2 Overview The menopause transition Sexual changes during and after menopauseEarly menopauseHormone replacement therapyAging and sexuality in men and womenThe “andropause” - male menopause?
3 Menopause Ovaries become less responsive to FSH and LH Patterns of GnRH release from the hypothalamus become alteredPituitary gland becomes less responsive to GnRH
4 Perimenopause Average age at onset in the late 40’s Irregular menstrual cyclesSomatic and psychological symptoms emerge
5 Post-menopause 12 months of amenorrhea Elevated FSH levels On average, reached by the early 50’s
6 No! The ovaries continue to produce androgens after menopause! Is that all?No! The ovaries continue to produce androgens after menopause!
7 Factors that may affect timing of menopause SmokingGeneticsNumber of pregnanciesBody mass
8 Symptoms of menopause Hot flashes Mood swings Vaginal dryness Vaginal atrophyFatigue, weight gain, sleep disorders, headache, cognitive changes…..
9 Menopause across cultures Do all women experience menopause as a major negative life event?
10 www.agelessforever.net www.youngeryounger.com www.no-wrinkles.com “Study after study documents the astonishing effects that estrogen makes women not only feel better but healthier. Estrogen vastly improves the quality of day-to-day life for women by making them more youthful, energized, and healthier.”–
11 Sexual changes at menopause Decreased sexual desireLower levels of vaginal lubricationMore painful sexual intercourseWhat doesn’t change?
12 Early menopause Surgical menopause Removal of the ovaries, usually accompanied by hysterectomyMenopause induced by treatment for cancerRadiation therapyChemotherapyEarly natural menopause
13 Early natural menopause Autoimmune disordersGeneticsProblems in ovarian developmentChromosomal irregularityTriple X syndromeFaulty second X chromosome
14 Hormone replacement Estrogen: systemic or local Estrogen + progesteroneAndrogen replacement?Potential benefitsPossible side effects
15 Aging and sexualityHow do you tell what is caused by menopause and what is caused by natural aging?A recent longitudinal study concluded that sexual arousal and orgasm are affected by both aging and menopause
16 Sexuality in the elderly Healthy sexual relationships may continue into old ageCommon problems associated with aging include:Sexual dysfunctionDeath of partnerCultural attitudes towards sexualityHealth problems
17 The “andropause” Progressive decline of androgens over time Symptoms: erectile dysfunction, cognitive impairment, fatigue, vague somatic symptoms40% of men have ED by age 40Over two-thirds of men by age 70Is the andropause a disorder?