Well, here they are, the last 3 questions women commonly ask their primary care doctors. It’s not entirely accurate to call these the “top” 3, as every woman is different and has different concerns and questions. For some women, answers to questions in Part 1 or Part 2 of my top 10 list may have been the most important to them.
Nonetheless, here are questions 3, 2, and 1:
#3. Is there anything I can do about painful intercourse?
Like question #7, this is also very common but has a complicated answer. Typically, the cause of painful intercourse falls into one of three categories: a skin/tissue problem, psychosocial, or some sort of pelvic floor or nerve damage.
An uncommon condition like lichen sclerosis or, more commonly, estrogen deficiency can cause skin problems in the vulva, the external parts of a woman’s genital organs or the vagina. Every woman will have some changes in estrogen levels with menopause, and the problems this presents go beyond vaginal dryness, which is often discussed.
Psycho social issues can also make sex hurt. If the woman is shy or there is not enough foreplay, these affect the level of arousal and how sex can feel. Pelvic floor and nerve damage are also possible, especially if a woman has had GYN surgery. The pelvic floor is a network of muscles, ligaments and tissues in the lower abdominal area. It acts like a hammock to support the uterus, bladder, vagina and rectum. Pelvic floor disorders cause weakness or poor function of the muscles and nerves in the pelvic floor. These issues can become more common with age, and if these muscles are damaged, it can affect how having sex feels.
#2. What kind of exercise is the best exercise for me?
I am passionate about exercise and could go on and on with my patients about it. My answer to my patients is to get out there and move, period. The benefits fall into two categories: fitness and cardiovascular risk. A study showed how important it was for people to move. People did 30 minutes of exercise in morning and then sat at their desks for 8 hours, and the other group did the same desk-sitting but got up for 2 minutes each hour to walk around. The second group dramatically reduced their cardiovascular risk. So get up and move, even if it’s for a little bit.
Find something you like to do, not something you think you should do; you won’t keep it up if you don’t enjoy it.
Why is this so important? The benefits of exercise are well-documented for most of the biggies: it cuts down on your risk for heart attack and stroke, lowers your blood pressure, and improves your joint health, sleep, mood and sex drive. There have also been studies showing how exercise helps energy levels: in people who were just hospitalized, those who, as they started to feel better, got up and walked got better faster than counterparts who stayed in bed.
Obviously, your age matters, and what exercises you can do will also change. Talk to your doctor about what exercise level is right for you, what exercises will make you healthier, how you’ll know if you’re doing too much, and get some ideas of exercises that will get you up and moving.
#1. Is it hot in here or is it just me?
I’ve often likened the change in a woman’s body leading up to menopause to the performance of an orchestra. When she is younger, her hormones are usually in perfect harmony, one is going up while the other is going down, much like different instruments in an orchestra as they play a particular piece of music. During the pre-menopause time, also known as perimenopause, it’s a sputtering phase, like the trumpet misses its cue and comes in two beats too soon, the violins are out of tune, and everyone is out of sync.
While we don’t fully know why, the symptoms and the overall experience are so different from woman to woman. Some women have very manageable symptoms, but some women find the symptoms of menopause to be overwhelming and even crippling to them as they (try to) go about their daily activities.
If the symptoms of menopause are having a major impact on a woman’s quality of life, the most effective treatment is hormone replacement therapy (HRT). As one of my colleagues, Dr. Alice Rothchild, outlines so thoroughly in her blog post here, we’ve learned an incredible amount about HRT in the past 45 years, but there are still risks. I counsel women very clearly on the pros and cons of HRT relative to the severity of symptoms they are experiencing. If we decide on HRT, I typically recommend keeping a woman on for about 5 years, monitoring along the way and deciding what next to do at the 5-year mark.
Other possible medical therapies are Prozac again, which helps with hot flashes, irritability and insomnia in some women. Gabapentin, a medicine that first came out as an anti-seizure medicine and now is used for sleep disorders and neuropathies, among other things, has also been found to effectively control hot flashes in women and it is very benign as far as risks or side effects. It comes down to a discussion between a woman and her doctor as to the impact symptoms are having on her life.
In conclusion, I hope as you’ve read my top ten list that it has emphasized to you how important it is to talk with your doctor – openly, honestly, and as frequently as you can. So many of the treatment approaches need to be customized for you, and only you and your doctor can have the correct level of conversation. One important message that I shared at the conference: if you can’t discuss these things with your doctor, maybe you have the wrong doctor. You need to feel able to ask your doctor anything – remember, knowledge really is everything.