Does an active sex life end at menopause?

December 3, 2020
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For many women, menopause is a desired relief from menstruation; it eliminates the risk of pregnancy. For others, still desirous of having children, menopause is death knell. Many women are aware that their menstrual periods will cease someday, but they are mostly not aware of the accompanying changes to menopause. This makes them stressed, and confused when they start to suffer from these effects. Women may think that these symptoms are ominous signs of illnesses. This is worsened as these symptoms usually occur before the cessation of menstruation.

Traditionally, many Nigerian women abstain from sexual intercourse after menopause. This may be partly due to loss of libido and other existing unscientific local beliefs that menstrual flow “cleanses” the woman, and, in the absence of menses, if a woman has sex, these impurities will cause illness in her.

The perception of 352 middle-aged women surveyed at the Family Medicine Clinic, University College Hospital, in 2016, is a reflection of the general view of many women in the community. Some women think that sexual intercourse after menopause causes ill health. Some believe that menopause marks the end of femininity and, thereafter, transforms the woman into “a man.” In fact, some women claimed that menopause leads to erectile dysfunction in their partners.

The survey to determine the level of awareness and perceptions about menopause and sex in perimenopausal women carried out by Folasade Adenike Bello and Olufunmilola Olutosin Daramola  was published in the journal, Obstetrics and Gynecology International.

Although the level of awareness on menopause is high, only 36.1 per cent anticipated associated symptoms. About half (55.7 per cent) were indifferent to menopause onset, while 23 per cent had a positive attitude and 21.4 per cent had a negative attitude, respectively.

Dr Folasade Bello, a consultant obstetrics and gynaecologist, University College Hospital (UCH), Ibadan, Oyo State, stated that “It is a myth that menopause causes fibroid. Fibroids are caused by sex hormones, mainly oestrogen. So, a woman that is not producing oestrogen cannot develop fibroid. Even if you develop fibroid during your reproductive life, and it is not treated, eventually it will shrink over the years because the oestrogen that was keeping them alive has stopped.

“Menopause does not cause ill health to the woman.  The perception that semen causes harm to a menopausal woman or that it is now poisonous since it is only for making babies is also wrong. That sexual intercourse should not be happening at all is not so.

“Sex is recommended for life. It is for bonding and during sexual intercourse, endorphin, the feel-good hormone is released. In fact, when you are not even afraid of getting pregnant, sex is easier to have and more enjoyable.”

However, Dr Bello said due to the reduction in oestrogen hormone, the woman may experience reduced libido and some dryness in the vagina that may make sex less pleasurable.

Basically, menopause marks the end of the natural reproductive capacity of a woman.  Its diagnosis is usually made after a woman goes 12 consecutive months without a monthly period. The months or years leading up to that milestone is called the menopause transition, or perimenopause, and its symptoms include hot flashes (internal heat) and sweating.

Others include heart problems, sleep problems, depression, irritability, anxiety, physical and mental fatigue, sexual problems, bladder problems, vaginal dryness and discomfort connected with joints and muscles.

Now, some women sail through menopause and may not notice until their periods stop. It’s not a prerequisite that a woman experience these symptoms of menopause! In fact, in some areas of the world, many women don’t suffer at all.

Dr Olubukola Adesina, a consultant obstetric and gynaecologist, stated that on the average, the age of menopause all over the world is about 51. She added that early menopause runs in some families even as women who smoke may attain menopause about a year earlier than their contemporaries who are nonsmokers.

However, Professor Oladeni Adeniji, a consultant obstetrician and gynaecologist at the Ladoke Akintola University of Technology Teaching Hospital, said awareness about menopause and the changes that come with it is very low in many communities due to poor sexuality education and cultural values in Nigeria.

He added that “in our environment, nobody wants to discuss most of these things. Once in a while, we see some illiterates come in to complain and it is when you look at them that you will know that it is related to menopause. They complain of a feeling of something crawling all over their bodies and some feel internal heat that they sometimes assume it is due to the weather.”

Professor Adeniji stated that menopause, which is actually an ovarian failure, will be experienced by every woman who lives up to the age of occurrence. It is indicative of the ovaries no longer releasing oestrogen and eggs.

He, however, added that when menopause occurs before the age of 40 years, it is termed premature ovarian failure.

Approximately one in every 100 women under the age of 41; one in 1,000 women under 30 and one in 10,000 women under 20 experiences premature menopause or Premature Ovarian Insufficiency (POI).

Professor Adeniji, however, stated that it is a myth that menopause causes women to become obese or that its symptoms have no treatment.

“There is no direct relationship between menopause and weight gain. If such a person is gaining weight, let’s look for what is making the person gain weight.  But obesity in this phase of life is more likely due to lack of exercise.

“Also, we give some form of treatment such as a hormone replacement patch to women with severe forms of menopausal symptoms to ameliorate those symptoms. But as with any drug, there are health risks associated with taking them,” he said.

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