Women's health

Intimate health during and after menopause

by Yulia Borukh
April 7, 2021
9 minute read
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Many women think if they stop menstruating or not much sexually active – they do not need to see gynecologist.

On one side if nothing is bothering it is already a positive sign, but women do not really need to wait for the warning symptoms of the disease and then rush to the doctor. It is recommended that women after 50 should see their gynecologist once a year. During routine GYN exam, women is also screened for breast cancer, Pap smear (screen for cervical cancer), annual mammography and, of course, STD (sexually transmitted disease) screen (yes, in United Stated over 20% of women after age 50 return positive for chlamydia and gonorrhea).

But how about sex life? Does it really exist after age of 50? According to the recent studies up to 70 % of women after age 50 have intimacy at least once a week; and women ages 60-70 reported sexual activity at least once a month. So, turning 50 years old does not mean you cannot enjoy your private life. While many women face health challenges, they age, many still can enjoy a satisfying sex life. So, let us talk about some myths and truths.

Q: My mom is 69 years old. She is healthy and does not want to go to a regular doctor or gynecologist. Should I insist?

A: Well, if your mom is feeling well, active and a happy woman at 69 – it’s already good news. And she can make an informed decision for herself that should be respected by us. However, you might discuss with her recent health recommendations. I usually go together with my mom to certain doctors like dermatologist. This is our «mother-daughter» time. We visit doctor, do some blood work and necessary screening tests and then go for dinner together.

So here is my health recommendation list for women after 50 years old:

· Blood work (sugar, cholesterol)

· Check Blood Pressure

· Vaccination (Pneumococcal, Herpes Zoster and now COVID-19)

· Annual mammography

· Pap smear (screen for cervical cancer) and STD – can be stopped at age 75. For high-risk group (strong family history of ovarian/endometrial cancer- consider genetic blood test BRCA)

· Colonoscopy – start at 50 (and then every 10 years)

· Osteoporosis screen – start at 50 (and then every 5 years)

· Once a year – Dermatology, Ophthalmology and Dental

Q: I am 68 years old, and I lost my husband 8 years ago. I do not have a sexual partner and I feel fine about it. But I heard its bad for my health if I do not have a regular sex life.

A: It is not true at ALL. If you do not have a sexual partner and you are OK about it – it will not hurt your health and wellbeing. Your emotional wellbeing and how you feel about having or not having regular intercourses is the most important. Every woman is different in her intimately needs and there are many other ways to be happy. In some married couples, health and the diminished sex drive are the reasons men cannot have sex.

Showing affection for each other (such as kissing or holding hands) and mutual respect are the major drive for a happy and long relationship.

Q: I am 55 years old. With severe hot flashes waking me up almost every night. I am afraid taking hormones because I heard it can cause cancer.

A: Hot flashes affect almost 60-80% of all women in menopausal period. Hot flashes present as a sudden flow of hot air to the face, radiating through the whole body. This can last about 2-4 minutes. For some hot flashes appear once a day and for others every hour, making woman’s’ life intolerable. While there are many non-hormonal options exist, the best management of the hot flashes is HRT (hormone-replacement therapy). Yes, not every woman can have HRTs and every woman is assessed individually since we give HRTs for shortest period of time and in smaller possible doses. Before initiating HRT, women can try few non-hormonal options to help with their hot flashes:

· weight loss, exercise, and yoga – all help to increase circulation and help to alleviate frequency and intensity of hot flashes.

· over-the- counter herbal remedies such as primrose oil, black cohosh, soy supplements, ginseng, and wild yam.

· Increase diet with Soy-containing products.

· for night sweats – wear cotton night gown and have extra near bedside along with extra bed sheets.

If all the above does not work, the next step is FDA-approved HRT (hormone-replacement therapy). According to 2020 ACOG statement (American College of Gynecologist and Obstetricians) HRTs are safe and amazingly effective in managing severe hot flashes. Besides helping to alleviate hot flashes, HRTs help in improving cardio-vascular health and prevention of osteoporosis.

Women with strong Family history of breast cancer, personal history of undiagnosed breast lumps or personal history breast cancer – Are NOT candidates for HRTs.

HRTs is a combination of estrogen and progesterone. Today we use estrogen (E2) that is exact analog that produces by woman’s ovaries. If woman still has her uterus – we add micronized progestin to her HRT regiment to protect her endometrial lining from estrogen overstimulation. HRTs are coming in many different forms such as pills, patches, rings, creams, and gels.

Also, I do NOT prescribe HRTs as a «youth medication». This therapy is only used for symptomatic management of menopause symptoms and not as reversing aging.

Q: I am 66 years old. Me and my husband are still very much intimate. We use over-the-counter vaginal lubricant, however lately it is not working. After each intercourse I have vaginal burning and irritation.

A: Vaginal atrophy is quite common and very real complaint of post-menopausal women. It is very bothersome in sexually active women as well as non-sexually active. It is often presented as burning on urination and many times mistaken for cystitis. After menopause vaginal lining becomes thinner and dryer, leading to itching and burning and often making intercourses painful. There are hormonal and non-hormonal ways to improve this matter.

Water-based and silicone-based vaginal lubricants help to lubricate vagina during intercourse to relieve extra friction. They are not absorbed by the vaginal walls and do not provide long-lasting relief thus has to be applied right before or during intercourse.

REVAREE – a non-hormonal vaginal moisturizer. It is made from Hyaluronic acid (HA) that helps to retain moisture in vaginal lining and helps with lubrication. It comes in a form of vaginal capsule and can be used on a regular basis. The only downside is – the price. One pack of 10 REVAREE capsules cost about $40.

Vaginal estrogen – low-dose vaginal application of estrogen works fast and restore vaginal lining most effectively. Because declining estrogen levels are typically cause vaginal dryness, it makes sense that bringing levels into normal range can help to restore vaginal health.

Ladies remember! Life does not stop at menopause, so make sure you are getting women’s health care you need! Staying healthy is important for you physical, mental, and emotional well-being. You are in control and we are here to help you to achieve your maximum health no matter how private and intimate the issue might be.

Gynecologist with 25 years of experience Dr.Yulia Borukh, DNP, CNM.