5 Things You Didn't Know About Menopause

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Most gynaecologists lack education and training on menopause.

"Most programs are not teaching menopause," says Gaudry. "We do our residencies to be excellent obstetricians, obstetrical surgeons and gynaecological surgeons. The majority of gynaecology has to do with reproductive health and the care of women during their reproductive lives."

But menopausal women face a different set of gynaecological health issues than younger women, which is why Gaudry is bringing attention to this disparity in ob-gyn education and experience. She advocates for a specialty in menopausal care.

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The year 2000 was bad news for menopausal women...

"The perfect storm happened in 2000," says Gaudry. "Viagra came out and all of a sudden men who couldn’t 'perform' now could perform—and well." It changed the sex lives of men and women overnight, with many women struggling to keep up with their partners.

Then in 2001, the Women's Health Initiative came out with findings that hormone therapy in post-menopausal women increased their breast cancer risk. These findings were based on oestrogen plus progestin therapy, a common combination hormone therapy. So at the same time men were being introduced to the wonders of Viagra, women were being taken off their hormone treatments.

"These women’s vaginas were dried up after stopping their oestrogen and they physically could not tolerate vaginal penetration," says Gaudry.

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...but now there are safe drugs that can help with sex after menopause.

"Women now have a choice of an approved drug just for them," says Gaudry. There are treatments available for women struggling with hypoactive sexual desire disorder (HSDD), a condition where you lack sexual desire but are otherwise healthy, plus other menopause-related issues like mood changes, hot flashes, and osteoporosis. The three drugs are:

1. Brisdelle (paroxetine): A low-dose antidepressant, which helps ease hot flashes by modifying levels of temperature-regulating serotonin and norepinephrine in the brain.
2. DUAVEE: An oestrogen and selective oestrogen receptor modulator, which helps alleviate hot flashes and prevent osteoporosis by stimulating estrogen production.
3. ADDYI (flibanserin): A medication for treatment of low libido in pre-menopausal women, which reawakens desire by increasing dopamine and noradrenaline within the brain.

Discuss these options with your ob-gyn to see if they're a good fit for you; as with any medication, there are possible side effects and risks. But these treatments may offer hope to menopausal women suffering from issues like low libido and painful sex.

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Topical vaginal oestrogen can do wonders.

"If you could spend a day with me in my office listening to women, you would see why I think that every woman should use vaginal oestrogen after menopause."

Here are examples of what she regularly hears from her menopausal patients:

• "I can't have intercourse any more because of the pain…."
• "You're my only hope to save my marriage; he's leaving if he doesn't have sex soon."
• "I always bleed after intercourse."
• "I want to orgasm again, but my vulva is so thin and tender now."
• "I feel like knives are piercing my vagina when I have sex."

Gaudry's remedy? Topical vaginal oestrogen. Unlike oral oestrogen, there is no evidence that local vaginal oestrogen causes breast cancer.

"There is a black box warning on all vaginal oestrogens but no studies have been done," says Gaudry. "This is just extrapolated data from oral oestrogen that does have a very low association with breast cancer (8 per 10,000 women over placebo)."

In fact, the North American Menopause Society recently sent a petition to the FDA asking for these labels to be removed from vaginal oestrogen.

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Your vagina needs physical therapy after menopause.

Menopausal women need to do physical maintenance on their vaginas—and we're not talking grooming.

"Many women who do not have a partner are masturbating by stimulating the clitoris and do not think about stretching out the vagina," says Gaudry. "The vagina will shrink in diameter and in length after menopause without use. I recommend vaginal vibrators for physical therapy."

Gaudry recommends putting the vibrator in the vagina as deep as possible for 15 to 30 minutes every other day to increase blood flow and prevent atrophy. She wants to make women more comfortable with the idea of using sex toys and abolish taboo around them.