Explore sex after menopause and how HRT needs may evolve with age. Dr Juanri Jonck explains why regular reassessments are important.
Menopause can change much of a woman’s life and afterwards its impact is not simply relegated to a changing body. It also impacts intimacy and it may not only be unpleasant, but associated challenges can escalate.
Pretoria-based healthcare practitioner Dr Juanri Jonck said vaginal dryness, painful sex and urinary problems are not simply inconveniences women should accept as part of getting older.
She said that the challenge is that while some of the better-known symptoms of menopause improve, the vagina, vulva, bladder and urinary tract remain in a low-oestrogen environment.
“Dryness, burning, painful sex and urinary symptoms may persist and can actually worsen over time,” she said.
Dr Jonck said embarrassment can prevent women from speaking about what they are experiencing.
Others may simply resign themselves to the idea that discomfort during sex, vaginal changes or urinary problems are part and parcel of getting older.
“Lubricants and vaginal moisturisers can help,” said Dr Jonck, “and local vaginal oestrogen is a highly effective treatment for genitourinary syndrome of menopause even for women who do not qualify for systemic estrogen therapy anymore.”
It also means that conversations around hormone replacement therapy, or HRT, do not necessarily end when the more obvious symptoms of menopause do, Dr Jonck said and added that one of the biggest misconceptions around HRT is that it is a short-term intervention, taken for a few years to help women navigate menopause before it must be stopped.
“The underlying hormonal change doesn’t suddenly disappear, so it makes little biological sense to think that treatment must automatically expire at a particular birthday,” she said.
There is also no universal age at which a woman who appropriately started HRT and continues to benefit from it must automatically stop. Dr Jonck said suitability for treatment should instead be considered individually and reassessed as a woman gets older.
“The type of hormone, dose and route also matter increasingly as women age. For example, transdermal oestradiol has a more favourable thrombotic profile than oral oestrogen.”
But continuing HRT that was started earlier and beginning systemic hormone therapy for the first time later in life are not the same thing. Dr Jonck said the latter requires consideration of timing, cardiovascular health, cancer history and a woman’s individual risk factors.
It moves the question away from a woman’s age as a sole marker and towards whether the treatment remains right for the individual.
“So I would like women to stop asking, at what age must they stop their HRT, and instead ask, is there a medical reason why continuing their HRT is no longer right for them?” Dr Jonck said.
Sexual health must not make an exit at all, said Dr Jonck.
She said that intimacy remains part of what it means to age well, alongside looking after physical health and maintaining relationships.
“I don’t want women to spend post menopausal decades frightened of ageing,” she said. “Menopause may change a woman’s body, but that doesn’t mean that it must retire her sexuality along with her periods.
“Menopause doesn’t expire and neither should a woman’s expectation of feeling strong, healthy, sexual, capable and well as she ages.”
