Decreased sexual desire (Hypoactive Sexual Desire Disorder, HSDD) or low libido is common after natural or surgical menopause. Numerous studies have suggested that low dose testosterone worn as a patch and currently marketed in the UK as Intrinsa® has benefit in the treatment of HSDD. Recent data from the Aphrodite Study in which women, not on hormone replacement, were randomized to either the testosterone patch or a placebo patch for an initial 24 weeks demonstrated significant improvements in the frequency of satisfying sexual episodes for those women on testosterone. This included an increase in sexual desire, arousal, orgasm and pleasure along with a reduction in personal distress. The testosterone patch was well tolerated except for a higher incidence of hair growth. During the study four patients in the testosterone patch group were diagnosed with breast cancer introducing a possible causal relationship with breast cancer.
Currently there is no FDA drug approved for the treatment of decreased sexual desire in the US. Low libido is a complex subject and sometimes a difficult subject to discuss. The different types of female sexual dysfunctional, namely problems with desire, arousal, orgasm or pain should be differentiated from each other during a careful evaluation by a health care provider with expertise in this area. It is estimate that anywhere from 9 to 40% of women experience some form of female sexual dysfunction.
SJ Wininger, MD, FACOG
Endometriosis is the presence of uterine glands (the inner lining or endometrium of the uterus) located outside the uterus on other organs or surfaces of the body.
Pelvic Pain
The hallmark of symptomatic endometriosis is pelvic pain. This pain may be constant, cyclic (frequently starting before the period) or occur during intercourse. If the implants involve other organs such as the bladder or bowel, symptoms may include pain during urination or the constant sensation to defecate around the time of ones period. The degree of pain has been shown to correlate with the depth of endometriotic lesions as seen on laparoscopy and biopsy and less with the type and location of these implants.
Etiology
The cause of endometriosis remains unclear although leading theories include retrograde or “backward” menstrual flow out the tubes into the pelvis and spread via the blood and lymphatic vessels. All women are probably susceptible to this disease but many women eradicate early implants via their immune systems. There is a genetic predisposition (10 fold increase risk with a sister or mother who has disease) but interestingly, many women who have endometriosis incidentally found during surgery are completely pain free.
The diagnosis of endometriosis requires surgery and the visualization of implants and biopsy of surfaces that are questionable. The surgical experience of the gynecologist in identifying implants is very important although even in the best hands visualization alone can miss borderline implants or falsely identified endometriosis where there is none. Most surgery is performed with a laparoscope in an out-patient setting.
Treatment
Despite opposing opinions no evidence firmly establishes the superiority of medical or surgical therapy in the treatment of endometriosis related pain. There is also no evidence suggesting that surgical excision of implants is superior or inferior to vaporization (laser) or cautery (burning) of implants. Both surgical approaches have good initial outcomes but reoccurrence of pain is seen in nearly 45% of women after one year. Medical therapies include birth control pills, Depo-Provera, Danazol, anti-inflammatory drugs and GnRH agonist therapy (Lupron). These may be effective in relieving pain but some of these therapies are associated with significant side effects (menopause symptoms, hair growth, oily skin) and discontinuation of therapy is often associated with reoccurrence of symptoms. None of these therapies are curative and many are abandoned because of side effects.
Birth control techniques are not only important, but are a necessity for all the sexually active females who lack the desire of a pregnancy. Luckily, there are a wide variety of options available for birth control and one of the most commonly used techniques is the intake of pills. When it comes to availability, birth control pills are extremely easy to purchase in the market and drug stores. Nevertheless, you will need to visit your health care provider and undergo a routine examination to analyze what type of pill best fits you, your body, and your behavior. After you research your options, and if you plan to take the pill as a form of birth control, the first thing you need to do is to visit a gynecologist. The doctor will prescribe the best medicine which suits your body after the medical check-up, which generally involves the examination of blood pressure and weight. With the increase of inventions and discoveries, many innovative pills are available now which do not have any major side effects. Once you get the prescription from the doctor you can very easily get these pills from your pharmacy.
The typical exam and consultation usually begins with checking your blood pressure, and answering a few basic questions from your doctor regarding your health history and that of your immediate family. Other areas of common interest will include whether you’re a smoker, if you use condoms on a regular basis, and current medical conditions you might be experiencing. When you begin taking the birth control pills for the first three months, you will have to visit the health care professional who will monitor your physical behavior including if you gain or lose weight, your blood pressure, etc. Accurate and consistent monitoring will help you have a successful birth control experience. Any side effects such as spotty irregular bleeding, weight gain and other side effects should be reported immediately. In regard to cost, most birth control pills are sold between $16 and $55 on a per month basis.
Female Decreased Desire or HSDD
Hypoactive (decreased) sexual desire disorder or HSDD is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal problems (problems within a relationship). It is not simply a loss of libido which is a term that belittles the complexity of sexual relationships. Decreased desire can however be further categorized as gradual onset or lifelong. Gradual onset means that at some point in time a woman who had or experienced a fulfilling sexual life began to loose some or all interest or desire for sexual activity. Lifelong on the other hand is someone who reports never having had sexual fantasies or a desire for sexual activity ever.. There are also women who have situational decreased desire i.e. (parents-in law spend the weekends) versus those with decreased desire that is generalized and unrelated to any set of circumstances.
The hallmark of the disorder is that by definition the loss or decrease in desire causes personal distress and/or creates problems within a relationship. Often partners/spouses of those affected believe that they are no longer desired or loved when often times just the opposite exists. Many women feel guilty or inadequate and feel that there is something the matter with them. Some women fulfill their partners desire for sex simply for the sake of protecting their relationship yet they feel no desire for sex, never initiate foreplay or experience sexual fantasies.In some cases relationships become completely jeopardized.
Approximately 10-20% of women suffer from this disorder in the US and there is presently no approved treatment available. Testosterone in a transdermal (patch) delivery system is available in Europe for the treatment of decreased or absent desire in post-menopausal women. To date, the patch however has not been approved for use in the USA
Birth control pills will help prevent pregnancy, but not the transmission of HIV and other STD’s. These diseases can occur if you have unprotected sex with an infected person. No birth control method like pills and intrauterine devices can protect a person from HIV and other STD’s.
Sexually transmitted diseases are caused by viruses that are transmitted through sexual contact. Only if a barrier method is used, like a condom, will you improve your protective measures. The only birth control method that has been proven to help protect from sexually transmitted diseases is the male latex condom. Most condoms are lubricated to enhance the natural pleasure and comfort of intercourse, and there are also non-lubricated condoms that can be used for oral sex. Those who are sexually active and looking to increase their protection against STD’s should highly consider the condom as one of their best defenses. There are some product considerations regarding condoms. Condoms labeled “natural” and others “lambskin” will not protect against sexually transmitted diseases. These have tiny pores that allow body fluids to seep in, and can also allow viruses like HIV, herpes and hepatitis B to go through the condom. Non-lubricated condoms can be accompanied by using “KY Jelly”. The use of massage oil, cold cream, and oil based products for lubrication is not recommended. These may cause the condom to weaken, tear and break.
When partners decide on using condoms, it’s still very important to educate both partners on how to administer the protective barrier properly. Don’t assume the other person will automatically know how to use the condom, as most men have not had enough education or learned how to use one effectively. Ensure you and your partner use a condom for all forms of skin-to-skin sexual contact whether it be vaginal, anal or oral. Incorrectly using a condom is one of the largest reasons accidents and infections can happen. Don’t be hesitant or shy regarding your safety and your future health. Another form of protection, and the only 100% effective measure to prevent unwanted pregnancies and the transmission of sexually transmitted diseases is abstinence.
When you were a growing child, your parents would often tell you to drink your milk and get some exercise. There is a reason for this. Lack of exercise and inadequate calcium intake can make your bones weak, and weak bones are susceptible to osteoporosis.
Osteoporosis is when a person develops weak, thin and brittle bones. Weakened bones are prone to fractures. When women are post menopausal and start losing bone mass, they’re developing osteoporosis. Some older women have weakened bones and show signs of osteoporosis.
Bone is not lifeless, it is something that changes and develops from birth till we reach thirty. Diet and exercise both play a major role in determining the health of our bones. Calcium gives our bones strength and density. So does regular bone strengthening exercise like walking and jogging. In particular weight bearing exercises help keep bone mass at a healthy level. Lifting weights not only helps you look great on the outside, but it can keep your bones fit.
Bone keeps growing and developing until 30 years of age. After age 30 our bones natually begin to deteriorate. This makes it so important to build up the strength of our bones before the age of thirty. After that bones start thinning down, become porous. This process is not limited to women only, but men also.
Women are more susceptible during menopause. During menopause estrogen levels fall, and this causes loss of bone tissue. It seems that estrogen helps bones absorb calcium present in the blood. The first ten years after menopause are the most crucial since the maximum amount of bone loss happens then.
To prevent osteoporosis both men and women need to ensure that they take adequate amounts of calcium and vitamin D. Excellent sources of calcium include, milk, cheese, okra, peas, cabbage, salmon, shrimp. Calcium rich breads, juices can also be consumed. Vitamins can also be a good source of calcium.
Vitamin D plays a very important role in the bone building process. Vitamin D helps your bones absorb the calcium from your blood streatm.
Vitamin D is present in eggs, dairy products and fish. A glass of milk consumed daily can give you about one fourth of your daily requirement. Exposing your body to sunlight can help supply your body vitamin D and you can also have supplements.
Migraine headaches are considered to be a very painful, intense and sometimes chronic condition that effect both sides of the head and behind the eyes. Migraines can sometimes cause nausea, vomiting and sensitivity to light. Some migraine sufferers may see light flashes or even suffer from temporary blindness. The attacks may last a few minutes or remain for hours. Some migraine sufferers have “moments” that only appear once in a great while, while others suffer frequently. Historically, women usually suffer from migraine symptoms more than men.
The exact cause of migraines is not known. For some, migraines may be genetic or possibly be some chemical changes that trigger migraine attacks. Experts have found some common associations that trigger a migraine attack such as too much sleep or lack of sleep, skipped meals, loud noises, stress, red wine, caffeine, nitrate rich food, or food containing MSG and Tyramine. Women sufferers are also advised to maintain a food diary so they can recognize their own possible triggers and avoid them.
Whether using birth control pills make migraines worse is still not yet known. For some women, birth control pills have actually lessened their susceptibility to migraine attacks and they may notice reduced frequency and intensity of the migraine attacks. In other women, however, birth control pills have actually made their migraines worse. There is a third group of women who seem to be unaffected by birth control pills.
Herpes and human papilloma virus (HPV) are categorized as sexual transmitted diseases (STDs) that affect both men and women during sexual “skin to skin” contact. Sexual intercourse is one of the most successful and easiest ways to spread the infectious disease, yet when using condoms, the risk of contracting the infection can be reduced. Although the use of condoms can offer some protective measures, it is safe to say that there is no completely “safe sex” or protective shield for sexually active men and women.
Use of condoms to protect against Herpes or the Human Papilloma Virus.
Sexual partners who advocate the use of sexual protection, such as condoms, can reduce their chances of acquiring harmful STD’s such as human papilloma virus (HPV), HIV, chlamydia, gonorrhea, and may reduce the chances of getting pregnant. When a man or woman initially becomes infected with a specific (HPV) strain, genital ulcers such as herpes usually arise within the genital areas of the body. Because the genital region is the most likely of areas to exhibit an infectious manifestation, the regular use of condoms may also help protect a female from the development of cervical cancer.
Although there is no 100% effective protection from STD’s (other than abstinence), it is very important that condoms are used every time sexual contact occurs. In order to increase one’s protective probability, condoms must be worn and used properly. Another consideration in personal protection from the viruses is to limit their number of sexual partners. Having sexual contact with a limited number of partners (or single partner) and properly using condoms during “skin to skin” sexual behavior or intercourse increases protection and reduces the opportunities to acquire these viruses and diseases.
In 1960, the approval for birth control pills became a reality for millions of women in the United States, where the “Pill” was developed. Birth control pills are basically a combination of the hormones estrogen and progestin, which are naturally present in a woman’s body. When administered properly and taken daily, they help women by preventing pregnancy.
The oral contraception pills can prevent the process of ovulation, which is the fusion of sperm cells and eggs by preventing the release of hormones called gonadotropins. Some birth control pills also help in the thickening of cervical mucus in women that restricts the sperm cells from going through the reproductive tract to reach the eggs. As with most prescription drugs, some side effects may appear with a select group of users. Some of the side effects of contraceptive pills are bleeding, weight gain and depression. Other side effects may include mastalgia (which is tenderness of breasts and an increase in breast size), nausea, increased blood pressure, and reduced acne breakouts.
Another form of contraceptive, the “Patch”, is a new method of birth control which came into existence very recently. It works similar to the contraceptive pills, by combining two hormones progestin and estrogen. These hormones have the same effect as contraceptive pills by preventing ovulation and the thickening of cervical mucus. They also prevent implantation of the egg making the lining of the uterus thinner.
The major difference between pills and the contraceptive patch is the method through which these hormones enter into blood stream. The pills are consumed orally and the hormones enter through the gastro-intestinal system, whereas in case of the patch, they are absorbed through the skin. Although the patch is considered an effective method, its efficiency with women can be varied based on the usage. For women weighing more than 200 pounds, the patch may have a reduced effect, as the absorption of hormones through skin is difficult because of fat content in skin.
Osteoporosis which literally means “Porous bone” is a disease related to bones which weakens the bones and increases the risk of unexpected fractures. The disease does not have any visible symptoms and is not exposed until the weakened bones lead to fractures especially in hips or back. The disease is predominant among women and one third of women in the world above the age of fifty are said to have osteoporosis.
Our bones are made of living tissue which grows and remodels itself continuously. There is dense bone which forms the outer shell and protects the internal trabecular bone which is sponge-like and is of soft nature. People, who suffer from osteoporosis, will have the holes in these sponge-like bones enlarged and this weakens the structure of the bones internally.
When people are young (less than 30 years of age) the bone mass is increased and bones are stronger. But after this age, the bones begin to breakdown leading to loss of bone mass gradually. When this bone mass reduces below a threshold level, the person suffers from Osteoporosis.
Postmenopausal Osteoporosis is very common among women over the age of forty and is usually caused as a result of menopause. There is a straight forward relationship between lack of estrogen hormone and osteoporosis in women. In case of some women early menopause can occur (i.e., below the age of 40) and this leads to Osteoporosis. In case of delayed periods during which the level of estrogen hormone is less and menstrual period is absent, there can be some bone mass reduction leading to the disease.
Postmenopausal Osteoporosis is very common and deadly than premenopausal osteoporosis as it occurs to people of age above 40. Women who have experienced menopause recently will have greater osteoclasts which are cells responsible for the destruction of bones than normal women who haven’t experienced menopause. Also, the menopause naturally leads to the decrease in production of estrogen hormone as a woman becomes sterile after menopause. But estrogen is also important for the regulation of remodeling cycle in bones. So, women can experience rapid loss of bones after their menopause. Estrogen helps in regulating the bone remodeling and keeps it under control but since the amount of estrogen secretion becomes low, the bone mass gets reduced. There are 2 types of cells that play dominant role in bone remodeling, osteoclasts which help in bone resorption (bone eating) and osteoblasts which help in bone formation. Due to lack of sufficient estrogen, osteoclasts become more dominant and bone resorption or bone loss occurs at faster rate than bone formation leading to the weakening of bones.
So, it is very clear that menopause has some direct impact on Osteoporosis as it leads to bone loss due to the insufficient secretion of estrogen hormone in women. The excessive bone loss leads to thinning of bones in women over age of 40 who have experienced menopause.
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