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OW sex after menopause

Posted 10/10/2016

Posted in

  Hoping that the title of today's blog got your attention. Many women have painfully discovered that sex after menopause can be painful. This is one reason why HRT (hormone replacement therapy) was so popular for so many years--until the evidence mounted up that it raised a woman's risk of breast cancer. For women who have had breast cancer, HRT or any kind of added estrogen is almost always a bad idea.

  The almost always is because there is less striking evidence for ER negative breast cancers and because sometimes QOL issues overwhelm the concerns about possibly feeding any remaining cancer cells. Certainly this is a "talk to your doctor" moment because each woman's situation is unique.

  For most, however, sex changes after menopause and one big reason is the lack of estrogen. For women with a breast cancer history, this may mean that there is even less estrogen than the small amounts lurking in other women (thanks to anti-estrogen/hormonal treatments, e.g. the AIs) and it may well mean that these problems happen sooner in life. I, for example, had chemically/chemotherapy-induced menopause at 44, and I am pretty sure it would not have happened for another decade or so otherwise.

  All of this is a prologue to a very interesting and disturbing report from The North American Menopause Society (NAMS) recent meeting (an aside: bet you didn't know they existed!). This report suggests that most women are completely unprepared for what sexually happens after menopause and don't understand the reasons. I am not going to try to summarize the report as I think that their press release does a far better job than I could. Please remember that this is not breast cancer specific, and our issues are somewhat unique.

New survey shows women still don't
understand why sex hurts after menopause

Women's EMPOWER survey confirms reluctance to discuss sex problems and seek treatment despite
major educational efforts

The Women's EMPOWER survey, an internet-based survey of 1,858 US postmenopausal women with
symptoms of VVA, was specifically designed to assess women's awareness of VVA and their behaviors and
attitudes associated with the treatment of symptoms. The findings came as little surprise to insiders in the
medical industry, because they were consistent with six other past VVA surveys that also confirmed that
postmenopausal women generally failed to recognize VVA and its chronic progressive course (including
urinary problems) and were reluctant to discuss vaginal or sexual symptoms with their healthcare providers.
In the Women's EMPOWER survey, 81% of women were not aware that VVA is a medical condition. More than two-thirds of respondents were not familiar or only somewhat familiar with most of the prescription VVA
"The results of the Women's EMPOWER survey demonstrate and reinforce that, even with multimedia
marketing and educational strategies in the years after other major VVA surveys, minimal progress has been
made toward increasing women's awareness and understanding of VVA," says Michael Krychman, MD, of the
Southern California Center for Sexual Health and Survivorship Medicine and a lead author of the Women's
EMPOWER survey. "Women remain naive to the safe and effective treatment options that are currently
available and are still, for the most part, underinformed and undertreated."


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