LIBIDO IN THE PERIMENOPAUSE

 

 

Dr Steven R. Goldstein is a Perimenopause Specialist NYC in private practice for over thirty five years. He has helped many women through the Perimenopause and Menopause stages of life.

 During the menopause transition, women face significant emotional and physical changes which may impact on their sexual health. For some, irregular bleeding, fatigue, hot flashes, dyspareunia (pain during intercourse), irritability and other perimenopausal symptoms may affect libido. A common cause for sexual dissatisfaction in the maturing woman is lack of a partner, resulting from divorce or death. It is important that the healthcare provider address these and other factors, which may be associated with the woman’s sexual health.

 As a Menopause Specialist NYC, Dr Goldstein has observed that patients often want a pill that will act as a panacea for all their problems, including decreased libido. The media have given much press to the benefits of androgens, and yet hormones may not be causative factors for changes in libido, in some patients.

 Instead for some, night sweats and disturbed sleep may affect a woman’s sense of well being and may deprive her of her perceived sexual drive. These factors must be evaluated before any type of hormonal therapy is begun. A symptom diary may help pinpoint causes for decreased libido for some patients. For example, one patient presented requesting androgens for her decreased libido. On intake history, initially, she vehemently denied that her decreased libido was associated with her spousal relationship. After keeping her diary, she was able to make an association between arguments regarding television and in-laws and successfully adjust her behavior so that she was able to improve her libido without any type of androgen therapy.

 However, for some women, testosterone levels can change during perimenopause, menopause and postmenopause. For patients with low free testosterone levels and severe menopausal symptoms, especially low libido and energy, whose symptoms are not relieved with estrogen or estrogen with progestin, then androgen therapy might be considered.

 Androgens are a group of hormones that play important roles in both men and women. In women, they are involved in reproductive health, bone health, muscle mass and strength, sexual function and their metabolic health. Androgens are most useful for women who have had oophorectomy prior to natural menopause. However, more research is needed regarding the safety of long term androgen use.

 Potential problems associated with androgens include its negative effect on serum lipids, hirsutism, aggressive behavior, and permanent voice deepening. Although androgens can be given alone, doses can be lowered when combined with estrogen and therefore, negative effects may be reduced.

 If you are late thirties to late forties and suspect you may be going through Perimenopause or have questions, a consultation with Dr Goldstein, a Perimenopause Specialist NYC , may be in order.

 Dr Steven R. Goldstein is a past President of the International Menopause Society and is a Certified Menopause Practitioner. He is a leading Menopause Specialist NYC .

 

BEATING OSTEOPOROSIS IF YOU ARE MENOPAUSAL

 

 

Dr Steven R. Goldstein is a Menopause Specialist NYC and was the Co Directory of Bone Densitometry and Body Composition at NYU Langone Medical Center from 1997 to 2016. He writes the Bone Health update for the OBG Management Journal and has worked with thousands of women to help them through the menopause stage of life where many experience issues with bone health. One of the ways to strengthen bone and improve your bone health during menopause is by weight bearing exercises.

 

Many patients ask if they need to worry about doing weight bearing exercises, watching their diet and general health while on hormone replacement therapy for menopause. In a word, yes. If you are smoking cigarettes, find a way to stop. If you are overeating, find a way to lose weight and keep your weight under control. There are hundreds of apps and other means of finding help to lose weight.

 

It’s old news that women can benefit from weight bearing exercise, especially during menopause. Chances are if you aren’t already doing it, it’s because you tried it and didn’t enjoy it or didn’t get the benefit you wanted in the time you gave it. Or your experience might have been like one of my patients who told me:

 

 “The weight room at my health club is filled with twenty year old muscled men pumping major iron in a testosterone feast. It’s pretty intimidating to walk in there. Even so, I’d give it a try again if it wasn’t for the fact that I need to lose twenty pounds, and have little time as it is to exercise. I understand about my bones and all, but given half an hour three times a week, I’m just more motivated to burn off the piece of pie I ate the night before than do weight training. So I go for the aerobic stuff. At least on the Stairmaster, I can read briefs etc. and burn calories.”

 

Many people confuse the suggestion to do weight bearing exercises with working out with weights. Weight bearing is not the same as weight training. The Stairmaster is weight bearing exercise. Your own weight is what you are bearing. There are certainly options beyond the weight room for women who want to gain strength, flexibility, and bone mineral density.

 

Dr Steven R. Goldstein MD is a Menopause Specialist NYC and a tenured Professor of Obstetrics and Gynecology at New York University School of Medicine. He is a past President of the International Menopause Society, a Certified Menopause Practitioner and a Past President of the North American Society.

 

PERIMENOPAUSE AND INSOMNIA

 

 

Imagine if you are a woman, early forties to late forties or so, and can’t remember the last time you had a good night’s sleep. Dr Steven R. Goldstein, a Perimenopause Specialist NYC has seen women come into his office with a range of symptoms that appear to have nothing to do with their menses or gynecological health. They have been to allergists, psychologists, psychiatrists and other specialists but never thought their issue was related to their gynecological health.

 

Perimenopause is the transition into menopause when a woman begins to slow the production of hormones. Some of the symptoms are irregular periods, hot flashes, and generally one of the least understood and most misdiagnosed stages of a woman’s life. One of the symptoms of Perimenopause is insomnia, the ability to sleep.

 

Insomnia generally gets worse as one gets closer to the last period. This is because night sweats – hot flashes that occur when you are sleeping – trouble many women when their bodies stop making estrogen.

 

While night sweats are a signal that you are close to actual menopause, many women complain about waking up in a sweat years before menopause happens. Or they complain that they wake up for no reason in the middle of the night and can’t go back to sleep.

 

Sleeping poorly is a big complaint for people, regardless of their age. For millions of people, bedtime is an invitation to hours of worry. Small annoyances like a truck driving by or a humidifier turning on interrupts sleep. Then come the worries of the day: Did I pay the gas bill or didn’t I?

 

If this is happening to you and you are a woman late thirties to late forties, then rule out stimulants such as the ones in cold medicines, some of the “natural” health pills, and diet sodas can keep you awake. Alcohol can send you to sleep only to wake up three hours later – for the rest of the night. A sedentary lifestyle and sleeping late can also be culprits.

 

Insomnia alone is not an indicator of Perimenopause. The stress of having subtle symptoms you’ve never experienced before can keep you up at night. Insomnia can exacerbate every other symptom of Perimenopause, so it’s important that if you’re having trouble sleeping, you talk to your doctor about it and formulate a plan for improving your sleep. The quality of your sleep is a major part of your sense of well being.

 

 Dr Steven R. Goldstein is a past president of the International Menopause Society, a Certified Menopause Practitioner and co author of the book “Could it be….Perimenopause?”. If you suspect you have Perimenopause, Dr Goldstein, a Perimenopause doctor in NYC  is available for consultation at his office in Manhattan