Women's Bodies, Women's Wisdom (125 page)

Here’s another potential side effect that is truly frightening: death of the bone tissue (osteonecrosis) of the jaw—a condition that is not treatable.
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Many individuals have also found that they require root canals soon after beginning alendronate. The reason for both these conditions is most likely inadequate circulation to the root of the teeth through the jaw and to the jaw itself.

To make matters worse, bisphosphonates stay in the circulation for decades, even after women stop taking them, because they bind tightly to bone. It will be at least another ten years before we truly know the long-term effect on bone health. So in the meantime, alen-dronate, if used at all, should be reserved for much older postmenopausal women (age seventy or older) with major risk factors for osteoporosis. And even then, treatment should be limited to five years or less.
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SEXUALITY IN MENOPAUSE

What we believe about sexuality and menopause has a lot to do with our sexual expectations and experience. A very common misconception about menopause is that sexual desire and activity significantly decline during this period. The newest research fails to show any significant link between menopause and decreased sexual functioning.
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Because our so ciety has viewed menopause as “failed productivity” and associates reproductive capacity with sexual capacity, many women have bought the belief that their sex drive is supposed to go away. But in humans, the ca pacity for sexual pleasure and the capacity for reproduction are two dis tinct functions. We can always have one without the other.

The most recent research shows that in healthy, happy women, there’s no significant decline in libido, let alone in sexual satisfaction, frequency of sexual intercourse, genital responsiveness, and ease or difficulty reaching orgasm after menopause. In fact, a woman’s rela tionship satisfaction, attitudes toward sex and aging, vaginal dry ness, cultural background, and overall mental and physical health have a much greater impact on sexual functioning than does being in menopause. That’s why many of my menopausal patients who left unsatisfying marriages and found more compatible mates ended up having better sex lives than ever. The number one predictor of good sex during and after menopause is a new partner! Instead of trading in your old partner, however, my advice to most women is to become a new partner yourselves. In other words, when you begin the work of reinventing yourself instead of being stuck in outmoded patterns of anger and resentment, you will find that your sex life is bound to improve. This is part of the reason why the research of Gina Ogden, Ph.D., shows that women in their sixties and seventies are having the best sex of their lives.
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I remember one very proper seventy-five-year-old woman who always came in dressed formally in blouses with high lace collars. She was having a problem with some vaginal dryness and was worried that she’d have to stop her sexual activity. Newly married, she was regularly having seven orgasms per lovemaking session with her husband, after being anorgasmic for her entire forty years of marriage with her first husband. She told me that she had had no idea how wonderful sexual activity could be. All she needed was a bit of estrogen cream and some reassurance that she was normal.

Another woman, age fifty-five, was at her most sexually fulfilled when she began a relationship with a man fifteen years younger than she. The combination of an older woman and younger man in this regard makes perfect sense—though up until very recently, this has gone against everything that our culture has taught us. Sexual preference may also change at midlife. Several of my patients have found themselves sexually at tracted to women after menopause, although they had defined themselves as heterosexual beforehand. Research shows that women’s sexuality is far more fluid than we’ve been led to believe, so this makes sense.
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Some women truly do notice a decline in libido at menopause. One of them told me that her lack of libido is not a problem for her personally, but she does worry about her husband getting enough sex. I suspect that this concern is shared by many. One of the reasons that libido falls during perimenopause for some women is that their life force, or
chi,
is simply exhausted from years of stress and they have nothing left over for sexual desire. Many women find their energy turned inward for a time as they reinvent themselves at midlife. It is also clear that levels of testosterone, which play a role in sexual desire, decrease in many older women for a wide variety of reasons.
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If this is the case, these androgenic hormones can be restored to normal levels.
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(See section on adrenal restoration in this chapter.)

For other women, however, the climacteric and postmenopausal period is associated with heightened sexual drive and activity. For many, it is the first time that they are truly free from the fear of unwanted pregnancy. Many physicians mistakenly believe older women who are not sexually active lack sexual drive. But studies have shown that the reason they are not sexually active is usually that they have no available suitable partner, or their partner is ill, or they have vaginal thinning leading to pain with intercourse (a condition that is easily remedied with one of the remedies on page 558). Of greatest importance to continued sexual desire and interest is marital happiness.
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Another problem for many heterosexual women is that their male partner’s ability to get and maintain an erection may change as he ages. If the male perceives this as impotence, he may avoid sexual activity altogether. Many women have told me that they would like to enjoy regular sexual activity, but their husbands won’t participate any more because of their fears of impotence. Because these women are afraid of offending their husbands’ egos, however, they keep quiet in stead of getting help. The most important way they can help is to let their husbands know that they don’t require an erect penis to be fulfilled. This is the time to get creative with hands, tongue, and so on. (see
chapter 8
.) Intercourse is such a limited way of expressing sexuality. And it’s time that all couples began to explore the range of other options.

A word about erectile dysfunction drugs. Pharmaceuticals such as Viagra, Levitra, and Cialis have helped many men achieve erections, but they haven’t always helped with true intimacy. Besides, new risks for these drugs are coming to light. The Health Research Group of consumer advocacy organization Public Citizen has asked the FDA for a black box warning on these drugs be cause reports of unilateral vision loss (loss of sight in one eye) have been linked to them. Men should also know, however, that the same diet and supplement programs that help support menopausal hormone balance in women also help men maintain optimal sexual function without drugs.
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Usually all the help most men need is a bit of education. Still, antihy-pertensive and other medications can interfere with erection and even orgasmic capacity in some men. Lifestyle changes such as weight loss, improved diet, supplementation, and increased physical activity can reverse hypertension in those who are motivated enough to make them.

Recall, too, what I said in chapter 8—that a turned-on woman is what turns on a man. This concept is so important to health and well-being that I wrote a small book about it entitled
The Secret Pleasures of Menopause
(Hay House, 2008), which is really all about the health-enhancing properties of nitric oxide—the circulation-enhancing chemical produced by the lining of all blood vessels and which is the mechanism by which drugs such as Viagra work.

Treatment

Treatment for lack of sex drive must be highly individualized, keeping in mind that the most common cause is the way a woman is thinking about and approaching sex, which is also related to her overall quality of health. That said, all women with this problem should consider having their testosterone and DHEA levels measured. If levels are low, the first line of treatment is to follow the program for adrenal restoration on pages 536–541 of this chapter. If there is still a problem, some women report feeling more like their former selves on estrogen replacement. Others note an increase in libido following the use of a transdermal 2 percent progesterone cream, which may work, in part, because natural progesterone is a precursor molecule and can be turned into androgens and even estrogen when the body needs more of these hormones. Testosterone is the major androgen associated with libido. In those women who don’t seem to be able to produce enough of their own androgens, DHEA or testosterone in the form of a cream, a gel, or a capsule can be given.

If both DHEA and testosterone levels are low, I prefer replenishing DHEA first, because it is a precursor of testosterone, and when women take it in the usual doses (10 to 20 mg per day), their testosterone levels increase by one and a half to two times.
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When given with progesterone, DHEA can enhance well-being in those women who don’t respond to progesterone alone. Some older women have naturally high levels of DHEA, so not everyone needs it. The side effect of too much testosterone or DHEA is a slight increase in hair growth on arms and legs and sometimes the face.

The dose of testosterone for those who don’t respond to DHEA is 1 to 2 mg every other day, depending upon the individual. Transdermal magnesium can also help increase DHEA (see page 739).

Other women have done well with homeopathic remedies, acu puncture, or herbs. You might also consider trying special exercises derived from ancient Taoist practices that have been refined for modern women by Saida Désilets, Ph.D., author of
Emergence of the Sensual Woman
(Jade Goddess, 2006) and teacher of what she calls the jade egg exercises (see
chapter 8
). This approach is perfect for women who want to retain their youthful appearance and sexual potency long after menopause. First championed by Grand Master Mantak Chia, it uses the mind to flow life force energy— especially potent ovarian energy—throughout the body.
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However, you don’t need to get into ancient Taoist techniques to keep your sex drive strong. What you have to do is actually train your body to be able to receive more pleasure. This takes care of the life force all by itself. (see
chapter 8
, “Reclaiming the Erotic.”) Regularly experiencing pleasure magnetizes you to attract more of the same.

Whatever therapy you choose, there is likely to be a placebo effect on the libido simply because you are doing something to help yourself. Remember, sometimes it’s your
life
that needs “medicine.” When you make positive changes (including adding more pleasurable activities), your hormones will balance themselves. Because sexual function and libido are so intimately connected to our thoughts and emotions, it’s also important for women who want to enhance li bido to actually take the time to think about sex more often. Reading erotic material, watching erotic movies, and spending time self-pleasuring can often jump-start a flagging libido.

Note: Often Estratest, a combination of equine estrogens and synthetic methyltestosterone, is the only solution offered to women with libido problems. However, the dose is too high for many women and it is difficult to make adjustments. The hormones in it are also in forms that are foreign to the female body. I do not recommend it.

THINNING HAIR

Up to one-third of menopausal and postmenopausal women in this culture have problems with thinning hair. Confusingly, hair loss on the head may be accompanied by excess hair growth on the face. This is because all hair follicles are not created equal in their response to hormones. Much of this problem is related to subtle imbalances of hormones, at the level of the androgen-sensitive hair follicle, that do not show up on standard testing. These imbalances are associated with insulin resistance and overconsumption of refined carbohy drates. Here’s a typical letter from a member of my Web community:

Dear Dr. Northrup,
I am currently going through menopause. My hair has always been thick and healthy. I am starting to lose a great deal of hair. I had blood work done by my primary care provider and everything came back fine except for my hormone levels. My estrogen level is low and my testosterone level is at 77. He mentioned that high testosterone levels can cause hair loss. He recommended hormone replacement, which I choose not to do, or spironolactone. My concern is that he mentioned I would have to stay on this for life if I do not wish my hair to fall out. Is this true? I am also interested in trying the Chinese herb you mentioned, shou wu pian. Will this herb stop my hair from falling out? I have changed my diet and am working out with weights and cardio. I would greatly appreciate your help. This is truly stressing me out.

The conventional approach to hair loss is drugs such as spironolactone. I do not have experience with them and prefer that women try a natural approach first.

Hair Restoration Plan

Try one or more of these approaches in the following order:

Check your thyroid. Your TSH should definitely be no higher than 3.0, although I recommend a limit of 2.5. If your levels are higher than that, try iodine supplementation or natural thyroid replacement, such as Nature-Throid (
www.nature-throid.com
), Armour thyroid, or a mixture of T3 and T4 made up by a formulary pharmacist. (See pages 540–541 for a fuller discussion of thyroid issues.)