Sex,Sex,Menopause,Menopause,and Agingand Aging

OverviewOverview

The menopause transitionThe menopause transition Sexual changes during and after Sexual changes during and after

menopausemenopause Early menopauseEarly menopause Hormone replacement therapyHormone replacement therapy Aging and sexuality in men and womenAging and sexuality in men and women The “andropause” - male menopause?The “andropause” - male menopause?

MenopauseMenopause

Ovaries become less responsive Ovaries become less responsive to FSH and LHto FSH and LH

Patterns of GnRH release from the Patterns of GnRH release from the hypothalamus become alteredhypothalamus become altered

Pituitary gland becomes less Pituitary gland becomes less responsive to GnRHresponsive to GnRH

PerimenopausePerimenopause

Average age at onset in the late Average age at onset in the late 40’s40’s

Irregular menstrual cyclesIrregular menstrual cycles Somatic and psychological Somatic and psychological

symptoms emergesymptoms emerge

Post-menopausePost-menopause

12 months of amenorrhea12 months of amenorrhea Elevated FSH levelsElevated FSH levels On average, reached by the early On average, reached by the early

50’s50’s

Is that all?Is that all?

No! The ovaries continue to No! The ovaries continue to produce androgens after produce androgens after

menopause!menopause!

Factors that may Factors that may affect timing of affect timing of menopausemenopause SmokingSmoking GeneticsGenetics Number of pregnanciesNumber of pregnancies Body massBody mass

Symptoms of Symptoms of menopausemenopause Hot flashesHot flashes Mood swingsMood swings Vaginal drynessVaginal dryness Vaginal atrophyVaginal atrophy Fatigue, weight gain, sleep Fatigue, weight gain, sleep

disorders, headache, cognitive disorders, headache, cognitive changes…..changes…..

Menopause across Menopause across culturescultures Do all women experience Do all women experience

menopause as a major negative menopause as a major negative life event?life event?

www.youngeryounger.com“Study after study documents the

astonishing effects that estrogen makes women not only feel better but healthier. Estrogen vastly improves the quality of day-to-day life for women by making them more youthful, energized, and healthier.”

–www.youthtek.com

www.no-wrinkles.com

www.agelessforever.net

Sexual changes at Sexual changes at menopausemenopause Decreased sexual desireDecreased sexual desire Lower levels of vaginal lubricationLower levels of vaginal lubrication More painful sexual intercourseMore painful sexual intercourse What doesn’t change?What doesn’t change?

Early menopauseEarly menopause

Surgical menopauseSurgical menopause– Removal of the ovaries, usually Removal of the ovaries, usually

accompanied by hysterectomyaccompanied by hysterectomy Menopause induced by treatment Menopause induced by treatment

for cancerfor cancer– Radiation therapyRadiation therapy– ChemotherapyChemotherapy

Early natural menopauseEarly natural menopause

Early natural Early natural menopausemenopause Autoimmune disordersAutoimmune disorders GeneticsGenetics Problems in ovarian developmentProblems in ovarian development Chromosomal irregularityChromosomal irregularity

– Triple X syndromeTriple X syndrome– Faulty second X chromosomeFaulty second X chromosome

Hormone replacementHormone replacement

Estrogen: systemic or localEstrogen: systemic or local Estrogen + progesteroneEstrogen + progesterone Androgen replacement?Androgen replacement?

– Potential benefitsPotential benefits– Possible side effectsPossible side effects

Aging and sexualityAging and sexuality

How do you tell what is caused by How do you tell what is caused by menopause and what is caused menopause and what is caused by natural aging?by natural aging?

A recent longitudinal study A recent longitudinal study concluded that sexual arousal concluded that sexual arousal and orgasm are affected by both and orgasm are affected by both aging and menopauseaging and menopause

Sexuality in the elderlySexuality in the elderly

Healthy sexual relationships may Healthy sexual relationships may continue into old agecontinue into old age

Common problems associated Common problems associated with aging include:with aging include:– Sexual dysfunctionSexual dysfunction– Death of partnerDeath of partner– Cultural attitudes towards sexualityCultural attitudes towards sexuality– Health problemsHealth problems

The “andropause”The “andropause”

Progressive decline of androgens Progressive decline of androgens over timeover time

Symptoms: erectile dysfunction, Symptoms: erectile dysfunction, cognitive impairment, fatigue, cognitive impairment, fatigue, vague somatic symptomsvague somatic symptoms

40% of men have ED by age 4040% of men have ED by age 40– Over two-thirds of men by age 70Over two-thirds of men by age 70

Is the andropause a disorder?Is the andropause a disorder?