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Perimenopause and the years beyond can bring new sexual health issues for women, writes Sarah Marinos.
While women may place a higher priority on their sexual health during their reproductive years, it's equally important at midlife and beyond. Pregnancy may no longer be a prime concern, but sexually transmitted infections (STIs) are still a risk for women.
Hormonal changes can mean sex becomes painful and women may also experience changes in their libido. Some women may find weight gain in their late 40s and onwards leads to a loss of sexual confidence.
Others will be entering new sexual relationships highlighting the need for them to remain informed about taking care of their sexual health. "As you reach menopause, it is not that you forget about your sexual health but you may not consider your sexual health and contraception as a top health priority anymore," says Dr Philip Goldstone, medical director for Marie Stopes International, a not-for-profit sexual and reproductive healthcare provider. "This can be because you think you are not at any risk, you mistakenly believe you're not fertile anymore, or your sexual health education may need an update."
While fertility declines in the lead-up to menopause, women can still become pregnant during this period, known as perimenopause. So contraception is
still essential, says Dr Elizabeth Farrell, a gynaecologist at Jean Hailes for Women's Health. "During perimenopause, some women can ovulate twice in a cycle and the second time is during a period. There's a myth of never being able to get pregnant during a period, that's proven (to be) completely wrong in the perimenopause," she says.
Women over 50 should use contraception until 12 months after their final menstrual period, while those under 50 should use contraception until two years after their last period. Around the time of menopause, however, women need to discuss contraception with their GP.
If women are smokers, have high blood pressure, are overweight or have a family history of heart disease, the Pill is not usually recommended, says Farrell. A safer option may be the Mirena IUD, which lasts for five to seven years and in most women reduces blood loss and discomfort during periods. It's believed to be safer than the Pill for these women because it releases a lower dose of hormones.
Condoms also protect against pregnancy and sexually transmitted infections.
"If you have unprotected sex, have an STI check-up, and if you are perimenopausal, you can take an emergency contraceptive pill the ‘morning-after' pill up to 96 hours after sex to prevent an unplanned pregnancy," says Goldstone.
Some women report a drop in sexual desire around menopause. Farrell says that while changing hormone levels may have an effect, life stresses
also dampen sexual desire.
"Hormones may have an effect and I emphasise ‘may'," says Farrell. "But how long you've been in a relationship, what the relationship is like, whether you have any health issues, whether women are tired and stressed, and some medications, such
as antidepressants, can also reduce libido."
Physical symptoms such as vaginal dryness can also dampen sexual enjoyment. "For women for whom sex has been a bit of a chore and has become prescriptive and boring, getting to menopause is a way of not having sex," says Farrell. "But where women have a good relationship and want to have sex but there are mechanical issues, those women can feel really let down."
Water-based lubricants or oestrogen creams applied locally may help relieve vaginal dryness. Rest, relaxation and exercise to relieve stress and tiredness can help improve libido and talking to a partner about your feelings may also help. Your GP can refer you to a professional for advice on improving libido, if needed.
For the full story, see the June issue of Good Health. Subscribe to Good Health and receive 12 issues of Good Health & 6 FREE issues of The Australian Women's Weekly that's 18 issues for just $69.95!