Dr. N’s Guide to Menopause, Hysterectomy and Hormone Replacement Therapy

I was asked this question by “Liza” a 56 year old menopausal woman during her first visit to my office. Liza shared that she and her partner as had always cherished their intimacy and that their inability to have comfortable sex was a distressing problem for both of them. Historically she had her final menstrual cycle at age 49 and following had hot flashes, night sweats, insomnia and mild depression. She went to her primary physician and was prescribed an antidepressant which she stopped after a month at she didn’t like the way it made her feel and lowered her sex drive. After a few months she returned to her physician with a concern about vaginal dryness which was making sex uncomfortable and he suggested a number of over the counter lubricants. That seemed to help for a while but after about a year despite using a lubricant sex was again uncomfortable and became progressively worse until sex was inconceivable.

 

Liza was aware that this was somehow related to her menopause and told me that was why she had been referred to me.

I told her that I agreed and that her symptoms were unquestionably related to the hormone deficiency associated with her menopause and that I believed she would almost certainly be able to regain her previous sexual comfort. A medical exam and testing confirmed that hormone deficiency was the cause of her problems and she was treated with the hormones that were missing. Within a month she was feeling much better and at 3 months was back to her desired level of comfortable intimacy.

Liza wanted to know how her hormone deficiency had caused her problems and I tried to give her a general idea of the process.

 

Within 6 months following menopause in more than 90% of women the hormone dependent structures of the genitalia including the labia, vagina, clitoris, urethra and base of the bladder begin to atrophy. The labia and clitoris noticeably decrease in size and after several years cannot be visualized in some women. The vagina becomes dry and loses elasticity. The principle cause of painful sex is introital stenosis which is a narrowing, closing and loss of flexibility of the vaginal opening. The narrowing can be so complete that there is no visible opening.

The above description of the effects of hormone deprivation on the female genitalia is accurate but is a brief simplification.

 

If you would like to schedule an in office or virtual visit you are welcome to call my office: (248)644-7200 or email: jln35210@gmail.com or call me directly: (248) 421-3368