What No One Tells You About Women’s Health Over 40

By Sue Sveum

While men and women share many common health concerns, there are some that only women experience and can fully understand. You know the ones — periods, pregnancy, perimenopause and pelvic health. From cramps to hot flashes, women go through physical and hormonal changes that are unique to them.

Here, four SSM Health providers share common health issues affecting women as we age. You’ll find expectations, explanations, advice — and most of all, assurance that you are not alone.

Treating Hot Flashes and Night Sweats

Many women going through perimenopause or menopause are all too familiar with the symptoms — especially hot flashes. But many don’t realize there are treatment options available. According to Dr. Marisa Sturza, OB/GYN at SSM Health, hormone replacement therapy (HRT) may be the answer.

What is hormone replacement therapy?

HRT commonly refers to a low-dose estrogen patch or oral progesterone. “It’s offered to women going through perimenopause or menopause with bothersome symptoms,” explains Sturza, adding that common symptoms include hot flashes, night sweats, vaginal dryness, urinary irritation or infections, and mood changes.

Who should consider HRT?

If symptoms interfere with your quality of life, talk to your provider. “It’s really a patient-centered decision,” she says. “Discussing options doesn’t mean that a person needs to move forward with treatment.”

How does it work?

Low-dose estrogen is given in patch form. “Typically, patients are started on the lowest level of estrogen that treats their symptoms,” explains Sturza, “and the patch is lower than the estrogen in most oral estrogen pills.” For patients whose main symptoms are vaginal dryness, pain with intercourse or UTIs, low-dose vaginal estrogen is a great therapy option.

Are there side effects?

Low-dose patches have been shown to be a much lower risk in terms of blood clots and stroke than oral estrogen, although some patients experience skin irritation with a patch. Risks, benefits and potential side effects are great things to discuss with your health care provider.

What should I expect at the appointment?

You should expect to discuss your complete medical history along with a detailed conversation about symptoms you’d like to control (such as frequency and time of day of your symptoms, as well as your goals for treatment). If you’re having vaginal and/or urinary symptoms, you’ll have a pelvic exam to evaluate whether vaginal estrogen would be helpful for you.

“There are lots of good treatment options to consider,” stresses Sturza. “Don’t hesitate to talk with your provider — and don’t feel embarrassed. These symptoms are super common, and we talk about them all the time with our patients.”

The Other Symptoms of Menopause

If you thought having hot flashes was the major sign of menopause you wouldn’t be alone — but there are many other symptoms of menopause beyond that. Most women have never heard of genitourinary syndrome of menopause (GSM). According to Dr. Daniel Pellicer, OB/GYN at SSM Health, if you’ve ever experienced the symptoms of GSM, you’re definitely not alone.

What is GSM?

GSM is a collection of symptoms (and physical exam findings) affecting the vulva, vagina, bladder and urethra — all related to low estrogen levels in postmenopausal patients. Some studies estimate that 50% or more of women report being bothered by symptoms of GSM after menopause.

What are the symptoms?

Symptoms can include dryness, irritation, itching or burning; decreased lubrication, pain or discomfort with intercourse; changes in vaginal discharge; or urinary symptoms (e.g. frequency, urgency, pain or discomfort with urination, or recurrent UTIs).

What causes GSM?

Vulva, vagina, bladder and urethra tissues have lots of estrogen receptors. “So when estrogen levels decrease after menopause (or after medical or surgical therapies that lead to menopause), the look and feel of tissues can change over time as a result,” explains Pellicer. “This condition is no one’s fault — and I always emphasize to my patients that while GSM can affect quality of life, it isn’t dangerous.”

When should I see a doctor?

You should seek care if you notice any GSM symptoms. Your provider will want to confirm the diagnosis before discussing possible treatment options.

What should I expect at the appointment?

Your provider will ask you about your symptoms and perform a pelvic exam. They may also recommend certain labs to rule out similar conditions like a yeast infection or a urinary tract infection.

How is it treated?

It’s typically treated with application of moisturizers, lubricants or estrogen. “Initial treatment is typically with over-the-counter non-hormonal vaginal moisturizers and lubricants,” says Pellicer. “For those with more severe symptoms, vaginal estrogen may be recommended.”

Understanding Female Sexual Dysfunction

One common consequence of menopause is female sexual dysfunction and low libido — an often embarrassing and difficult issue for women to discuss. If this sounds like you, Dr. Dawn Kalin, OB/ GYN at SSM Health, says don’t feel embarrassed — and do talk to your doctor.

What is female sexual dysfunction?

It encompasses issues causing distress related to low libido or hypoactive sexual desire disorder (HSDD), arousal and sexual pain. “Female sexual dysfunction is actually incredibly common — especially among women ages 45-64,” stresses Kalin. “As many as 40- 50% of women report experiencing these problems.”

How do I know if I have HSDD?

You may notice a lack of interest in sexual activity — even to the point of causing stress in your relationship. The diagnosis is made by a healthcare professional after a thorough history is obtained. A pelvic exam may also be done. “But the most important part of diagnosis,” says Kalin, “is talking openly with your provider about your questions and concerns.”

Possible Causes

Low libido and painful sex are often caused by a combination of psychological, social, biological and environmental contributors. The most common are:

  • Menopause
  • Depression and/or anxiety
  • History of sexual trauma
  • Problems with your partner
  • Stress — emotional and environmental
  • Postpartum and/or breastfeeding
  • Medical problems such as diabetes
  • Drug and alcohol use
  • Some antidepressants such as SSRIs

How is it treated?

HSDD can be treated with medication, therapy or a combination of the two. There are two FDA- approved medications for HSDD — a pill and an injection that you give yourself. Certain medications can help increase libido. And hormones such as testosterone, estrogen and progesterone are also frequently prescribed to help postmenopausal women with HSDD.

“If you want to avoid medication, therapy using cognitive behavioral techniques and mindfulness is an excellent way to treat HSDD and help you work through this disorder,” says Kalin. “Talk to your provider about the best treatment for you.”

5 Things to Know About Pelvic Health

You may be surprised to learn that pelvic health issues are very common among women over 40. They range from pelvic floor disorders — such as urinary and bowel incontinence — to pelvic organ prolapse, vulvar disorders, pelvic pain and sexual dysfunction.

Something to talk about

If you haven’t heard a lot about these problems, you aren’t alone. That’s because they aren’t things that many women feel comfortable discussing.

“It’s not uncommon to suffer in silence,” says Dr. Bruce Drummond, urogynecologist at SSM Health, adding that there are effective therapies that relieve symptoms for bladder and bowel control, and pelvic organ prolapse or vaginal hernia. “When pelvic symptoms bother you — or you’re avoiding social interactions and not doing the activities you’d like to do, it’s time to ask for a referral.”

Can urinary incontinence be treated?

Urinary leakage can be treated with physical therapy, medications, Botox, neuromodulation or slings — starting with minimally invasive procedures designed to get you back to the things you would like to be doing. “Think of getting older as inevitable,” says Drummond, “but aging is a manageable condition.”

How is pelvic prolapse treated?

Pelvic organ prolapse is quite common. It’s not surprising that pregnancy may damage the pelvic floor — including the supporting pelvic structures, nerves and muscles. There are many treatment options available for pelvic prolapse. Some women may opt for surgery to address the issue. In fact, one out of nine women will undergo prolapse surgery.

Are treatments effective?

Yes! Surgery for pelvic organ prolapse and urinary incontinence is 85% effective in reducing the sensation of protrusion or urine leakage.

What should I expect at my first appointment?

“It’s normal to be nervous, but most women are relieved to know what’s going on and that something can be done,” explains Drummond. “You’ll discuss bothersome symptoms, have a screening urine test, bladder volume scan and pelvic exam to evaluate for vaginal hernias, pelvic masses and Kegel muscle responsiveness. Then a plan is made.”

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