Mid-life Sex and Love
Between the ages of approximately 40 and 65 most people’s concerns are about dealing with teenage children, family finances, success and failure, planning for the future, and so on. Sexually there are no sudden changes, but during some part of this period, probably toward the age of 50, both men and women may go through a difficult psychological phase called the mid-life crisis.
In addition women experience the menopause, which means that they cease to ovulate and menstruate and are no longer able to conceive children. It is helpful to separate the notions of climacteric and menopause: there is plenty of information about sex in midlife here. Menopause is about physical change and comes to every woman, whereas the mid life crisis cannot be so precisely defined and may or may not affect both women and men.
The Menopause
Menopause is surrounded by myths, fear and misinformation. It is often read as a wholly negative as some kind of disease; some people call it the “change of life” to show how marked an event they (wrongly) think it to be. Menopause is as much defined by ignorance and superstition as menstruation.
This is what happens during menopause. As a natural result of aging, the quantity of female hormones produced by the ovaries slowly declines. Gradually, ovulation ceases and so does the menstrual flow. Once a woman has stopped ovulating she is infertile. There is no single moment at which one can say this has happened.
The reduction in hormone production is over a number of years, but the ovaries will continue to produce small amounts of estrogen, and so will the adrenal and other glands. Ovulation and menstruation may become irregular (rather as they are for girls in puberty) until neither happens at all.
The main physical changes that accompany menopause are hot flashes – also called flushes – and reduced vaginal lubrication. Neither of these need make any difference to sexual desire. In fact some women, free of the possibility of pregnancy, relax and enjoy a greater level of sexual activity than before. All women retain their capacity to enjoy sex and orgasm – menopause should make no difference at all.
The psychological response to menopause varies enormously. Women who have been trained to believe that menopause is a disaster signaling the end of their femininity and of their value as people may react with severe anxiety and depression. They may accordingly seek medical help.
Other women who, on the other hand, accept menopause as a natural stage life-cycle and who are secure in their roles and relationships often find themselves looking forward positively to the next stage in their lives rather than looking back with regret.
Some doctors do not help. They prescribe tranquilizers or sleeping pills when an explanation of normal physiology and the meaning of what the patient is feeling could bring greater relief.
The most controversial treatment of menopausal symptoms is hormone replacement therapy (HRT). Many physicians believe that HRT is a proper treatment for menopausal symptoms such as hot flash symptoms and severe vaginal wall dryness and thinning (estrogen creams are used here). Always get medical advice.
Combining progesterone with the estrogen reduces the chances of adverse effects to levels comparable with those of women who are not having any therapy at all. In addition to combating the common menopausal symptoms of hot flashes and vaginal dryness, HRT also helps prevent osteoporosis, a loss of bone density that causes weakening and may lead to bone fractures (especially of the hip). Osteoporosis is not so much a result of menopause as a natural part of aging.
Q. “Why do so many women have emotional difficulties during what should be a natural menopause?”
A: “Some women may become depressed for a while, but the impression that large numbers of women have serious emotional problems is a false one. The premium placed on youth in our culture is very high, so such an obvious sign of aging as menopause may cause some women distress. On the other hand, most women by the time they reach the age of 50 or so have come to terms with the fact that they are no longer young. The inability to have children in the future worries some women… And of course children are often leaving home at about the time of the menopause and the family seems to be breaking up. This can be a reason for distress which, entirely understandable though it is, does not relate specifically to menopause. Then there is the matter of most people’s uncertainty about what menopause is and means.
The confusion between the physical event of menopause and psychological aspects of the mid-life changes can result in temporary feelings of depression. But the menopause can indicate the approximate mid-point in a woman’s adult life, with a “new life” in the future.”
Q. “What are hot flashes?”
A: “In response to local variations in hormone levels, blood vessels suddenly expand. More blood comes close to the surface of the skin and the woman appears flushed; this is because the skin is warmer and the body reacts by perspiring. They are entirely unpredictable, may last for seconds or for a minute or so, may recur the same day or not for weeks. Hot flashes can occur anywhere on the body and may be accompanied by heavy sweating.
Women who have them feel temporarily hot and tingly. Perhaps 50 percent of women experience hot flashes during their menopausal stage. If the flashes are severe a physician may treat them with oestrogen for a while, but many women tolerate the mild inconvenience of flashes and wait for them to cease naturally, without medical treatment.”
Q . “A friend of mine told me she had no problems and her sex life got better. Can this be so?”
A: “Yes. Some women experience very minor menopausal symptoms and the new freedom from worry about getting pregnant can mean a gain in the spontaneity of their lovemaking.
Incidentally, the changes in hormone levels that set off menopause can work to a woman’s advantage. The new balance of androgen and oestrogen arrived at during menopause can actually stimulate sexual interest. In addition to having few menopausal symptoms, it sounds as though your friend was fortunate in experiencing none of the problems that may come with the mid-life crisis.”
Q. “Do women have pain during intercourse after the menopause? “
A: “No. During menopause, especially toward the end of that period, perhaps 25 percent of women experience pain or burning during intercourse. This is due to the thinning of the vaginal wall that comes naturally with age. Vaginal lubes may be sufficient to overcome this problem, but in some cases oestrogen cream is prescribed as it helps thicken the vaginal lining. Since the oestrogen is absorbed into the body, this treatment must be carefully monitored.
Q: “When I started to feel signs of menopause, I got confused, angry, and wasn’t myself. I handled it after a while, but was what I was feeling abnormal?“
A: “No. What you felt is quite common. After all, most of the literature on the subject arouses fear; the language used to describe this natural stage of life for all women is enough to cause every woman to react with panic: ‘change of life,’ ‘hormonal imbalance,’ ‘loss of femininity,’ ‘drying up,’ ‘hot flashes,’ ‘treatment’ all suggest something negative and lead us to have confused, inadequate and angry feelings about menopause.
Many women handle menopause as you did – successfully. But we must all work to change society’s negative attitudes that make people view the prospect of menopause with dread and its occurrence with confusion.”
Q. “How should my partner handle this?”
A: “Like so many of us, your partner may have been influenced to see menopause as a disease rather than as a natural stage in the life cycle. Public discussion of menopause has been slanted toward the problem aspects, spending too little time on its naturalness and the ability of women to experience the process without anguish. Literature describing the benefits of oestrogen replacement therapy frequently portrays the husband as a helpless victim of menopause and depicts the wife as irritable, depressed and in pain.
For many women (and for many couples) this simply is not true. If they approach menopause and the midlife crisis positively and with a clear understanding of what is involved physically and what may be involved psychologically, they are much less likely to find it a traumatic stage in their lives. If they do find it traumatic, then counselling or therapy may be helpful. Obviously this is something you might prefer to talk about with a female therapist. Counselling, psychotherapy and shadow work are all good forms of therapy. Some female facilitators in shadow work are Laura Stoddart, Marianne Hill, and Sue Rayner.“
Q. “What if things are difficult?”
“I had these awful hot flashes, headaches, my skin looked old and wrinkled, my breasts started to sag, I started getting heavy. I wondered whether this was real or imaginary and I just felt ugly. I thought everyone was looking at me, and my husband thought I was having a nervous breakdown. I went to several doctors, and between tranquilizers, sleeping pills, estrogen pills, and estrogen creams we were spending a fortune and nothing changed.
I really felt I was about to have a nervous breakdown. Believe it or not the thing that really helped me was going to a woman’s group with women my age and listening to them talk about something I thought was only my problem and concern. The support and suggestions really helped turn things around for me. More and more women are being helped by sensitively run groups of this sort. The bonds of common experience and the opportunity to express feelings and fears honestly and to receive constructive feedback from peers has been a liberating experience. Such groups can give women the chance to appreciate the variability of the menopausal stage.