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Menopause: Is There Life Beyond Hormone Replacement Therapy?

Post-HRT, what are women doing to manage menopause symptoms? And are compounded bioidenticals safe?

Are bioidenticals the answer? continued...

Bioidenticaldoses aren’t regulated. “The doses they’re promoting are much greater than what patients should be taking,” says Michelle Warren, MD, of the Center for Menopause, Hormonal Disorders, and Women’s Health at Columbia University Medical Center. And, because compounded hormones aren’t regulated, they carry no black box warnings, nor are there requirements to report adverse effects to the FDA.

Bioidenticals are chemicals. Many women mistakenly believe that compounded hormones are “all natural” and come straight from plants, but they’re actually chemically manufactured in a lab, Minkin says, and the actual compounded hormone product isn’t FDA-regulated. Experts say there’s no way to vouch for potency, purity, safety, or efficacy.

Menopause and sex

Flagging libido bedevils many women during menopause. Midlife is often jam-packed with major responsibilities: a job, a household, children, and aging parents among them. The stress, combined with hot flashes that create insomnia and fatigue, can drive sex to the bottom of a woman’s priority list.

What’s more, some menopausal women start to dread sex because it hurts. As estrogen levels drop, skin, eye, and vaginal tissues become drier. “I call it ‘the Sahara decade,’” Giblin says of the perimenopause years leading up to menopause. Vaginal tissues get thinner and less elastic. As a result, “the pain during intimacy can flatline sex.”

Gass also sees patients who are reluctant to acknowledge midlife dissatisfactions that interfere with sexual desire. “Take a big step backward and ... try to be honest about feelings you might have,” she advises. “Maybe the husband has gained a whole lot of weight and isn’t very attractive to the woman anymore, and yet they don’t want to admit that to themselves. In reality, things like that serve as a wet blanket to our libido.”

By bringing such problems into the open, women -- and their partners -- can find solutions that enable them to relish their sex lives again. For starters, a water-based lubricant can make intercourse more comfortable. If women still have pain, they should talk to their doctors about other options for treating vaginal dryness, such as vaginal estrogen creams and pills, moisturizers, and low-dose estrogen rings.

Some more good news: Having regular sex increases blood flow to a woman’s genital area, helping prevent vaginal pain that comes with menopause.

Menopause and healthy aging

Although menopause brings difficulties, the experience also prompts women to think anew about their health and sexuality -- and to consider future directions in their lives as they accept aging.

Easier said than done, but experts say Richardson and other women her age can look forward to a number of payoffs once they get through menopause: freedom from fear of pregnancy when menstruation stops, freedom to reignite a loving relationship after children leave home, and freedom to undergo a personal metamorphosis as another life stage begins.

To help chart her way through the big M, Richardson read everything she could “to understand what was happening to my body as it shifted into this new me,” she says. Her hope was “to recapture some of the things that I enjoyed when I was youthful ‘me’ and not feel embarrassed or ashamed about the changes my body was experiencing.

“I will take a ‘menopause’ to celebrate this midpoint in my life,” she adds. And to get the party started, reports Richardson, she has started to dance again.



Reviewed on April 24, 2009

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