Genitals postmenopause...

[NickyNora]

I'm 44. Periods stopped almost a year ago. FSH 126, 130, best FSH was 30.

Been on Estrogel & Utrogestan for 5 months. Now on 4 pumps of Estrogel daily. Utrogestan every 6 weeks for 14 days.
Menopausal symptoms at long last being managed.

Except I have no sex drive. I don't bother to masturbate anymore. I can't orgasm propley. My clitoral hood has shrunk. I'm presuming this is part & parcel of the menopause?

My GP & consultant at the Menopause Clinic have never acknowledged my lack of labido even though, I bring it up at every appointment.

I've had sex once in about the last year. My relationship has broken down, not just due to this but it is a factor.

Is it normal for genitalia to shrink in menopause?

---

If you've found this page in your search of orgasm gels and orgasm lubes that have been recommended by fellow Mumsnet users, you might find our guide to the best orgasm gels useful. Hope this helps! MNHQ

Don't know about that but maybe speak to your GP anyway but look into supplementing with testosterone. You may have to go private for that

I don't really want my sex drive to come back!

I'm a similar age, but my lovely old neighbour who was American and worked for Cosmopolitan back in the day told me the shrivel a bit and dry skin and general dryness makes sex quite painful and bruising more easy.

I'm confused, if you aren't bothered about sex drive then what's the problem. Or are you just wondering if this is the norm. Sorry I don't know about that but would be interested to know too. Hopefully someone more knowledgeable will be along.

My relationship is no longer intimate so not wanting sex isn't an issue.

I was more concerned about the physical changes as I'm on HRT. I've never come across any info on what to expect physically but presume genitalia would change like the rest of me has over the last 18 months.

Sex was never painful & no dryness but that was a year ago.

Is everything in the genital area comfortable?
I had a minor issue with dryness - it didn't feel that dry to me but wasn't as lubricated as it was before my periods began to slow down - and was prescribed Vagifem pessaries, which have made things much more pleasant and 'normal' again. They haven't affected my libido as such but sex is much more enjoyable now that I'm not wondering about friction burns(!).
Haven't noticed any particular difference in the structure or appearance of my genitals and if anything I find it easier to orgasm. I'm in my early 50s. I know women your sort of age who've given up on even wanting a sex life, and having seem them go through all kinds of perimenopausal period nightmares I don't blame them.
I don't know how common it it for your body to just decide it wants to shut up shop, but it's certainly not that unusual.

Except I have no sex drive. I don't bother to masturbate anymore. I can't orgasm propley. My clitoral hood has shrunk. I'm presuming this is part & parcel of the menopause?

Not for women on HRT (usually) but you might need testosterone or estrogen cream.

Sounds as if you need to use topical estrogen on your vulva- it ought to help prevent shrinkage. It's for vaginal use for atrophy but some women also use it externally to help prevent shrivelling.

My GP & consultant at the Menopause Clinic have never acknowledged my lack of labido even though, I bring it up at every appointment.

Is this NHS? You need to ask outright for testosterone but may be told they don't give it for women, in which case you'd need to see someone privately.

But if you aren't wanting your libido back, what's the point? I'm confused too

Is it more the appearance you are worried about or lack of a partner now due to no libido?

You've only been on HRT for 5 months- it might take longer to improve things anyway. But 4 pumps is a lot of gel anyway.

Are you clear about what outcome you want? You sound a bit muddled...worried about no libido and lack of orgasm but don't want your libido back.

Sorry if my post was confusing.

I'm only concerned about the physical changes I'm experiencing. I've not read anything about physical changes only about dryness.

Is it lack of hormones causing the changes? Are they an inevitable part of aging & menopause? Is it normal to have zero labido whilst on HRT?
My GP told me my sex drive would return when i started HRT.

I've been on HRT 9 months in total. I was on Femoston for 3 months.

I attend an NHS menopause clinic.

I wondered if the lack of labido & shrinking genitalia were connected...
I was trying to explain the total lack of sexual interest i now have. I don't need testosterone as i don't have a sexual relationship with my partner & we will be separating very shortly. So I don't 'need' my labido to return, its too late to save the relationship.

Thanks for the replies.

Clitoral atrophy, along with vulvovaginal atrophy, is not uncommon in menopause particularly if you're not sexually active (the increased blood flow during arousal and sex helps keep it at bay). As long as you aren't having any other issues like pain or bleeding, it shouldn't be of concern unless you change your mind about wanting sex. There are some treatments, though as mentioned most are only available privately, and it's usually easier to prevent with early treatment (and regular arousal) than get it back later.

While HRT can help some women's sex drive, decreased sex drive is a common side effect of estrogel and a common issue during menopause with or without HRT.

Oestrogel ( estrogen as gel) does not depress libido. Tablets can as they somehow bind to testosterone and reduce it.

Usually HRT revives libido. If it doesn't testosterone is the next step.

This is the Mail but at least there are quotes from good consultants in it www.dailymail.co.uk/health/article-3831645/Should-women-testosterone-NHS-boost-sex-drives-Experts-divide-use-male-hormones-cure-sexual-desire-disorder.html

NN if you have vaginal atrophy , and notice shrinkage even if you don't feel dry, it's something to tackle. left without treatment (topical estrogen) it will get worse. Very worst case, the inner labia fuse together or shrink altogether and it's very hard to reverse at that stage.

NIckyNora- there is a thread here about testosterone- might be useful

www.mumsnet.com/Talk/menopause/2840872-Testosterone-gel-how-much-is-a-dose-and-how-do-you-apply-it

Oestrogel on its own doesn't help with libido I found. You need to ask for testosterone to help your libido. It is available on the NHS - I get it prescribed from Chelsea & Westminster Hospital Menopause Clinic in London.

It's available on the NHS but is not licensed for women through a GP.
You will be getting it at the C&W as a consultant somewhere along the line is prescribing it- Nick Panay (as in linked article below) is the person who is trying to push this (and he's at the C&W clinic.)
GPs are not allowed to unless they are willing to do so off licence and most aren't. Some women see a private dr who writes to the GP so they can provide repeats scripts.

QueenoftheNights Nick Panay is my consultant at C & W - he now lets my GP prescribe it drectly. I have had it in the past when I was first on HRT when Professor Studd (Panay's predecessor) prescribed it for me. For a period of time the NHS did stop prescribing it to new patients and for two years I was on a break from HRT anyway.

Panay doesn't need to 'push' testosterone - it works and does revive libido and should be available to those women who need it and don't suffer side effects.

You misunderstand me :)

When I said he 'pushes it' I meant educationally, via the media to inform GPs etc. I follow the BMS and various meno specialists on Twitter and have professional contact too- and they are constantly trying to get the message over on it.

It's not a case of a consultant allowing a GP to prescribe it- it's the other way round. Consultants can recommend to a GP that they continue repeat prescriptions but a GP is not obliged to follow a consultant's recommendations (most do but legally they can refuse.)

Yes that's why you have no issues with obtaining it but of course very few women can get to the C&W.

This is their leaflet and last bullet point says it is 'off label'.

www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/Testosteronereplacementforfemaleandrogendeficiency092017CWAGREED.pdf

Thank you for all the information.
I don't feel testosterone is something i need right now.

I really wouldn't feel comfortable discussing this with a doctor or being physically exaimined.

The menopause seems to just get better & better!

I see no sex drive as a bonus. Just a lot of hassle. Not noticed shrinking or dryness but not been on hrt either.

I was 43 so HRT was very important health wise.

No sex drive is a bonus if your not in a relationship.

I personally think that libido and sexual desire is more than simply replacing hormones.
It is more complicated, it depends on our emotional state, our relationships, our psychology.
When we don’t use our genitalia parts, we lose them independently from meno.

Emerald13 That's good to know.

I have zero sex drive and my last marriage broke down because of it. Simply not interested in any way, shape or form and pleased about it.
However I thought medical help for this was appalling, I was constantly asking and always being ignored. It just isn't an issue for GPs even if your marriage is going south.
But given I don't want sex at all I'm glad my constantly demanding husband has gone.
I don't think my genitals have shrunk or changed at all with the menopause, a bit dry maybe but that's it.

I really wouldn't feel comfortable discussing this with a doctor or being physically exaimined.

This is something you need to try and get over. You need a dr you feel you can be honest with. It's nothing to be ashamed of.

I have a lovely gynae and he asks directly' How's your vagina' and I have no qualms discussing it- it's his job, he' s seen thousands of women, to him it's just another bit of the body.

I agree with Emerald- libido is complicated. If your relationship has foundered because of this, was it not that good anyway? ( a good man would stick around and help you get help.) So maybe deep down it's not hormonal but a relationship/emotional issue? Libido does change and change again over our lives, so it may be a temp blip.

The other thing I meant to say is that at 44 and 1 year post meno it's really unusual to get that amount of atrophy so soon- it often takes a few years post meno. That's why you need a gynae (not a GP) to take look and decide on the right treatment. If you do have quite severe atrophy now, it needs treatment, sex or no sex.

Presume if you are using long cycle HRT, you are seeing a consultant anyway as GPs won't be happy or offer long cycle.?

Sorry Queen!

I attend a Menopause Clinic...

The lack of sensation etc has gone on for about 5 yrs. 19 year relationship, i think many men wouldn't have hung around for 5 years!! Yes its all very complicated but no physical contact is a major issue in the relationship ending.

I stopped ovulating 18 month's ago. My experience of menopause has been quite diffetent to whay i read about. Its like my body just stopped working. Only few symptons until my periods stopped. Then was hideous crippling sweats that lasted hours. Joint pain etc

Invariably I've seen 2 consultants & 6 GPs. Apart from hormones, i have been offered no other treatment.

Sadly I've not managed to meet a doctor i feel comfortable with.

Thanks again.

If your genitals are shrinking you need to ask for topical estrogen. (Ovestin to apply to your vulva.) If the problem is ignored it usually gets worse. The HRT you use may well help- 8 months isn't that long - but as you are so young for men, you ought to think about treating this genital issue whether you want sex or not, separate to libido.