Sexual Wellness

Intimacy is Possible After Menopause

February 20, 2023

By: Rachel Noonan, PharmD

Menopause is no stranger to sexual dysfunction. Its slow and steady build is surprisingly pervasive.  Symptoms cast in a supporting role end up taking the lead. Sexual problems can be hard to talk about. Which is why many patients don’t.

Vaginal atrophy is just the beginning. Localized dryness can contribute to painful intercourse. Libido declines while your patients find sexual intimacy less enticing. The REVIVE (Real Women’s Views of Treatment Options for Menopausal Vaginal Changes) survey revealed 59% of postmenopausal patients experience decreased enjoyment of sexual activity due to symptoms. Underdiagnosed and undertreated, sexual health often gets buried beneath less complicated concerns.

These progressive issues require attention. Menopausal sexual dysfunction generally stems from steep estrogen decline. Estrogen optimization can

  • Thicken the vaginal mucosa to promote healthy tissue
  • Improve vaginal secretions and circulation to address dryness
  • Lower vaginal pH to restore natural flora

It’s reported that once estrogen therapy is on board, nearly all patients experience a level of symptom relief. Months of vaginal distress or sexual upset may show improvement after mere weeks of hormonal alignment. Consistent therapy is essential.

How to paint a picture of sexual health? Different strokes for different folks.  Not all sexual dysfunction therapies begin and end with estrogen.

Dehydroepiandrosterone (DHEA) metabolizes into sex hormones, activating these receptors along the vaginal wall with local administration. Daily dosing may translate to healthier vaginal epithelium and decreased sexual pain.

Testosterone is considered the hormone of sexual desire. It’s thought to act on dopamine pathways in the brain, affecting receptivity and intimate interest. When optimized, it can positively impact sexual function and limit distress.

Oxytocin can enhance intimate feelings, sensitivity, and openness to sexual activity. Systemic options have great promise addressing libido fluctuations. Targeted vaginal formulations may reverse tissue decline.

Age related hormonal changes can negatively impact sexual health. From localized therapy to systemic options, you and your patients deserve unparalleled support. Many patients discontinue vaginal therapy after a few months. Reasons range from irritating dosage forms to frustrating discharge. That’s where customizable compounds come in, designed to fit individual need. When hormonal unpredictability goes up against therapeutic adaptability, it’s no contest.

References

  1. Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013 Jul;10(7):1790-9. doi: 10.1111/jsm.12190. Epub 2013 May 16. PMID: 23679050.
  2. Labrie, Fernand MD, PhD; Archer, David F. MD; Koltun, William MD; Vachon, Andrée MD; Young, Douglas MD; Frenette, Louise MD; Portman, David MD; Montesino, Marlene MD; Côté, Isabelle BSc; Parent, Julie PhD; Lavoie, Lyne MSc; Beauregard, Adam BSc, MBA; Martel, Céline PhD; Vaillancourt, Mario BSc, MBA; Balser, John PhD; Moyneur, Érick BSc, MA members of the VVA Prasterone Research Group Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause, Menopause: March 2016 – Volume 23 – Issue 3 – p 243-256 doi: 10.1097/GME.0000000000000571
  3. Liu N, Yang H, Han L, Ma M. Oxytocin in Women’s Health and Disease. Front Endocrinol (Lausanne). 2022 Feb 15;13:786271. doi: 10.3389/fendo.2022.786271. PMID: 35242106; PMCID: PMC8886718.
  4. Marko KI, Simon JA. Androgen therapy for women after menopause. Best Pract Res Clin Endocrinol Metab. 2021 Dec;35(6):101592. doi: 10.1016/j.beem.2021.101592. Epub 2021 Oct 12. PMID: 34674962.
  5. Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018 Jul 31;10:387-395. doi: 10.2147/IJWH.S158913. PMID: 30104904; PMCID: PMC6074805
  6. Parish SJ, Hahn SR, Goldstein SW, Giraldi A, Kingsberg SA, Larkin L, Minkin MJ, Brown V, Christiansen K, Hartzell-Cushanick R, Kelly-Jones A, Rullo J, Sadovsky R, Faubion SS. The International Society for the Study of Women’s Sexual Health Process of Care for the Identification of Sexual Concerns and Problems in Women. Mayo Clin Proc. 2019 May;94(5):842-856. doi: 10.1016/j.mayocp.2019.01.009. Epub 2019 Apr 4. PMID: 30954288.
  7. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.
  8. Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. Medicina (Kaunas). 2019 Sep 2;55(9):559. doi: 10.3390/medicina55090559. PMID: 31480774; PMCID: PMC6780739.
  9. Shim S, Park KM, Chung YJ, Kim MR. Updates on Therapeutic Alternatives for Genitourinary Syndrome of Menopause: Hormonal and Non-Hormonal Managements. J Menopausal Med. 2021 Apr;27(1):1-7. doi: 10.6118/jmm.20034. PMID: 33942583; PMCID: PMC8102810.
  10. Sinković M, Towler L. Sexual Aging: A Systematic Review of Qualitative Research on the Sexuality and Sexual Health of Older Adults. Qual Health Res. 2019 Jul;29(9):1239-1254. doi: 10.1177/1049732318819834. Epub 2018 Dec 25. PMID: 30584788.