The facts about sexual health and the menopause
You can run but you can't hide - at least if you're a woman. The average age of the menopause is 51, but any time from 45 is quite normal. The menopause is technically the time you have your last period, but of course you don't know that at the time! Most women get hot flushes, which can start before their periods stop but usually settle within 2 or 3 years of the menopause.
Even if you're well past the broody stage, knowing you can't have children can make you feel less feminine. Mood swings are common, and it can be hard to tease out the cause. There are often lots of other major life events at the same time - the 'empty nest', maybe starting to think about early retirement or feeling stuck in a rut with your job. Even worse, lots of the symptoms of the menopause have an impact on your love life - perhaps at a time when you've found love second time around.
A word of warning - sexually transmitted infections among women in their 50s and 60s are on the up - you may not have to worry about pregnancy, but do stay safe.
Losing that loving feeling
Loss of libido is common after the menopause. It can be down to hormone changes, but the psychological impact of going through the change is a remarkably common culprit. Painful sex because of vaginal dryness can also be a driver, so do read on for possible solutions. Plan a special evening with your husband or partner with no distractions and get into a romantic mood; and most importantly, talk to him gently about it. He may be relieved to know it's not that you've gone off him.
Dryness down below
Unlike hot flushes, vaginal dryness after the menopause is here to stay. It's caused by a permanent drop in the levels of your female hormone, oestrogen. Sometimes it just causes problems in the bedroom, but it can cause soreness and make you prone to vaginal and urine infections. It can also make incontinence - particularly stress incontinence - worse.
If your only issue is during intimacy, try a simple lubricant during love-making - avoid anything perfumed to cut the chance of irritation. For more severe problems, hormone replacement tablets or a topical oestrogen cream may be needed. There are also non-hormonal vaginal moisturisers called Replens®, Sylk® and Hyalofemme® available from pharmacies - apply a couple of times a week for lasting relief.
Soreness can be due to menopausal hormone changes, but the itchy white discharge of thrush affects women of any age. Do see your doctor - the solution could be as simple as a single pessary.
Vaginal prolapse - often described by my patients as a 'feeling of a lump down below' - can happen before the menopause. However, it gets more common after the menopause as low oestrogen levels make the tissues supporting your vagina less springy. The more children you've had and the higher your weight, the greater the risk. As well as discomfort and a sensation of heaviness, prolapse can cause problems with your bowels or waterworks. In mild cases, regular pelvic floor exercises and weight loss may be all that's needed. Specialist women's health physiotherapists do some great work in helping you strengthen your pelvic floor and reduce the impact of prolapse. Fitting a supporting vaginal pessary (done in minutes - you shouldn't notice it once it's in place - and changed every six months or so) can be highly effective. Many GPs now either offer this service themselves or can refer you to a community gynaecology service. If you're really struggling, your GP may refer you to a specialist to discuss surgery - there are several procedures which depend on your symptoms and preference.
One for the men
Erectile dysfunction is no laughing matter - it's estimated that one in four men over 40 have problems in the bedroom. It can have a huge effect on your relationship and self-esteem, so it's really important to speak to your doctor. Sometimes it's due to medication, including blood pressure-lowering tablets - speak to your pharmacist if you think this might be the cause. It can be down to furring up of the arteries - get your blood pressure and cholesterol checked - or complications of diabetes. It's easy to get into a vicious cycle - you can't perform once, so you get anxious next time, which means you can't 'perform', so you get more anxious. Medication can often help - and your GP will be far more sympathetic than you might think!
With thanks to 'My Weekly' magazine where this article was originally published.