. This is due to the thinning of the vaginal walls, another result of the lack of estrogen. Topical estrogen can be applied to the vagina, with minimal systemic absorption, and is very safe for most women. For those who do not have an adequate result, sometimes systemic hormone therapy can be used, especially in patients who may have other reasons to take hormones.
There still remain women who do not respond to any of these treatments, or prefer or cannot use estrogen. I learned about a vaginal laser treatment in 2014, when it had just been introduced to the U.S. Developed in Italy, Dr. Salvatore of Milan experimented with using a laser in animal models and found marked changes in the vaginal tissue after using a fractioned carbon dioxide laser. Dermatologists had been using this treatment for about 25 years on the skin, to diminish wrinkles and rejuvenate the face.
The procedure which he developed uses a laser to penetrate the vaginal and vulvar tissue in little dots that penetrate the vaginal skin and beneath it. The laser energy is interpreted by the tissue as an injury, and the response to the injury is repair. Biopsies before and after the laser treatments demonstrated that the blood vessels grew back, and collagen and elastic fibers were formed. This left the vaginal tissue much closer to the premenopausal state. Patients noted much more lubrication and more comfort with intercourse. Some patients note a decrease in urinary tract infections, and less discomfort of the vulva, the external genitalia.
The procedure is performed in the doctor’s office, takes less than 10 minutes, and is painless.
There is some mild discomfort after the procedure, likened to a mild sunburn, which usually lasts only a couple of hours, Three treatments six weeks apart are recommended initially, and one touch-up treatment is usually performed yearly after that. The initial studies in Italy demonstrated a 90% satisfaction rate. There are virtually no serious complications. It is great to have one more treatment in our “tool box” to treat this very difficult problem.
Marilyn Jerome, M.D.
"What happens to your physical relationship during and after menopause?" from Focus on the Family. Click Here to read full article.
Many, and I could safely say most women experience a decrease in sex drive as they go through menopause. The reasons for less sexual activity are multifactorial, but there is little doubt that a decrease in hormone levels play a large part in decreased sex drive. The lack of estrogen also causes atrophic changes in the vagina and vulva, and intercourse can be painful. If intercourse is painful, who would want to participate? There are treatments for this, but today let's just focus on "sex drive." Sex drive is defined as sexual thoughts and feelings, fantasies, and seeking out sexual activity, either alone or with a partner. Levels of testosterone decrease in both men and women as they age. Testosterone in women comes from two sources, the adrenal gland and the ovary. As the ovary ages, the production of ovarian testosterone decreases. If you test for testosterone levels in menopausal women, most will test in the low normal range, as there is a large range of normal. Studies have not really been able to correlate the levels of testosterone in women with sex drive.
When women complain of decreased libido, we may offer testosterone treatment. Testosterone is often supplied as a transdermal cream or gel that is compounded. The products available that are FDA approved are for men, and greatly exceed doses that are appropriate for women. The results of testosterone use in women are quite variable. Some women note considerable increased libido, but others note no difference at all. It is hard to understand why there is such a variable response. In this month's issue of Menopause, The Journal of the American Menopause Society, Drs. Krapf and Simon discussed a hypothesis of why there might be such a variability. They cited data that if women with hypoactive sexual desire are given low doses of testosterone, there was no change in sexual desire. When moderate doses were given, sexual desire increased. When higher levels were given, the benefit seen with the moderate dose was not apparent. It seems that there is a bell-shaped curve that explains this. We know that higher doses of testosterone have side effects that often cause women to stop taking the medication. These side effects include hair growth in unwanted areas, and loss of hair on the scalp, acne, and psychological side effects such as aggression, anger, anxiety and depression. It seems that there is a level of testosterone supplementation in women that is "just right", too little having no benefit and too much having no benefit for increasing sex drive, and also causing too many adverse effects, often leading to discontinuation of medication. As a physician, the results of this article encourages me not to think in a black or white model. Titrating dose for testosterone, starting low and gradually increasing dose to benefit, and minimizing side effects may be the best approach.
Dr. Marilyn Jerome
Reference: Menopause, The Journal of the American Menopause Society, Volume 24. Number 4, April 2017
Personal Perspective: A sex-specific dose-response curve for testosterone: could excessive testosterone limit sexual interaction in women?
For many years, we have been told that exercise boosts our immune system, helps cognition and sleep, and maybe even extends our lives. Researchers at the Mayo Clinic actually studied this down to the cellular level, to determine how cells changed with different types of exercise. They actually found that high-intensity interval training was able to reverse the decline in our cells' ability to generate energy that occurs with aging.
In study reported in the journal Cell Metabolism of March 7, 2017, Dr. Sreekumaran Nair looked at two different age groups performing three different types of exercises. He took a cohort of younger people ages 18-30 years old and compared them to a group 65-80 years old, and assigned them to either high-intensity interval biking, strength training, or a combination of both. After three months, muscle biopsies were taken from their thigh muscles and they were compared to the muscles of sedentary volunteers. They also looked at the participant's muscle mass and insulin sensitivity, a marker for the development of diabetes.
Here is what they found: There is no doubt that strength training increases muscle mass more, but the high-intensity interval training, on the cellular level was more effective. Younger volunteers increased mitochondrial activity 49%, but the older exercisers increased mitochondrial activity 69%. Mitochondria are the power generator of the cell. The mitochondria take in nutrients and turns these nutrients into energy. It is known that the activity of mitochondria decreases as we age, which would decrease the ability of the muscle cell to metabolize sugars. This decline was reversed in the older group that did the interval training, and the results were similar to what was seen in the younger group. Oxygen consumption increased in the interval trainers vs. the weight trainers. The group that combined weight training and interval training demonstrated intermediate results. Additionally, they found that exercise increased protein production in the mitochondria, but also proteins that increased muscle mass.
Muscle cells don't multiply in the body, so maintaining the cells that we have is important, and even at older ages, we can still significantly build these cells and increase their metabolic function. Go for it!!
News and Technology, 7 March 2007, Best anti-aging exercise is high intensity interval
training, by Andy Coghlan
Cell Metabolism, Volume 25, Issue 3, p581, March 2017, Enhanced Protein Translation
Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training
Modes in Young and Old Humans
Science Daily, March 7, 2017. How exercise--Interval training in particular--helps your mitochondria stave off old age
Doctors are finding an increased incidence of throat and tongue cancers that are HPV related. The more common type of throat cancer occurs in those exposed to cigarette smoking and alcohol. The HPV related cancers are more often found in younger men and less often women, middle-aged, who can present with an enlarged lymph node in the neck, or discomfort in the throat that does not resolve. The tonsils seem to be vulnerable. The good news is that this type of throat cancer is more responsive to treatment.
Although there is no screening test for HPV of the throat, a careful exam done at the time of a dental visit is very important. If there is an enlarged lymph node or mass in the neck or mouth, or persistent discomfort in the throat, an exam or additional tests, can be done that can indicate if an HPV related cancer is present.
Less then 50% of children receive the HPV vaccine, which is usually given to boys and girls at the age of 12. It is believed that many cases of HPV related cancer can be avoided if the vaccine is more widely utilized.