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MenoPause Blog

  • Approaching menopause? Don’t forget about birth control

    by Margery Gass | Nov 06, 2014
    If you’re having hot flashes and other menopause symptoms but still getting your period now and then, there is a slight chance you could become pregnant, unless you have already taken care of that. If not, and if you would like to avoid pregnancy, birth control is recommended until one year after your last period. Many options are available for midlife women:

    • Birth control pills, patches, or rings—added benefits include more regular cycles with perhaps lighter bleeding, perhaps fewer hot flashes and a reduced risk of cancer of the uterus and ovaries. Note that these methods are not recommended for women who are smokers over age 35, have high blood pressure, migraines or who have had a blood clot in their legs or lungs. 
    • Progestin-alone pills, implants and injections—a potential option for those who smoke, have certain cancers,  high blood pressure, diabetes (without kidney, retina, or neurologic complications), history of blood clots, or obesity. These conditions should be discussed with your healthcare provider.
    • Barrier methods (condoms, diaphragm, spermicide)—condoms are the only method than provides some protection from HIV and other sexually transmitted infections. Note that these methods depend upon one of the two partners using the method with intercourse every single time.
    • Intrauterine devices with or without hormones—safe, highly effective, convenient, and long-term.
    • Sterilization (Tubal ligation, fallopian tube inserts, or vasectomy for men)—very effective and permanent methods, but require a surgical procedure.
    • Note that the last two methods, as well as progestin implants, require procedures that produce long-lasting contraception. They are highly effective, but they are more costly up front and in the short term. If you are quite close to menopause, they may not be worth the cost and the necessity of undergoing a procedure. 
    For all of these methods be sure to review the pros and cons with your healthcare provider in order to be sure the method is a good choice for you.
    Go comment!
  • Invitation to women with low desire and sexual dysfunction

    by Margery Gass | Sep 23, 2014

    The time has come. This is your opportunity to discuss your concerns and to share your thoughts on the need for treatment with the United States Food and Drug Administration (FDA). There have been many products brought to market over the last 15 years for male sexual dysfunction, but we still have nothing for women.

    The most common female sexual dysfunction is female sexual interest/arousal disorder, often referred to as “low desire” or “low libido.” The FDA wants to hear from women who have this condition. How does it affect your life? What is the most distressing aspect of it? Has anything helped?

    On October 27, 2014, the FDA is holding a Patient-Focused Drug Development public meeting on Female Sexual Dysfunction in Silver Springs, Maryland. You can apply to appear in person or submit your comments online. Webcast participants will also have an opportunity to provide input through webcast comments. A panel of patients and patient advocates will present comments to start the dialogue, followed by a facilitated discussion with all patients and patient representatives in the audience. I will be there in person in the audience to hear your comments, and I will also be participating on the scientific panel the following day.

    All parts of the event are free but you must register online and by October 20, 2014. For event details and to learn more visit Eventbrite: Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction event page.

    For more information, refer to the FDA meeting website.

  • Do you need a yearly pelvic exam?

    by Margery Gass | Aug 22, 2014

    Some medical societies are calling into question the annual pelvic exam, at least for those women who have no symptoms and are not pregnant. As you might expect, this topic is being hotly debated.  

    Those in favor of annual screening pelvic exams argue that sometimes there are abnormalities found in women who have no symptoms. Those opposed to the yearly exam counter that the pelvic exam is not helpful in detecting ovarian cancer or  bacterial vaginosis, and was not associated with improved health outcomes or reduction of ovarian cancer mortality rates. They further point out that women can now screen themselves for the common sexually transmitted infections like chlamydia and gonorrhea in the privacy of their own homes.

    Harms of testing included false positives, unnecessary surgical procedures, fear, anxiety, embarrassment, pain, and discomfort – particularly for women with a history of sexual violence and/or post-traumatic stress disorder.

    Pelvic exams should be tailored to what is in the best interest of each individual woman. Most women do not need a pelvic exam every year but should be sure to see a healthcare provider if they have a new problem or concern. It is important to remember that screening for cervical cancer (with a pap smear, cervical cytology or high risk human papilloma virus test) is still recommended. That is a separate and important issue. The timing interval for cervical cancer screening depends on your age and the findings on your last pap smear.

    Go comment!
  • Video from our 2013 meeting: Physical therapy for painful sex

    by Margery Gass | Nov 19, 2013
    Over the next weeks, we’ll be sharing highlights from our October meeting in Dallas, Texas. First up, physical therapist Hollis Herman gets frank and funny on the topic of sex after menopause and pelvic floor problems in women. 

    She explains comfortable positions for those with hip problems and pelvic pain, what you need to know about lubricants and dilators, and the location of the g-spot. You’ll learn fun facts (did she say boomerang?) and vital information about sexuality and aging. Frankly, it’s a must-see.

    Watch it here

    Go comment!
  • 7 tips for better sex after 50

    by Margery Gass | Aug 01, 2013
    I recently compiled some tips for better sex after age 50 for the Cleveland Clinic—here’s the quickie version of the list:

    1. Practice, practice, practice. Remaining sexually active preserves the physical functioning of your vagina.
    2. Lubricate and moisturize if you’re experiencing dryness.
    3. Don’t be shy—talk to your healthcare provider about any sexual problems you are experiencing.
    4. No libido? Therapy may help. Relationship issues may be related to a lack of desire.
    5. Think your sex life could be better? Talk it through and share your feelings with your partner.
    6. Talk a walk—and do it regularly. Exercise will make you feel and look better.
    7. Try something different. Different sexual positions can make intercourse more comfortable and more interesting.
    For more detailed sexual problems and solutions, read the full article and visit our Sexual Health & Menopause module.

    Go comment!
  • Menopause and the volatile vagina

    by Margery Gass | Sep 27, 2012
    Bothersome symptoms of the vagina and vulva occur in women of all ages, but they become much more common around menopause. Loss of estrogen at this time is a major cause of vaginal dryness, itching, burning, discomfort, and pain during intercourse. These symptoms range in severity from mild annoyance to a point where they significantly affect a woman’s quality of life in the following ways:

    • Vaginal atrophy. Tissues of the vulva and the lining of the vagina become thin, dry, and less elastic.
    • Decreased lubrication. Lack of lubrication is due to diminished vaginal secretions.
    • Pain with intercourse. With severe vaginal atrophy, the tissues of the vagina become dry and sometimes fragile and inflamed. As a result, they are more prone to injury, tearing, and bleeding during sexual intercourse or even a pelvic exam. Over time, especially in the absence of regular intercourse, the vagina may also become shorter and narrower. The resulting discomfort can intensify to the point where sexual intercourse is no longer pleasurable or even possible.

    Treatment options:
    • Vaginal moisturizers. Available without a prescription, these nonhormonal products help maintain vaginal moisture in peri- and postmenopausal women. Just like moisturizing your face or hands, the vagina should be moisturized on a regular basis, usually twice weekly at bedtime. There are many effective brands, including Replens and K-Y Long-lasting Vaginal Moisturizer.
    • Vaginal lubricants. These products reduce discomfort with sexual activity when the vagina is dry by decreasing friction during intercourse. There are many options and you should find one that works for you and your partner.
    • Regular sexual stimulation. Intercourse promotes blood flow to the genital area, helping to maintain vaginal health.
    • Developing expanded views of sexual pleasure. If vaginal penetration (intercourse) is difficult or uncomfortable, consider so-called “outercourse” options such as extended caressing, mutual masturbation, and massage. More and more women are using vibrators  for sexual pleasure.
    • Local prescription therapy. For vaginal dryness and discomfort that does not respond to over-the-counter lubricants and moisturizers, low doses of local vaginal estrogen therapy are very effective and safe. Local estrogen increases the thickness and elasticity of vaginal tissues, restores a healthy vaginal pH, increases vaginal secretions, and relieves vaginal dryness and discomfort with intercourse. Government-approved products are available as vaginal creams, a vaginal estradiol tablet (used twice weekly), and a vaginal estradiol silastic ring. All are highly effective.
    • Systemic prescription therapy. Low doses of systemic estrogen in the form of a pill or skin patch used to treat hot flashes are also effective for treating vaginal dryness, although some women might benefit from adding local treatment to their systemic treatment to relieve discomfort. If only vaginal symptoms are present, local therapy described above is recommended.
    • Vaginal dilators. After many years of severe vaginal atrophy, especially if sexual intercourse is infrequent, the vagina may become so shortened and narrowed that it cannot accommodate an erect penis. In addition to regular use of vaginal estrogens and moisturizers, some women also may require several months of daily “exercises” with lubricated vaginal dilators to stretch and enlarge the vagina. Once intercourse becomes comfortable again, dilators typically are no longer needed, as the vagina remains healthy with regular intercourse and low-dose local estrogen therapy. Dilators may be purchased from pharmacies, medical supply stores, and online, and should be used under the guidance of a gynecologist, physical therapist, or sex therapist.
    With their healthcare provider, women can assess the symptoms, causes, and treatment for vulvovaginal distress and find a comfortable and healthy solution for their distress. For more information, visit the sexual health section of our website.

    Go comment!
  • Moisturize to stay sexy! (We don’t mean your face.)

    by Margery Gass | Sep 18, 2012
    You may need moisturizing in more than one place. After menopause, your vagina can become thin and dry, especially if you are not using it regularly. Using estrogen in the vagina is one way to ease the problem, but non-hormonal, non-prescription options are available in the form of vaginal moisturizers or lubricants. Moisturizers are absorbed into and cling to the vaginal lining like natural secretions, and they can last a few days. Lubricants reduce friction and are used right before sex. Go for water-based or silicone-based lubricants and not oil-based ones, which can cause irritation and make it easier for condoms to break. Learn more here.
    1 Comment

MenoPause Blog

We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

JoAnn V. Pinkerton, MD, NCMP
Executive Director



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