Madeeha Syed

Explore important considerations for having intimacy after menopause. Meri Sehat provides insights into navigating intimacy during this life stage.

What To Know About Having Sex After Menopause

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

To Bleed Or Not To Bleed?

Introduction

Society, culture, and religion have fixed certain roles for each gender. For women, it is traditionally the role of the mother, the nurturer, and the caretaker. For centuries, they have prioritized family life. Whether they have been asked to, whether there was no other option available, whether out of choice; the thing is many women have come to put others&rsquo; needs above their own. They become givers and, in the process, forget they are also entitled to love and care.&nbsp;

&nbsp;

Moreover, in South Asian communities, women are often restricted in mobility. As a result, they have limited healthcare access, are subjected to male violence, and do not hold the power to make decisions for themselves or their families<a href="#accordion">[1]</a>. This further devalues their role in terms of how they perceive themselves as well as how society perceives them.&nbsp;

&nbsp;

When even their basic needs are not met, women stop paying attention to common and major healthcare concerns. Thus, they are less likely to seek care, especially when it concerns reproductive health. Of course, the existence of cultural taboos does not help this situation; they&rsquo;ve just internalized this lack of confidence along with a poor sense of worth.&nbsp;&nbsp; 
&nbsp;

Understanding Post Menopausal Bleeding

Although menstruation is a natural biological process, in low- and middle-income countries, there are several stigmas surrounding the physiological phenomenon<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

The lack of knowledge regarding female reproductive health and the spread of incorrect information means many women are unaware of when to seek help. A cross-sectional survey conducted at a government hospital in Karachi, Pakistan, found that more than 90% of women had heard of menopause<a href="#accordion">[3]</a>. However, only 30% knew about the symptoms<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

A lack of awareness of <a href="https://merisehat.pk/disease/menopause">menopause symptoms</a> means many women are also unaware of what&rsquo;s normal and what&rsquo;s not. Therefore, they often disregard symptoms such as postmenopausal bleeding.&nbsp;

&nbsp;

But is postmenopausal bleeding a cause for concern? Should you be booking a visit to the gynecologist?&nbsp;

&nbsp;

<h5>Menopause&nbsp;</h5>

Menopause is defined as the cessation of menstrual cycles for a period of 12 consecutive months. Postmenopause is the period following menopause. The average age of menopause is 51 years<a href="#accordion">[4]</a>, whereas in Pakistan, the mean age of menopause for women is 49.3 years<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

The common symptoms of menopause include:

<ul>
	<li>Mood changes</li>
	<li>Hot flashes</li>
	<li>Hair loss</li>
	<li>Vaginal dryness</li>
	<li>Insomnia</li>
</ul>

&nbsp;

Often, these symptoms linger into the postmenopause period.&nbsp;

&nbsp;

IMPORTANT: One thing that&rsquo;s not a normal side effect of menopause, and should be a cause for concern, is the presence of vaginal bleeding.&nbsp;

&nbsp;

<h5>Postmenopausal Bleeding</h5>

Postmenopausal bleeding is defined as vaginal bleeding after a year or more of cessation of menstruation. Approximately 4-11% of postmenopausal women report vaginal bleeding<a href="#accordion">[4]</a>. And about 1-14% of postmenopausal bleeding is secondary to endometrial cancer<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

Although vaginal atrophy is the most common cause of postmenopausal bleeding, 90% of postmenopausal women with endometrial cancer have vaginal bleeding as the presenting sign<a href="#accordion">[6]</a>. Therefore, there is a need for raising awareness about postmenopausal bleeding and its possible causes.&nbsp;

&nbsp;

After menopause, there is a drop in estrogen levels in the body. The tissues lining the vagina and endometrium begin to undergo atrophy. Micro-erosions along with chronic inflammation develop on the epithelial surface. This inflamed endometrium is then prone to slight bleeding.&nbsp;

&nbsp;

Other causes of postmenopausal bleeding include:

<ul>
	<li>Endometrial Or Uterine Cancer:&nbsp;Endometrial cancer could result in a thickening of the uterus lining. It causes the lining to shed and result in vaginal bleeding.&nbsp;</li>
	<li>Polyps:&nbsp;These result from an overgrowth of the endometrium and could appear in the uterus or cervix. They&rsquo;re not cancerous but likely to result in spotting or heavy bleeding.&nbsp;</li>
	<li>Fibroids:&nbsp;Also called leiomyomas, fibroids are noncancerous growth of muscle and tissue that form from the uterine walls. While small fibroids are typically asymptomatic, larger ones could cause vaginal bleeding.&nbsp;</li>
	<li>Endometrial Hyperplasia:&nbsp;Low progesterone levels and too much estrogen result in endometrial thickening. The thickened endometrium is at risk of bleeding and also able to transform into cancer.&nbsp;</li>
	<li>Sexually Transmitted Diseases (STDs):&nbsp;Vaginal bleeding after sexual intercourse might be a result of STDs such as chlamydia and gonorrhea.&nbsp;</li>
	<li>Medications:&nbsp;The use of certain drugs is associated with vaginal bleeding as a side effect. These include tamoxifen, blood thinners, or hormone replacement therapy.</li>
	<li>Pelvic Trauma:&nbsp;Injury to the vagina also causes bleeding.</li>
</ul>

&nbsp;

A cross-sectional study conducted in Mardan, Pakistan, determined the patterns of bleeding and endometrial biopsy in women presenting with postmenopausal bleeding. As per the results, 26% of the patients had atrophic endometrium while 23% had endometrial carcinoma<a href="#accordion">[7]</a>, thus, proving the need for a proper assessment of postmenopausal bleeding in women.

&nbsp;

Another cross-sectional study was conducted among postmenopausal women in Sahiwal, Pakistan. Half of the women were obese, which established obesity as a risk factor for postmenopausal bleeding<a href="#accordion">[8]</a>. Moreover, the incidence of endometrial carcinoma was 7% among women<a href="#accordion">[8]</a>. The study points to the need for endometrial cancer screening programs, especially among menopausal women complaining of vaginal bleeding.&nbsp;

&nbsp;

Conclusion

Regardless of the reason, postmenopausal bleeding is a cause for concern. Therefore, if you notice spotting or vaginal bleeding post-menopause, book an appointment with the obstetrician-gynecologist. Early diagnosis would improve prognosis for the patient, and their overall quality of life.&nbsp;

Key Points

<ul><li>Postmenopausal bleeding is defined as vaginal bleeding that occurs 12 months after the cessation of the menstrual cycle.&nbsp;</li><li>Vaginal or endometrial atrophy is the most common cause of postmenopausal bleeding. However, 90% of postmenopausal women with endometrial cancer have vaginal bleeding as the presenting sign.</li><li>Other common causes of postmenopausal bleeding include polyps, fibroids, endometrial hyperplasia, medications, and sexually transmitted diseases.&nbsp;</li><li>All cases of postmenopausal bleeding require immediate consultation with the obstetrician-gynecologist. A delay in diagnosis could have a poor outcome for the patient.&nbsp;</li></ul>

[1] Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: the South Asian context. BMJ (Clinical research ed.), 328(7443), 823–826.

[2] Arshad Ali S, Baloch M, Riaz L, et al. (August 20, 2020) Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers. Cureus 12(8): e9894. doi:10.7759/cureus.9894

[3] Karim, F., Ghazi, A., Ali, T., Jabbar, S., Naz, S., & Aslam, R. (2013). Women’s Perception Towards Menopause. Journal of Surgery Pakistan (International), 18(3).

[4] Sung S, Abramovitz A. Postmenopausal Bleeding. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[5] Jadoon AK, Sohail F, Qabulio SN, et al. Perception and Awareness of Menopause among Premenopausal Women of Different Socioeconomic Backgrounds. J South Asian Feder Menopause Soc 2019;7(1):8–13.

[6] ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding. Obstet Gynecol. 2018 May;131(5):e124-e129.

[7] Jadoon S, et al. Postmenopausal Bleeding - A Strong Indicator of Endometrial Carcinoma. Pak Armed Forces Med J 2019; 69 (2): 368-72

[8] Perveen, S., Azhar, M. S., Shah, F., Mahmood, F., & Mahmood, U. (2022). Association of postmenopausal bleeding with endometrial carcinoma. Pakistan Journal of Medical and Health Sciences, 16(3), 103–105.

Nimrah H. Sattar

Iqra Mazhar

This article or video has been viewed by many visitors, and is popular.

I’m Hot. It’s Not Summer, It’s Just Menopause

<a href="https://www.merisehat.pk/disease/menopause">Menopause</a> marks the evident end of regular menstrual cycles. The term can depict any progressions one goes through nearing the end of menstruation, or what one may experience closely after it, indicating the completion of your reproductive years and stages.&nbsp; 
&nbsp;

Menopause and perimenopause can cause side effects like nervousness, mood swings, mind haze, hot flushes, and irregular periods. These side effects can begin a long time before the end of the menstrual cycle and continue a while later. Menopause and perimenopause side effects can hugely affect the individual&rsquo;s life, including social interactions and work. However, there are multiple ways that can help you deal with these side effects. Several medications, for instance, can help replace the missing or reduced chemicals associated with menopause and help ease the unavoidable signs and symptoms.

&nbsp;

Understanding menopause and how to deal with its symptoms

Menopause is a natural process that all menstruating women must go through. It may occur due to one of the following reasons: 
&nbsp;

<ul>
	<li>Natural Menopause: During their 40s, most women observe changes to their regular cycles. The cycles may become longer or more limited, heavier or lighter, more frequent or with much significant dry spells, until the ovaries stop producing eggs and menopause commences. This occurs, on average, by the age of 51 years<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Surgical Procedures: Surgical procedures such as oophorectomy or removal of ovaries are also associated with causing menopause. The ovaries are responsible for producing hormones, including estrogen and progesterone that control, monitor, and synchronize the monthly menstrual cycle. Thus, medical procedures to remove the ovaries cause early and prompt menopause. The monthly periods halt, and the person goes through the various menopausal signs and symptoms<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Chemotherapy Or Radiation Therapy: These disease treatments can affect menopause by causing side effects such as hot flashes during or not long after the course of treatment. Following chemotherapy, the stop to the monthly cycle (and fertility) is not necessarily irreversible or long-lasting, so contraceptive measures might be needed<a href="#accordion">[1]</a>. 
	&nbsp;</li>
	<li>Primary Ovarian Insufficiency: Early menopause might result from the inadequate production of reproductive hormones by the ovaries, a condition called primary ovarian insufficiency. It can result from hereditary elements or immune system illness. Hormone treatment is regularly suggested until the normal period of menopause to safeguard the cerebrum, heart, and bones<a href="#accordion">[2]</a>.&nbsp;</li>
</ul>

&nbsp;

Menopause is not easily self-diagnosed and missing a period for more than three months is a concerning state. The most common symptoms of menopause include: 
&nbsp;

<ul>
	<li>Hot Flashes</li>
	<li>Insomnia</li>
	<li>Vaginal Dryness</li>
	<li>Urinary Incontinence</li>
	<li>Mood Changes 
	&nbsp;</li>
</ul>

An individual may experience one or more symptoms and should consult medical healthcare providers to confirm the suspicion of menopause. They will monitor and examine your symptoms to guide you towards an efficient treatment.&nbsp; 
&nbsp;

While certain lifestyle changes and drugs may forestall menopause, it is a natural and inevitable process every menstruating woman must go through. However, certain measures may help alleviate its symptoms.

&nbsp;

<h5>1. Hot Flashes</h5>

Hot flashes are the most prevalent symptoms of menopause. It is the unexpected sensation of warmth in the chest area, but is normally experienced with a greater sensation over the face, neck, and chest. Your skin can blush, as though you are becoming embarrassed. A hot flash can likewise cause extreme perspiration. Assuming you lose a lot of body heat, you can feel chills a short time later. Night sweats are hot flashes that occur at night<a href="#accordion">[3]</a>. 
&nbsp;

Phytoestrogens naturally occur in plants and certain food sources. Research suggests that these substances can, to some extent, reverse the hormonal imbalance associated with menopause<a href="#accordion">[4]</a>. Soy-based food varieties contain elevated degrees of phytoestrogens, so eating loads of tofu is recommended to decrease the overwhelming effects of hot flashes. Moreover, it is highly recommended to stay away from food triggers that can make you sweat as they increase your basal temperature. These include hot drinks, spicy food, and liquor. And remember to stay hydrated! 
&nbsp;

Exercise likewise facilitates the discomfort of hot flashes by bringing down levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Try to get at least 20 minutes of physical activity, three times each week. As per the National Center for Complementary and Integrative Health, acupuncture can also help reduce hot flashes in postmenopausal women<a href="#accordion">[5]</a>. 
&nbsp;

<h5>2. Insomnia</h5>

During menopause, it appears as though you are constantly drained and exhausted. To exacerbate the situation, hot flashes and various other side effects disrupt a person&rsquo;s sleep. Having a consistent sleep routine helps individuals to get the necessary amount of rest, especially during menopause when they are fatigued. To adhere to a timetable, set up your brain and body for rest by fostering a soothing bedtime ritual that starts around a similar time each night. For instance, clean up, listen to calming music, read a book, or do different exercises that help you relax. These practices indicate to your body that it&rsquo;s almost time to sleep. Thus, helping you to nod off with ease. 
&nbsp;

Once you get in bed, abstain from staring at the TV, using your laptop, or checking your phone. The blue light from gleaming electronic screens smothers your body&#39;s development of melatonin, a hormone that affects sleep. Moreover, try to abstain from working, eating, and having a serious conversation with anyone especially your spouse once you have settled into your bedroom. Reinforcing the relationship between your bed and rest might assist you with clearing your brain at bedtime. Ensure you are in a comfortable atmosphere by adjusting the temperature of the AC or heater, and getting a new fluffier pillow. If you live in a metropolitan city, get ear plugs so that the noises outside do not disturb you, and drink a cup of chamomile tea before going to bed.&nbsp; 
&nbsp;

<h5>3. Vaginal Dryness</h5>

The vagina might become dry, or irritated because of menopause and perimenopause. A GP can prescribe estrogen medicines that can be placed into the vagina, in the form of a tablet, cream, or ring. This multifaceted treatment can also help alleviate any urinary side effects of menopause and perimenopause, such as urinary incontinence. These vaginal estrogen medicines cannot enter the circulatory system and just have a local effect. Moreover, they do not have a rigid time frame and can be used throughout the post-menopause stage. Discontinuing the use of the product might bring back the unpleasant symptoms. There have not been any recorded repercussions, therefore, vaginal estrogen is safe to be used with hormone replacement therapy (HRT)<a href="#accordion">[6]</a>. 
&nbsp;

Over-the-counter vaginal lubricants are recommended to address vaginal dryness experienced during intercourse. These items lower the frictional erosion associated with vaginal dryness and prevent any sexual discomfort. It should be noted that only water-soluble lubricants are recommended as the counterpart oil-soluble items, for example, Vaseline increases discomfort and make the situation more complex. Reach out for products intended for the vagina; keep away from hand creams and moisturizers containing alcohol or those that are scented. These can disturb the vaginal tissue and disrupt the vaginal pH<a href="#accordion">[7]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>4. Urinary Incontinence&nbsp;</h5>

While it is characterized as the constant and uncontrollable urge to urinate, most individuals would agree that urinary incontinence is an unwanted disturbance. Fortunately, there are systems to assist with various types of incontinence without drugs or medical procedures. Ensure you are drinking satisfactory water to keep urine diluted. This can be confirmed if the urine is clear or has a light-yellow hue. Keep away from food varieties or refreshments with a high acid or caffeine content, as that can disturb the bladder lining. These include grapefruits, oranges, tomatoes, coffee, and caffeine-containing sodas. Likewise, attempt Kegel exercises to reinforce your pelvic floor muscles and diminish incontinence episodes<a href="#accordion">[7].</a>&nbsp; 
&nbsp;

<h5>5. Mood Changes</h5>

Discussing your mood swings with a healthcare professional can assist you with recognizing the reason, gauging the probability of depression, and settling on the most suitable mediation. For depression, treatment would be different as your doctor might prescribe drugs that alter the chemical imbalance associated with menopause. Normally, these medications take half a month to bring about any noticeable improvement. A few antidepressants have, likewise, been found to treat hot flashes.&nbsp;Antidepressants work best when combined with therapy or psychotherapy. 
&nbsp;

When you reach menopause, you might anxiously wait to transition to post-menopause. This is the period after menopause. However, that does not guarantee complete liberty from discomforting menopausal symptoms. 
&nbsp;

There is no conclusive timetable for when menopausal symptoms begin and end. Your experience generally depends on hereditary qualities. Figuring out how to adapt to your symptoms can bring you long stretches of solace as you progress to the next chapter of your life. 
&nbsp;

While there are no treatments to reverse menopause, an individual can make certain changes in their lifestyle to alleviate the persisting symptoms: 
&nbsp;

<ul>
	<li>Stay hydrated and wear light clothes to avoid intense hot flashes. Also, keep away from spicy food and hot beverages.</li>
	<li>Try to include physical fitness and exercise into your routine to help with hot flashes and insomnia.</li>
	<li>Do not be fickle with your sleep routine. Adhere to a consistent cycle, even on weekends, to get uninterrupted sleep.</li>
	<li>Schedule an appointment with a counselor or therapist to address mood changes in a comfortable and safe environment.</li>
	<li>Engage yourself in social gatherings to increase serotonin.</li>
	<li>Try Kegel exercises to strengthen pelvic bone muscles and reduce the recurrence of urinary incontinence.</li>
</ul>

&nbsp;

[1].Mayo Clinic. (2022). Menopause.

[2].Welt, C. (2020, September 8). Clinical manifestations and diagnosis of spontaneous primary ovarian insufficiency (premature ovarian failure).

[3].Santen, R. J., Loprinzi, C. L., & Casper, R. F. (2020, Feburary 18). Menopausal hot flashes.

[4].Chen, M. N., Lin, C. C., & Liu, C. F. (2014). Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric, Vol 18(2), 260-269.

[5].Mudd, L., & Shurtleff, D. (2017, May). Menopausal Symptoms: In Depth. Retrieved from National Center for Complementary and Integrative Health: https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth#hed3

[6].NHS. (2022, May 7). Menopause. Retrieved from NHS

[7].NAMS. (2022). Five Solutions for Menopause Symptoms. Retrieved from The North American Menopause Society:

Zarlish Kazmi

Menopause And Breast Cancer

According to research, in all of Asia, Pakistan has the highest rate of <a href="https://merisehat.pk/disease/side-effects-of-breast-cancer-treatment">breast cancer</a>, with 1 in 9 women at risk of getting diagnosed with breast cancer<a href="#accordion">[7]</a>&nbsp;<a href="#accordion">[6]</a>. This is usually because of the myths associated with the condition. Delayed screening means the cancer is diagnosed when it has advanced and there is little chance of survival.

Understanding the link between Menopause and Breast cancer

Age is one of the major risk factors for developing breast cancer. The likelihood of being diagnosed with a malignant tumor in the breast is greatest between the ages of 45 and 55. Unless an individual has previously undergone chemotherapy, surgeries such as hysterectomy or oophorectomy, or possesses a genetic predisposition to experience early menopause, this is when a natural decline in hormone levels occurs.

The decreased production of estrogen and progesterone leads to irregular menstrual periods before they eventually cease. During this phase, one may experience hot flashes, sexual difficulties, insomnia, memory problems, osteoporosis, and anxiety.

However, menopause itself is not our concern here. Menopause itself is not related to a higher risk of getting cancer. It&rsquo;s the fact that 1 out of 8 cases of breast cancer occur during their lifetime, mostly in women over 50, that&rsquo;s worrisome<a href="#accordion">[8]</a>. This is why the age factor is important &ndash; a girl who starts menstruating before 12 and/or experiences menopause after 55 will have an increased number of ovulations and, thereby, increased exposure to hormones like estrogen.

And then there&rsquo;s the issue of medications or treatments like hormone replacement therapy one may be taking to manage the menopausal symptoms, which increases the risk of breast cancer. 
&nbsp;

While menopause is a risk factor for breast cancer, interestingly, breast cancer can also induce menopause. Treatments like chemotherapy, ovarian suppression (through surgery, hormone therapy, or radiotherapy), and hormone therapy (e.g., anastrozole, exemestane, letrozole, and tamoxifen) cause menopausal symptoms<a href="#accordion">[9]</a>.&nbsp; While each woman reacts differently to therapy, premature menopause due to breast cancer may be permanent (rather than temporary) if they&rsquo;re closer to the natural age of experiencing it. 
&nbsp;

Menopausal signs that are frequently experienced include:

<ul>
	<li>Joint pain</li>
	<li>Night sweats</li>
	<li>Anxiety and irritation</li>
	<li>Mood change</li>
	<li>Heart palpitations</li>
	<li>Change in libido</li>
	<li>Hot flushes</li>
	<li>Changes to hair and skin</li>
	<li>Weight gain, especially around our waist</li>
	<li>Difficulty sleeping</li>
	<li>Memory issues</li>
	<li>Vaginal dryness 
	&nbsp;</li>
</ul>

The onset of these symptoms can be gradual or sudden. It is worth mentioning that not all individuals experience all the listed symptoms, and the severity of symptoms can vary among individuals. 
&nbsp;

The estrogen-driven breast cancers, also known as estrogen-receptor-positive cancers, are a more common occurrence than aggressive cancers. They tend to develop gradually and have a lower mortality rate. In other words, they require less aggressive therapy and have a better outlook and reduced chance of recurrence.

According to studies, if you&rsquo;re overweight or obese post-menopause, you have a 20-60% greater risk of developing breast cancer than those who are lean<a href="#accordion">[10]</a>. This extra fat is the main source of estrogen at that time. It also produces proteins that increase inflammation throughout the body, which causes breast cancer to recur. 
&nbsp;

<h5 style="text-align:justify">Medications</h5>

There are two distinct kinds of drugs, and they both function differently. Aromatase inhibitors (AIs) reduce or halt the body&#39;s production of estrogen, which causes the tumors to die. Tamoxifen prevents estrogen from acting on breast cancer cells.

Both tamoxifen and an aromatase inhibitor can be used to treat postmenopausal individuals with estrogen-positive breast cancer. However, aromatase inhibitors are generally more effective and do not increase the risk of blood clots or uterine cancer<a href="#accordion">[10]</a>. 
&nbsp;

Exercising, a balanced diet, quitting smoking (including avoiding passive smoking) and drinking alcohol, and relieving stress can help breast cancer patients deal with the symptoms. 
&nbsp;

Menopause can be a risk factor for breast cancer and vice versa. However, you can overcome both issues with a balanced diet, a healthy lifestyle, proper checkups, and the right therapy.

[1]Sohail S, Alam SN. Breast cancer in Pakistan-awareness and early detection.

[2] Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer. 2010 Dec 15;127(12):2893-917

[3] Clemons M, Simmons C. Identifying menopause in breast cancer patients: considerations and implications. Breast cancer research and treatment. 2007 Aug;104:115-20.

[4] Biglia N, Bounous VE, Sgro LG, D'Alonzo M, Pecchio S, Nappi RE. Genitourinary syndrome of menopause in breast cancer survivors: are we facing new and safe hopes?. Clinical Breast Cancer. 2015 Dec 1;15(6):413-20.

[5] De Villiers TJ, Pines A, Panay N, Gambacciani M, Archer DF, Baber RJ, Davis SR, Gompel AA, Henderson VW, Langer R, Lobo RA. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric. 2013 Jun 1;16(3):316-37.

[6] Academic.oup.com.

[7] Khan NH, Duan SF, Wu DD, Ji XY. Better Reporting and Awareness Campaigns Needed for Breast Cancer in Pakistani Women. Cancer Manag Res. 2021;13:2125-2129. Published 2021 Mar 2. doi:10.2147/CMAR.S270671

[8] NHS choices.

[9] Menopausal symptoms and breast cancer. Breast Cancer Now.

[10] Stepko B, En español , español E, 03 O. Dealing with breast cancer after menopause. AARP

Syeda Qurat-ul-Ain

Humza Khizer

First Period? No Worries, We Got You Covered

Menarche &ndash; first menstrual period &ndash; is a normal phenomenon for girls. It is significant because it implies growth, both physically and socially.&nbsp; 
&nbsp;

Menstruation is the &quot;periodic discharge of blood from the uterus.&quot; It may or may not occur as a monthly cycle and continues for the entirety of the women&rsquo;s active reproductive life&quot;<a href="#accordion">[1]</a>. 
&nbsp;

Periods can be very challenging to manage, regardless of how long you have had them; but they are especially difficult the first time when you are totally unprepared for them.&nbsp; 
&nbsp;

In this article, you&#39;ll find everything you need to know about your periods &ndash; from finding the right menstrual products, including napkins and tampons, to managing pains and preserving stained clothes.&nbsp; 
&nbsp;

Puberty is the main cause of menstruation. This is the stage when the girl&rsquo;s body becomes capable of reproduction. The estrogen (female hormone) levels increase in the female body due to the beginning of the menstrual cycle, which plays an important role in the thickening of the endometrium or the inner lining of the uterus.&nbsp; 
&nbsp;

The main purpose of the endometrium lining is to aid a fertilized egg during pregnancy. In case the sperm does not fertilize the ovum (egg), the thickened lining is broken down by your body&#39;s natural mechanism and pushed out of your uterus in the form of periods. 
 
&nbsp;

<h5>When Will I Get My First Period? 
&nbsp;</h5>

Girls start menstruating when they reach the age of puberty, between the ages of 12 and 13<a href="#accordion">[2]</a>. Typically, menstruation takes place 2 years after the development of your breasts. 
&nbsp;

<h5>What Symptoms Should I Look For? 
&nbsp;</h5>

Some girls would not experience any symptoms. Their periods start abruptly and without warning. Other girls experience some symptoms in the days preceding their periods, otherwise known as Premenstrual Syndrome (PMS).&nbsp; 
&nbsp;

Symptoms of PMS include:

<ul>
	<li>Skin problems</li>
	<li>Abdominal bloating and pain</li>
	<li>Breast tenderness</li>
	<li>Pain in the lower back</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Mood swings, feeling sensitive or irritable</li>
	<li>Food craving, especially sweets</li>
	<li>Transparent or white discharge from the vagina 
	&nbsp;</li>
</ul>

To avoid being caught unprepared when your period starts, you should start keeping a &quot;<a href="https://merisehat.pk/article/a-guide-to-period-products">period kit</a>&quot; in your bag as soon as you reach that age and feel that your body&rsquo;s changing. This kit should include: 
&nbsp;

<ul>
	<li>A pair of clean underwear</li>
	<li>Pad, menstrual cup, or tampon</li>
	<li>Cleaning wipes</li>
	<li>Over-the-counter pain relievers, such as ibuprofen 
	&nbsp;</li>
</ul>

<h5>What Should You Do For Your First Period? 
&nbsp;</h5>

Try not to panic if your menstruation has begun and you don&#39;t have anything to utilize for the blood. Until you can obtain a good pad or tampon, you can make a temporary pad out of toilet paper to tide you over. 
&nbsp;

A quick tutorial: 
&nbsp;

1. Fold the layers of a long piece of toilet paper (at least 10 squares) over one another.

2. Place this on your underwear where the napkin would be placed &mdash; down the central part of your underwear, along the piece of fabric between your legs (known as the gusset).

3. Use a second toilet paper to wrap the pad and your underwear repeatedly. This will help keep the tissue in its place.

4. Finish the wrap by tucking the tissue&#39;s end into the top. Now, you have a temporary pad that you can easily manage and remove.&nbsp;

You might think of asking your teacher /school nurse/ friends for a pad if you are at your school. It&rsquo;s nothing to feel ashamed or embarrassed about.&nbsp; 
&nbsp;

Understanding How to Deal With the First Menstrual Cycle

Your first period would continue for a few days. It takes some time for your period to become regular and consistent. Usually, periods last between 2-7 days every month when they become regular.&nbsp; How Much Blood Will Be Lost From Your Body? The first few periods are considered typically light compared to those later in your life and only bring a few patches of red-brown blood throughout the week.Once the hormones have stabilized, your cycle will follow a schedule that will be more predictable. However, it is possible to experience a strong flow in the first few months and it's not always a problem if the bleeding is heavier. But, if you believe you are bleeding too much, you need to inform your parents or consult the school nurse.You can also tell any adult whom you trust if you:<ul><li>Have to replace/change your sanitary napkin and tampon every couple of hours.&nbsp;</li><li>Feel giddy</li><li>Feel dizzy</li><li>Feel heart palpitation</li><li>A period of bleeding that lasts more than 7 days.&nbsp; </li></ul>You might need to be taken to the gynecologist by your guardian to discuss your signs. The doctor can also prescribe some medicines to help you with your symptoms.&nbsp;

In this section of the article, several menstrual products have been outlined. Your choice of product depends on a variety of factors such as flow, pain, comfort etc. It is important to bear in mind that your preferred option might change down the line.&nbsp; 
&nbsp;

<h5>Period Underwear</h5>

The concept of period underwear is quite recent. The only difference between it and conventional underwear is that it is made of a unique fabric that absorbs menstrual blood and keeps it inside the fabric. 
&nbsp;

Period underwear caters to all girls and women, i.e. they have different levels of absorbency of blood. If your first period is light, you might be able to rely solely on these. But, if you feel it&rsquo;s a heavy flow, then period underwear is a great backup; it&rsquo;s pretty helpful in preventing accidental leakage.&nbsp; 
&nbsp;

There are numerous brands available, but they all function similarly. Choose one according to your flow and comfort. 
&nbsp;

<h5>Sanitary Napkins And Panty Liners</h5>

Rectangular pieces of absorbent material that you can stick on the inside your underwear are called sanitary napkins. Every pad has a sticky strip on the underside, allowing for the pad to remain attached to your underwear. Some pads may include &quot;wings&quot; on the sides that you drape over the borders of your underwear. This aids in keeping the pad in position and also prevents leakage. 
&nbsp;

There are many different sizes of pads. Each size is specifically designed to accommodate various degrees of blood flow. The amount of blood a pad can absorb varies depending on its size and is usually indicated on the box/cover 
&nbsp;

You&#39;ll most probably use different sizes of pads within one cycle for example at the start of the cycle, you will need more absorbent pads since the flow is heavy, while towards the end of the cycle a lighter absorption pad would be adequate due to less flow.&nbsp;&nbsp; 
&nbsp;

Most women prefer using pads at night compared to tampons as it is easier to change and if left overnight will not cause any health related issues.&nbsp; 
&nbsp;

At the start of your cycle, you will notice some spotting. To prevent staining your underwear due to spotting, you can use panty liners. These are thinner and more compact. They can also be used towards the end of your periods when your bleeding could be sporadic.&nbsp; 
&nbsp;

<h5>Tampons</h5>

Tampons are menstruation products that are tube-shaped and absorbent. They are placed within the vagina to soak up menstruation blood before it gets to your underwear. 
&nbsp;

Applicator tubes made of cardboard or plastic are often sold with tampons. These tubes have been made to aid you in inserting the tampon into your vagina. A string is on one end of every tampon to help you remove it easily.&nbsp; 
&nbsp;

Tampons are available in various sizes and levels of absorbency. Beware of scented tampons, though, as your vagina might become irritated by fragrance. 
&nbsp;

When it&#39;s time to insert the tampon, carefully press it inside your vaginal canal until only the string is left exposed.&nbsp; If your tampon has an applicator, gently pull it out by holding onto the tube. You should let the tampon stay in your vagina so that it&#39;ll absorb the blood.&nbsp; 
&nbsp;

When it is time to take it out of the vagina, just pull the string till the tampon is free.&nbsp; 
&nbsp;

Please make sure to change your tampon every 4 to 6 hours, but no longer than 8 hours. If left for 8 hours, the risk of infections and&nbsp; irritation increases. You also risk developing Toxic shock syndrome (TSS), although it&#39;s rare but it always better to be safe than sorry&nbsp; 
&nbsp;

<h5>Menstrual Cups</h5>

If you are uncomfortable using pads or tampons, another option is menstrual cups. Cups are inserted into the vagina, similarly to tampons, where they collect blood before it leaves the body. 
&nbsp;

Cups normally come in two size options &mdash; small or large &mdash; generally based on the female&#39;s age and previous delivery experience, their menstrual flow, and cervix height. 
&nbsp;

The smaller variant will probably be more convenient, easy to use and more comfortable for you to insert. You should receive step-by-step instructions for your product, but you can also refer to a guide to insertion and removal.&nbsp; 
&nbsp;

One major advantage of these cups over pads or tampons is that they can be washed and used repeatedly. This implies that you only need to remove the cup, clean it, and reinstall it when it&#39;s time to replace it. 
&nbsp;

The lifespan of reusable cups ranges from 6 months to 10 years with proper maintenance depending upon the type of brand and manufacturer of it. In other words, menstrual cups are not only safe and effective, they also save you money and are eco-friendly.&nbsp; 
&nbsp;

No, not always! Before we get into the details, know that it can happen to anyone. 
&nbsp;

When you start your period, you&#39;ll be learning about how much blood will be shed from your body, the amount your menstrual item can absorb, and when your flow seems to be at its heaviest. 
&nbsp;

Keep a few cleaning wipes in your bag if you can. They can help you remove the stain until you can thoroughly wash the fabric.&nbsp; 
&nbsp;

As a temporary solution, you can tie a jacket around your waist to hide the stain&nbsp; 
&nbsp;

Try this technique to remove the stain when you reach home: 
&nbsp;

1. Soak the stained fabric in cold water as soon as possible. Do not use warm water because that would set the stain and make it impossible to get out.&nbsp;

2. Spray a stain remover if it is available. Be sure to soak the affected region thoroughly. Let it sit for the amount of time labeled on the product&#39;s packaging.&nbsp;

3. If you don&#39;t have a stain remover on hand or wish to use two different methods to make it more effective, you can rub a bar soap or dab some liquid soap into the stain-affected region to build up a thin lather.&nbsp;

4. Wash and repeat the process till the stain washes out.

5. Wash your pants in the washing machine if the stain is not completely removed. Just be certain to use cold water rather than warm.&nbsp;

6. Air dry the washed clothes since the dryer&#39;s heat has the potential to set the stain permanently.&nbsp; 
&nbsp;

<h5>Can Other People Tell That I&rsquo;m On My Period?</h5>

Not at all! You don&rsquo;t have a different appearance or fragrance. Someone could smell the blood only if you leave your napkin or period underwear on for a longer period than advised. 
&nbsp;

You should not use scented menstrual products as they can aggravate your vulva.&nbsp; 
&nbsp;

Wash your vaginal area with lukewarm water if you are worried about body odor. Another great alternative is use of baby wipes to clean your intimate regions during periods. 
&nbsp;

<h5>Can I Still Swim And Play Sports?</h5>

Swimming and other physical activities are allowed during your period. It may also have the potential to lessen cramps.&nbsp; 
&nbsp;

Choose a tampon or a menstrual cup to stop leakage in the water when you intend to swim.&nbsp; 
&nbsp;

For the majority of activities, pads or period underwear can be used.&nbsp; 
&nbsp;

<h5>What Can I Do About Cramps?</h5>

Cramps are, without a doubt, uncomfortable. But think about it this way: your body needs periods &ndash; and, therefore, cramps &ndash; to remove the uterine lining. 
&nbsp;

To feel better:

<ul>
	<li>Follow the directions on the label or advice of medical healthcare professionals for use of&nbsp; over-the-counter pain relievers such as ibuprofen.&nbsp;</li>
	<li>Put a heating pad or heating wrap as a source of heat on your lower back or stomach.</li>
	<li>Take a warm bath. 
	&nbsp;</li>
</ul>

Speak to an adult if your cramps are worsening and you feel sick and unable to get out of bed or do routine activities. In some instances, excruciating cramping could signify an underlying illness like endometriosis so don&rsquo;t ignore or take it lightly and consult a gynecologist&nbsp; . 
&nbsp;

<h5>Other Symptoms I Might Have ?&nbsp;</h5>

Besides cramps, you might also experience the following symptoms:

<ul>
	<li>Acne</li>
	<li>Abdominal bloating</li>
	<li>Sore breasts</li>
	<li>Back pain</li>
	<li>Constipation</li>
	<li>Diarrhea</li>
	<li>Fatigue</li>
	<li>Feeling sensitive or irritable</li>
	<li>Food cravings 
	&nbsp;</li>
</ul>

All these symptoms don&#39;t necessarily need to be present when you have your period. They appear or disappear depending upon the hormonal swings.&nbsp; 
&nbsp;

<h5>How Frequently will I Get It?</h5>

The period is basically one part of the menstrual cycle. This implies that your period will follow a more regular pattern over time.&nbsp; 
&nbsp;

Typically, a menstrual cycle lasts for 28 days. But it can be around 21-45 days, which is also normal.&nbsp; 
&nbsp;

Menstruation may not start consistently for about 6 years following your first period. This is because your body has to learn how to control the release of your reproductive hormones.&nbsp; 
&nbsp;

<h5>How Can I Predict When It Will Come?</h5>

It would take a few years for your periods to develop a regular pattern. But you can keep a track of your symptoms, which would prove useful in spotting patterns and getting (mentally) ready for your period till it arrives.&nbsp; 
&nbsp;

This record can also be used to discuss severe pains with the nurse or other healthcare professionals.&nbsp; 
&nbsp;

You can use signs or code words to aid you in symbolizing the start and end of your period if you don&#39;t want people to know what you are tracking. You can maintain it on paper or on a phone. Or you can download an app. Fitbit, for instance, has a tracking option; others like Flo Period &amp; Ovulation Tracker, Clue Period Tracker &amp; Calendar, and Eve Period Tracker App work, too. 
&nbsp;

<h5>Will I Have Periods Forever?</h5>

You won&#39;t have periods for your entire life, but you&#39;ll have them until menopause. The onset of menopause is directly related to the level of hormones that triggered your menarche i.e. Menopause occurs when these hormones start to decrease in your body. 
&nbsp;

Usually, menopause starts between the ages of 45 and 55. But it&rsquo;s not just the age factor; your period may stop/ become irregular due to stress and other medical conditions as well. Talk to your healthcare professional about when you miss a period. 
&nbsp;

Meanwhile, there&rsquo;s the option of hormonal birth control if you want to stop your periods for health reasons/ travel purposes. Again, it&rsquo;s better to get in touch with your doctor first regarding it.&nbsp; 
&nbsp;

You will not have any periods during pregnancy. In case you experience any bleeding or spotting during pregnancy, please consult your doctor immediately. 
&nbsp;

<h5>Can I Get Pregnant After Menstruation?</h5>

The brief answer? Yes. When the semen comes in touch with the vagina, pregnancy is a possibility. Although the start of a period is mostly considered to mark the start of your reproductive years, it is possible to conceive before your period.&nbsp; 
&nbsp;

Hormones determine everything. In some circumstances, your body may secrete ovulation-inducing chemicals before the start of menstruation. Getting pregnant is conceivable even if you have intercourse during your menstruation.&nbsp; 
&nbsp;

Ultimately, it depends on where you are in your cycle. If you want to prevent pregnancy, you can use any of the contraceptive methods suggested by your doctor.&nbsp; 
&nbsp;

Talk to a responsible adult or visit a doctor if: 
&nbsp;

<ul>
	<li>By the age of 15, you have not begun your period.&nbsp;</li>
	<li>It&#39;s been almost 2 years since you have had your periods and they are still irregular.&nbsp;</li>
	<li>Bleeding occurs in between your periods.&nbsp;</li>
	<li>You are in excruciating pain and unable to carry out routine tasks.&nbsp;</li>
	<li>You must replace your pad or tampon every 1-2 hours as you experience heavy intense bleeding.&nbsp;</li>
	<li>You experience periods longer than 7 days.&nbsp; 
	&nbsp;</li>
</ul>

Make sure you&rsquo;ve kept a record of when your last period began and ended, when did the erratic bleeding start, or any other signs you experienced during your cycle. 
&nbsp;

Women in low- and middle-income countries frequently lack access to medical information, particularly regarding menstruation-related hygienic concerns. Lack of formal guidance from the schools, cultural resistance to using alternate menstruation products, a lack of economic resources, and inadequate water and sanitation infrastructure make this natural process difficult for young girls.&nbsp; 
&nbsp;

As a result, a biological process that naturally dignifies women and girls becomes a source of embarrassment and frustration. Such societal stigmas and beliefs make post pubescent girls more susceptible to engaging in unsanitary behaviors that result in various diseases, including those of the reproductive and urinary systems. 
&nbsp;

Hence, this article aims to provide a comprehensive guide to educate young girls about safe menstrual health.&nbsp; 
&nbsp;

<ul>
	<li>It might be challenging for a parent or guardian to know how to help a child during their first period.</li>
	<li>Every woman goes through the period as part of her regular cycle.</li>
	<li>The guardian should keep it factual. Don&rsquo;t let your menstrual past, whether it&#39;s been positive or negative, influence how you think and eventually affect how your daughter feels about menstruation.</li>
	<li>There are various menstruation product options to help you with the process.</li>
	<li>Make a period kit with some underwear, stain remover, and menstrual supplies that they can conveniently put in a locker or backpack.</li>
</ul>

[1] Fingerson, L. (2012). Girls in power: Gender, body, and menstruation in adolescence. SUNY Press.

[2] Marques P, Madeira T, Gama A. Menstrual cycle among adolescents: girls' awareness and influence of age at menarche and overweight. Rev Paul Pediatr. 2022;40:e2020494. Published 2022 Jan 5. doi:10.1590/1984-0462/2022/40/2020494

Neelam Asad

Is Male Menopause Real?

If you&rsquo;re a middle-aged man who&rsquo;s suddenly having thoughts of buying a leather jacket and riding a Harley Davidson, chances are you&rsquo;re going through a midlife crisis. Or maybe it&rsquo;s just menopause? But isn&rsquo;t menopause a female phenomenon?&nbsp;

Generally, menopause signifies a time in a woman&rsquo;s life when her hormone levels begin to decline and cause symptoms such as fatigue, mood swings, and hot flashes. So, by extension, does it mean that if you&rsquo;re experiencing male menopause, it&rsquo;s basically a reduction in your hormones, too? Yes, perhaps.

The fall in testosterone levels, the main sex hormone in men, is largely blamed for the occurrence of menopause in men. However, there is no specific period that can be labeled as menopause in men as the decline in testosterone is a gradual process. It is unlike female menopause because the reduction in hormones in women is abrupt and results in a complete halt in hormone production.&nbsp;

In your case, for instance, a drop in testosterone levels may simply be a normal part of aging. According to research, men experience a steady decline of less than 2% a year in testosterone levels when they are 30-40 years old<a href="#accordion">[1]</a>; there&rsquo;s no sudden drop that causes symptoms like mood swings and loss of sex drive as it happens with women. Therefore, male menopause is a misleading term to use, mostly because the symptoms of male menopause can be explained by other reasons as well.&nbsp; 
&nbsp;

Understanding Male Menopause ( Andropause)

Also known as andropause, male menopause is a state of low androgen levels, particularly testosterone. Testosterone is the sex hormone which responsible not only for regulating sex drive, but also for muscle and bone growth, fat distribution, and even sperm production in men<a href="#accordion">[2]</a>.&nbsp;

The concentrations of bioavailable testosterone may decrease by up to 50% in men between the ages of 25 and 75 years. Moreover, more than half the men above the age of 50 years suffer from low testosterone levels<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

A decline in testosterone levels may result in:

<ul>
	<li>Mood swings</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a></li>
	<li>Irritability</li>
	<li>Fatigue</li>
	<li>Loss of libido</li>
	<li><a href="https://merisehat.pk/disease/erectile-dysfunction">Erectile dysfunction</a></li>
	<li><a href="https://merisehat.pk/disease/infertility-in-men">Infertility</a></li>
	<li>Sleeping difficulty and insomnia</li>
	<li>Difficulty concentrating</li>
	<li>Lack of enthusiasm or energy</li>
	<li>Weight gain</li>
	<li><a href="https://merisehat.pk/disease/gynecomastia">Gynecomastia </a>due to fat redistribution</li>
</ul>

&nbsp;

In rare instances, men may also experience:&nbsp;

<ul>
	<li>Decreased testicle size&nbsp;</li>
	<li>Hot flashes</li>
	<li>Osteoporosis 
	&nbsp;</li>
</ul>

While aging is associated with a drop in testosterone levels, other conditions may also cause a similar effect. For example, late-onset hypogonadism and diabetes. Hence, andropause is more commonly referred to as androgen deficiency, testosterone deficiency syndrome, and hypogonadism.&nbsp;

Hypogonadism is a condition in which the testes produce little to no hormones. The condition may present at birth, but it may also develop later in life due to obesity or type 2 diabetes (late-onset hypogonadism). Hypogonadism present from birth causes delayed puberty and smaller testes.&nbsp;Several comorbid factors high cholesterol levels, high blood glucose concentrations, and higher waist-to-hip ratio may also lead to hypogonadism.&nbsp; 
&nbsp;

The decline in testosterone levels is a normal part of aging, and a simple blood test will quickly detect your testosterone levels. However, if hormonal changes are disrupting your daily activities, your doctors may suggest various treatment strategies.

The first and foremost advice is to adopt a healthy lifestyle. Healthy lifestyle habits include:

<ul>
	<li>A healthy diet</li>
	<li>Regular exercise</li>
	<li>Stress management</li>
	<li>Adequate sleep</li>
</ul>

Additionally, if you have been diagnosed with depression, your doctor may also prescribe antidepressants and therapy. 
&nbsp;

Testosterone replacement therapy is another possible treatment option. If your doctor is hesitant to prescribe the treatment, it may be because of its numerous side effects.&nbsp;Generally, HRT improves your symptoms and restores any physiological changes. It may enhance:&nbsp;

<ul>
	<li>Mood</li>
	<li>Physical activity</li>
	<li>Sexual function</li>
	<li>Cognitive function</li>
	<li>Bone density&nbsp;</li>
	<li>Muscle strength&nbsp;</li>
</ul>

You may receive it in the form of oral agents, injections, transdermal patches, or gels.&nbsp;

However, there is limited evidence on the long-term effect of testosterone replacement therapy. While some studies have reported improvement in the overall quality of life in male subjects, they have also, unfortunately, revealed several adverse effects of HRT on men, including fluid retention causing weight gain, increased cardiovascular disease risk, worsening of sleep apnea, and mood fluctuations<a href="#accordion">[4]</a>.&nbsp;

Besides, there is also a slight risk of HRT causing prostate cancer. It&rsquo;s better to consult your doctor and if it&rsquo;s a suitable treatment in your case, they&rsquo;ll be able to prepare you for evaluation and screening for cancer before the administration of HRT.&nbsp; 
&nbsp;

Since male menopause is a misleading term to describe the low testosterone levels in older men, doctors prefer calling it andropause. However, it’s not easy to diagnose andropause because its symptoms often mimic those of other diseases and medication side effects, and there are no established normal testosterone levels for different age groups.&nbsp;It is important to note that male menopause is not the same as female menopause. In women, menopause signifies an end of the ability to reproduce due to a complete stop in hormone production. On the other hand, in men, the decline in testosterone is a gradual process and, more importantly, the testes do not stop producing the hormone. Another striking difference is while every woman will experience menopause at a particular stage in life, not all men will experience andropause.&nbsp;Hormone therapy may be beneficial in some men suffering from andropause, but it is advised to always consult a doctor before starting any form of treatment. Talk to a healthcare professional who is aware of various alternatives available and who may be able to develop a personalized treatment for individual patients.&nbsp;

<ul><li>Male menopause is also called andropause. The term andropause describes a state of low androgen levels in men, particularly testosterone</li><li>Testosterone is responsible for regulating sex drive, muscle and bone growth, fat distribution, and even sperm production in men. A decline in its levels may cause depression, decreased libido, gynecomastia, insomnia, fatigue, and weight gain</li><li>Men experience a steady decline of less than 2% a year in testosterone levels between 30 and 40 years of age. However, this produces no effect.&nbsp;</li><li>While aging is associated with a drop in testosterone levels, other conditions may also cause a similar effect. For example, late-onset hypogonadism and diabetes. Hence, andropause is more commonly referred to as androgen deficiency, testosterone deficiency syndrome, and hypogonadism.&nbsp;</li><li>Male menopause is considered a misleading term because the symptoms of male menopause may be explained by other reasons as well.</li><li>A healthy lifestyle is often the first treatment advice for patients. Adequate sleep, a healthy diet, regular exercise, and stress management help deal with andropause in men. For those diagnosed with clinical depression, doctors may also prescribe antidepressants and therapy</li><li>Testosterone replacement therapy is another possible treatment option for male menopause. However, doctors are often hesitant to prescribe it due to its possible side effects, which include fluid retention causing weight gain, increased cardiovascular disease risk, worsening of sleep apnea, and mood fluctuations</li><li>It is important to note that male menopause is not the same as female menopause. In women, menopause signifies an end of the ability to reproduce due to a complete stop in hormone production. However, in men, the decline in testosterone is a gradual process, and the testes do not stop producing the hormone</li></ul>

[1] NHS. The Male Menopause. NHS choices.

[2] Understanding how testosterone affects men. National Institutes of Health.

[3] Gould DC, Petty R. The male menopause: does it exist?: for: some men need investigation and testosterone treatment. West J Med. 2000;173(2):76-78. doi:10.1136/ewjm.173.2.76

[4] Brawer MK. Testosterone replacement in men with andropause: an overview. Rev Urol. 2004;6 Suppl 6(Suppl 6):S9-S15.

Sexual Health After Menopause

Overview

Menopause marks a significant transition in a woman&#39;s life, where the body goes through several hormonal changes that can affect physical and emotional well-being, including sexual wellness. Sexual wellness refers to the ability to have a satisfying and fulfilling sexual life, and it is essential for overall health and quality of life. 
&nbsp;

Understanding Menopause and Sexual Wellness

Menopause is a natural biological process that marks the end of a woman&#39;s reproductive years. It typically occurs between the ages of 45 and 55 and is characterized by a decline in the production of estrogen and progesterone hormones, which can lead to several physical and emotional changes. One of the most common changes is a decrease in <a href="https://merisehat.pk/article/the-impact-of-hormonal-birth-control-on-sexual-health-and-libido">libido</a>, or sex drive, which can affect sexual wellness. 
&nbsp;

Sexual wellness involves several factors, including desire, arousal, orgasm, and satisfaction. The decline in estrogen levels during menopause can cause vaginal dryness, thinning of the vaginal walls, and decreased blood flow to the genital area, which can lead to discomfort and pain during sex. This can make it difficult to maintain sexual wellness, but there are several steps that women can take to overcome these challenges. 
&nbsp;

<ol>
	<li dir="ltr">
	Talk To Your Healthcare Provider: The first step to maintaining sexual wellness during menopause is to talk to your healthcare provider. Your healthcare provider can evaluate your symptoms and provide appropriate treatment options to help alleviate any discomfort or pain during sex. They may prescribe hormonal therapy or suggest over-the-counter vaginal lubricants or moisturizers to help with vaginal dryness. 
	 
	It is also essential to discuss any underlying medical conditions or medications that may affect sexual wellness. Certain medications, such as antidepressants or blood pressure medications, can cause a decrease in libido or sexual dysfunction. Your healthcare provider can suggest alternative medications or treatment options to help minimize these side effects. 
	&nbsp;
	</li>
	<li dir="ltr">
	Practice Self-Care: Practicing self-care is an essential step to maintaining sexual wellness during menopause. 
	 
	This can involve several lifestyle changes, such as:
	</li>
</ol>

<ul>
	<li dir="ltr">
	Eating A&nbsp;Healthy And Balanced Diet: Eating a diet rich in fruits, vegetables, whole grains, and lean protein can help maintain overall health and promote sexual wellness.
	</li>
	<li dir="ltr">
	Exercising Regularly: Exercise can help increase blood flow and promote hormonal balance, which can improve sexual wellness.
	</li>
	<li dir="ltr">
	Getting Enough Sleep: Getting enough sleep is essential for overall health and well-being, including sexual wellness.
	</li>
	<li dir="ltr">
	Managing Stress: Stress can affect sexual wellness, so it is important to find healthy ways to manage stress, such as meditation, yoga, or deep breathing exercises. 
	&nbsp;
	</li>
</ul>

<ol start="3">
	<li dir="ltr">
	Explore Different Sexual Activities: During menopause, it may be helpful to explore different sexual activities to find what works best for you. 
	 
	This can include:
	</li>
</ol>

<ul>
	<li dir="ltr">
	Engaging In Non-Penetrative Sexual Activities: Non-penetrative sexual activities, such as kissing, touching, or oral sex, can help maintain sexual intimacy without the discomfort or pain associated with vaginal penetration.
	</li>
	<li dir="ltr">
	Trying Different Positions: Certain sexual positions may be more comfortable than others, so it may be helpful to experiment with different positions to find what works best.
	</li>
	<li dir="ltr">
	Using Sex Toys: Sex toys, such as vibrators, can help increase arousal and pleasure during sex. 
	&nbsp;
	</li>
</ul>

<ol start="4">
	<li dir="ltr">
	Communicate With Your Partner: Communication is key to maintaining sexual wellness during menopause. It is important to communicate openly and honestly with your partner about any discomfort or pain during sex. Your partner may be willing to try different sexual activities or positions to help alleviate any discomfort. 
	 
	It is also essential to discuss any emotional changes that may affect sexual wellness, such as decreased libido or changes in mood. Your partner may be able to offer support and understanding during this transitional period 
	&nbsp;
	</li>
	<li dir="ltr">
	Consider Hormone Replacement Therapy: Hormone replacement therapy (HRT) is a treatment option that involves taking estrogen and progesterone to replace the hormones that are lost during menopause. HRT can help alleviate several symptoms of menopause, including vaginal dryness, hot flashes, and mood changes, which can improve sexual wellness. 
	 
	However, HRT has some risks, including an increased risk of breast cancer, stroke, and blood clots. It is important to discuss the risks and benefits of HRT with your healthcare provider to determine if it is the right treatment option for you. 
	&nbsp;
	</li>
	<li dir="ltr">
	Seek Counseling Or Therapy: Menopause can be a challenging time emotionally, and it can affect sexual wellness. Seeking counseling or therapy can be helpful in managing any emotional changes that may affect sexual wellness. A therapist can help address any emotional or psychological issues that may be impacting sexual wellness and provide strategies to manage these challenges. 
	&nbsp;
	</li>
	<li dir="ltr">
	Practice Kegel Exercises: Kegel exercises involve contracting and relaxing the pelvic floor muscles, which can help improve vaginal tone and control. These exercises can be helpful in maintaining sexual wellness by increasing sensitivity and improving sexual satisfaction. 
	 
	To perform Kegel exercises, tighten the muscles used to stop the flow of urine and hold for five seconds before relaxing. Repeat this exercise ten times, three times a day. 
	&nbsp;
	</li>
</ol>

Bottom Line

Menopause can be a challenging time for women, and it can affect sexual wellness. However, with proper education, resources, and lifestyle changes, it is possible to maintain sexual wellness during this transitional period. It is essential to talk to your healthcare provider, practice self-care, explore different sexual activities, communicate with your partner, consider hormone replacement therapy, seek counseling or therapy, and practice Kegel exercises. By taking these steps, women can maintain sexual wellness and improve their overall quality of life during menopause.

&nbsp;

Rukhsana Rizwan

Much like puberty, <a href="https://merisehat.pk/disease/menopause">menopause</a> is also a different stage of life that we all go through. There are several body changes, biochemical changes and just generalised changes involved in this new phase.

Menopause does not have to be depressing or sad. Ageing is a reality of life and when we are young, we cannot wait to be old but the moment we reach our &lsquo;ideal&rsquo; age we realise how good we had it when we were young. However, we often tend to ignore the hard facts. You have multiple things now that you were not able to afford simply because we are dependent on other people. Every age and phase has its perks.&nbsp;

&nbsp;

Menopause and Sex

Menopause is a natural part of the aging process for women and it often brings a range of physical and emotional changes. One aspect of menopause that is often overlooked is the impact it can have on sexual function. If you&rsquo;re approaching menopause or are already post-menopausal, it&rsquo;s important to understand what to expect and how to navigate any changes in your sexual health.

One of the most common side effects of menopause is vaginal dryness. This can occur due to the decreased levels of oestrogen in the body, which can lead to a thinning of the vaginal walls and decreased natural lubrication. This can make sex uncomfortable, painful and even impossible.

Another issue that can arise during menopause is a reduction in libido. This can be due to hormonal changes, stress, and other factors, and it can make it difficult for women to feel as interested in sex as they did before. Additionally, stress, fatigue and pain can all have an impact on sexual function and satisfaction during menopause.

In some cases, women may experience sexual dysfunction during menopause. This can include problems with arousal, orgasm and even pain during sex. These symptoms can be the result of physical changes such as vaginal dryness or hormonal imbalances, or they may be related to psychological factors like stress or anxiety.

Despite these challenges, it is possible for women to enjoy fulfilling sexual lives after menopause. Some strategies to consider include using lubricants or vaginal moisturisers to address dryness, exploring alternative forms of intimacy and seeking help from a healthcare provider or counsellor if needed.&nbsp;

Hormonal treatments like oestrogen therapy may also be an option for some women, but it&rsquo;s important to discuss the risks and benefits with your doctor to determine if this is the right choice for you.

It&rsquo;s also important to keep in mind that sexual function can be affected by other health issues, such as cardiovascular disease, arthritis, or other conditions. If you&rsquo;re experiencing any difficulties with sex, it&rsquo;s important to speak to your doctor about any underlying medical issues that may be contributing.

Many women also experience emotional and psychological changes during menopause. It&rsquo;s important to address these changes and to seek support from loved ones, friends, or a therapist if needed. This can help women navigate the challenges of menopause and find new ways to enjoy intimacy and sexual pleasure.

Finally, it&rsquo;s important to remember that every woman&rsquo;s experience with menopause is unique, and there&rsquo;s no right or wrong way to deal with the changes it brings. Some women may have very few symptoms, while others may experience more significant physical and emotional changes. By being open and honest with yourself and your partner, and by seeking support as needed, you can find ways to enjoy sexual intimacy after menopause. 
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Sex after menopause can bring new challenges, but it&rsquo;s also an opportunity to explore new forms of intimacy and sexual pleasure. By addressing physical and emotional changes, seeking support, and working with your doctor to address any underlying health issues, you can continue to enjoy fulfilling sexual experiences after menopause.

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