What we know
As women reach menopause and estrogen levels decline, the most noticeable symptoms can be changes to the vagina and vulva, or the “lips” of the vagina. Up to 50 per cent of postmenopausal women report experiencing some vaginal dryness, soreness or painful sex. Bladder function is often a concern as a woman ages as well. Left untreated, these symptoms can become serious health problems, leading to more frequent urinary tract and vaginal infections, urinary incontinence and bleeding.
Incontinence
When women have leaking from the bladder, they have what is called “urinary incontinence”. This problem comes in three forms:
- Urge Incontinence - Failure of the bladder’s capacity to store urine resulting in the feeling that you need to go to the bathroom even right after you have just done so.
- Stress Incontinence - Failure of the urethra or the "valve" which closes the bladder, resulting in urine leaking out of the bladder when you sneeze or cough, or are vigorously active
- Mixed Incontinence - Both stress and urge incontinence at the same time.
It’s also true that hormonal changes in our bodies during perimenopause and menopause will likely have an impact on our sexuality. This means you might become more interested in having sex, or lose your desire altogether. Often women will notice that they have less vaginal lubrication when they are intimate.
These symptoms and feelings are normal and can be addressed when communication with a partner and a health care professional is open and comfortable.
Emotions Change
Menopause can be a time of great emotional upheaval for women. The changes in our bodies will likely have an impact on the way a woman feels about her body and her sexuality. Sadness and guilt can be companions to a reduced level of interest in sexual activity. When intercourse becomes painful, women avoid sex, and relationships may suffer as a result. On the flip side, the freedom from concerns about possible pregnancies can remove a lot of stress and worry.
Since sexuality is linked to a person’s physical and psychological make up, it can take some time to find the solutions that restore both sexual function and confidence after a physical or emotion problem has turned up. It is often a good idea to turn to qualified health professionals for counseling support.
Treatments
There is no need for women to worry silently, or suffer unnecessarily, when menopause symptoms begin to affect their health and their sexuality. Various medications (some taken by mouth and others applied as creams), pelvic exercises, counseling and lifestyle changes can lessen, or eliminate vaginal and/or bladder problems all together. There are even surgeries that can be investigated.
Estrogen therapies (e.g. oral medication, local creams and rings), antibiotics and a variety of applied creams can be successful in dealing with vaginal problems. And when you apply estrogen cream locally, that is, you don’t swallow a pill, you just apply it to the vagina, you don’t need to be concerned about any of the potential concerns related to estrogen therapy; the hormone is not absorbed into the bloodstream.
Hormone therapies may also be recommended for women who have had a hysterectomy, or what is often called a surgical menopause.
A variety of lifestyle, non-surgical support devices, and surgical options are available to address urinary tract issues as well. Sometimes it is as simple as pelvic exercises, such as the Kegel exercises that are recommended after childbirth, that strengthen muscles in the pelvic floor, or even the use of a mechanical support device such as a pessary, which can be inserted into the vagina to support the urinary tract and its function. Physicians and other health professionals can help you figure out what will work best for you if you have these kinds of symptoms.