Hi, I'm Dr. Jen Gunter.
I'm an ob-gyn and
author of The Menopause Manifesto,
and I'm here to answer some
questions.
When I was on tour for the Vagina
Bible, at almost every
stop -- at every stop, there were
questions about menopause, totally
unrelated to the vagina.
They weren't like, "My vagina is
dry" questions, they
were questions about, "Should I be
taking hormones?" "I have depression
--", you know, all these sort of
intricate questions.
And I was like, wait a minute.
Like, how does nobody know this?
The vagina and the vulva are
rated as shameful by this
patriarchal system that we're in.
You can't talk about it.
It's down there. But there's still
whispers about it.
And it's on the cover of women's
magazines, like
traditional women's magazines like
Glamor. They always want to tell you
about vaginal mayhem.
They're interested in scaring you
about the vagina and all that
because that it sort of ties into
purity culture, patriarchy.
But nobody was
having conversations about
menopause, and I started looking
around and I was like, wow,
that's totally been erased from our
public discourse.
So, menopause is the planned
end of ovarian function
that happens around the average
age of 51, but
there are many symptoms that are
kind of a lead-up in the years
before called the menopause
transition.
Menopause itself is said to happen
sort of a year
after your final period -- because
you don't know it's your final
period until it's your final period.
But looking back, you'd say
you're menopausal from the age of
your final period onwards.
The menopause transition is
what's often referred to also
as pre-menopause or perimenopause,
and that is that time period leading
up to the final menstrual period.
And that's kind of a time of
hormonal chaos.
The ovaries are sometimes making
more estrogen than normal, sometimes
less. Sometimes there's breaks in
between.
And the menopause transition is
really like puberty in reverse.
There is an
increased risk of having
depression triggered during the
menopause transition, and
there's also an increased risk of
anxiety as well, and that can be
super complex because
when people have hot flushes or hot
flashes, they can also feel anxious
from that. And so the symptoms can
kind of overlap and it can be hard
to tell which is which.
So I would say that somebody with a
history of depression and anxiety
should really just be on the lookout
to make sure that they're not having
a worsening in their depression or
anxiety, and if they do, to
really bring that up with their
health care provider, if
there's treatment available or they
need to change a therapy or maybe
even for some people, there may be
a consideration for menopausal
hormone therapy to sort of even
things out.
It's going to depend on an
individual case-by-case basis.
But I think just having the
knowledge and being aware of that
possibility is really empowering.
So, menopause can
affect sex drive and
it can also affect sexual
performance. So we'll talk about
performance first, meaning from a
pain standpoint.
If you're someone with a vagina and
you have
a decrease in estrogen, you may very
well get vaginal dryness.
You may get discomfort with
additional penetration.
And obviously, if
it hurts to be touched, you're not
going to want to be touched.
And that absolutely affects libido
drive.
And there is great therapy for that.
There's all kinds of treatments.
There's vaginal estrogen, and
there's also a vaginal DHEA
product, which is sort of like a
prodrug to estrogen.
And those drugs are not absorbed
into the bloodstream.
We often even use these medications
for trans men
who are taking testosterone because
sometimes that can have some effects
in their vagina.
And we even use these medications
for people who might be having
vaginal dryness earlier in their
life for other reasons.
And so they're really very
safe, they're very
effective, and we can replace
the hormones vaginally in a variety
of different ways. So basically, it
can be customized for you -- I would
say that's really the answer.
So, making things so they don't
hurt is one way.
Also, too, there
are so many amazing over-the-counter
moisturizers that can be really
useful, and they're bio adhesive,
meaning they cling to the tissues.
So you insert them about every
three days and that can also
help a lot with vaginal dryness.
So there's some really good therapies
for that.
From a sex drive perspective,
that's far more complicated and
that's really more like a puzzle.
For some people, there is an
increase in loss of
libido associated with menopause,
and the exact reason isn't
known because hormone levels
are actually not predictive of sex
drive.
So, for example, if you're someone
who's had depression that's been
triggered during your menopause
transition, that can affect sex
drive. If you have pain, that can
affect sex drive.
If you're not sleeping well because
of hot flashes at night or you've
developed sleep apnea, which starts
to increase during menopause
transition, those are all
going to affect libido.
And then also, for someone who's
in a long-term partnered
relationship, libido waxes
and wanes over time as well.
And we have to also learn
to tolerate the lows as well as
celebrate the highs.
And so for for
many people, there's a fantastic
book that I always recommend by
a Canadian expert in libido, Dr.
Lori Brotto, Better Sex
Through Mindfulness -- and so there
are many other
fantastic resources from sex
therapists to
help with that as well.
And that's usually the sort of go-to
initial treatment, working
with a sex therapist. And there
are medications for libido, but
in general, the results are
pretty underwhelming,
I would say.
And they also really
have only been tested in
heterosexual relationships.
And I'll also add that they
are tested really in heterosexual
relationships that don't really
apply even to sort of
how I would apply it to the general
population in the sense that
most people in the studies are
already having a fair amount of sex,
and so
you're getting an increase of maybe
like one episode a month.
And so we don't have any ways
to translate these drugs to people
who are having sex once or twice a
year.
So, how we would translate that
to the general population who
is not a heterosexual couple already
having sex a couple of times
a month, we just don't know.
People are always shocked to find
out that hormone levels don't really
predict libido and menopause.
There's women who have higher levels
of testosterone, who have low
libido, and women who have rock
bottom levels of testosterone who
have very high libido.
I'm not a testosterone researcher in
any way, but
I think that we've
been sold a bill of goods
about testosterone because
it's been -- a lot of, part
of patriarchal messaging for a long
time.
And so I think that we've only
heard one part of the story, right?
But hormones are super complicated,
just like the people who have them.
And to assume that one hormone
is always going to do one thing for
every person, especially something
as complex as testosterone is -- or,
all
hormones are super complex
-- the answers are not usually
yes or no or always or never.
And for example,
as I mentioned in the book, women
who have polycystic ovarian
syndrome, which is a condition with
disordered ovulation, they typically
have higher levels of testosterone
and they don't have higher levels of
libido.
You can find me on Twitter
@DrJenGunter, on Instagram,
at @DrJenGunter, I have a Substack
called the Vajenda -- with a J, play
on words -- and I have
a new podcast with the Audio
Collective called Body Stuff with
Dr. Jen Gunter.
The book is The Menopause Manifesto,
and it was published on May
25th, and you can get it everywhere
that you can buy books.