Is it time for HRT or Husband Replacement Therapy?

Did you and your partner have problems before your menopausal symptoms began?

Has this life-stage simply put the spotlight on issues that were already there?

Were you so busy with life that it was easier to carry on and put any relationship problems you had on the back burner? 

Has your relationship simply grown stale through lack of attention?

Are you or your partner struggling with physical, sexual and emotional changes related to the menopause?

Are your mood swings making you difficult to live with?

If you have answered yes to any of these questions then, to put it bluntly, your options are: stay as you are; see your GP, put some effort into your relationship and make some changes, or perhaps the most drastic option of all, is to admit that sadly your relationship has reached the end of the road.

Common physical, relationship and emotional changes that can occur around menopause

After some deliberation about the title, I remembered the Masters &Johnson quote:

There is no such thing as an uninvolved partner in a relationship where sexual problems exist.

I feel this eloquently acknowledges that a partner is a participant in a relationship, not simply a spectator. So it is inevitable that a woman’s menopausal health, sexual or otherwise, will impact on her partner too. This coupled with the fact that these changes occur at a time of life that is considered to be a significant life stage for many couples has the potential result in significant relationship distress.

So what is the menopause?  

It is a time when a woman’s body is going through major hormonal changes. The decline of our hormones is not necessarily a smooth and steady descent, for some, there will be a very long and bumpy journey ahead.

A lot has been written about these changes and below are just a few potential threats to your sexuality and sense of well-being:

• Hot Flushes/Night Sweats – These affect your sleep, make your hair frizz and evoke feelings of desperation for a chilly north easterly breeze. Also, it’s difficult to feel sexy when you are hot and sweaty for all the wrong reasons.
• Insomnia – Sleep deprivation is a form of torture and can make you unbearable to live with. Remember when your children were babies and sleep became a very precious commodity? Well it starts all over again. Woe betides any partner whose snoring is enough to raise the dead or who pokes you in the back as an act of foreplay.
• ‘A Dry Vagina’ – In 2007, Menopause matters estimated that there were over 3 million dry vaginas in the UK. Oh, how I love this statement! But, never fear help is at hand! You can speak to your GP about Hormone Replacement Therapy (HRT), or there are local oestrogen treatments that you insert directly into your vagina. For those of you who don’t want to or have been advised not to use hormonal treatments, non-hormonal vaginal moisturisers such as Hyalofemme are available.  These are very effective and help re-hydrate (make it moist!) your vagina. Alongside a good lubricant these will make sexual penetration more comfortable and sensual touch more pleasurable.
• Weak Pelvic Floor Muscles – A lack of oestrogen can result in less collagen production that can impact on the strength of these muscles and lead to continence issues. So remember to squeeze and tense them daily, after all you don’t want to become a ‘wet woman’ for all the wrong reasons!
• Prolapse – Another equally thrilling result of a weak pelvic floor is a prolapse. This is when the walls of the vagina bulge because the muscles are less able to support or hold up the organs in the pelvis, such as the bladder, womb and rectum.
• Anxiety & Cognitive issues – Changes in our hormone levels can also impact on our mood and our memory recall. Suddenly your ability to remember why you walked into a room to get something will be a thing of the past and your ability to multi-task could be seriously challenged.
• And what about him? – Well, he may experience some changes too! Whilst men don’t experience the dramatic changes in their hormone levels in the same way as women do, they can experience a gradual decline in their testosterone levels. Also with aging there is an increased risk of erectile problems and he might need some gentle persuasion from you to see his GP. An unreliable manhood can be a symptom of diabetes or an early warning sign of problems with his heart so a check-up is vital.

Whilst all of the above are problems in themselves, they are also sexual saboteurs.

Just imagine for a minute, that you are hot and sweaty, haven’t slept in days, you can’t remember your eldest child’s name, you would wet yourself if you had anything to laugh about and your vagina has collapsed! Hardly erotic and then to top it all, you may have specific sexual symptoms to deal with, related to your dwindling hormones, such as your orgasm has become a distant memory, your vagina is irritable, your clitoris has all but disappeared and you have developed a strong preference for chocolate and wine rather than  G-strings and a monthly Brazilian!

Psychological and Emotional Issues

• Getting older is no fun!  As we get older there is a greater sense of aging that no amount of candle light will disguise! However, if we embrace it perhaps with the help of a bit of Botox and look on the bright side i.e. aging is much better than the alternative,  then this will in turn improve our…
• Psychological well-being – Get to grips with your symptoms and find ways to manage them. Regular exercise releases endorphins and makes you feel better. You can’t always stop negative thinking but you can distract yourself by doing things you enjoy. Treat yourself to a massage or get your nails done. Focus on what you can do, rather than what you can’t do.  If you feel really low or anxious talk to your GP who is there to help you.
• Can you adapt? Can you experiment and explore new ways to stimulate your less responsive body parts and discover new ways to ‘trigger’ your sexual interest and arousal.
• The ‘empty nest’ syndrome – Suddenly finding yourself alone with your partner after years of looking after the ‘little ones’, can be scary. Now they’ve flown the nest do you feel sad? Do you still like your partner? Are you looking forward to spending more time together or does it feel like you’re living with a stranger? Maybe now’s the time to re-connect and discover each other all over again. But if you don’t like what you find or he doesn’t either, then it may be time for more drastic action.
• Teenagers – If you had children in your 30’, you will be living with hormonally charged teenagers at the same time yours are fluctuating wildly! Stressful with a capital ‘S’.

Your relationship with your ‘significant other’

Long term relationships go through many changes, sometimes the priorities and commitments you have in life, mean that the quality time and the effort you make with your ‘other half’ can be neglected.

Trying to get pregnant, giving birth, and juggling a busy household with work commitments, small children or hormonally confused teenagers can be very demanding. And then, suddenly, along comes the menopause with its own unique set of challenges.

You might be one on the lucky ones, sailing through this life-stage, with minimal hormonal changes, your relationship intact and dreams of far-away places. But what about those that are not so lucky, hot and sweaty, with a dry vagina, a relationship  struggling to cope or who now have so little in common that they can’t even remember the last time they sat in the same room together, let alone romped around naked?

First things first – If your relationship is in trouble you need to ask yourself whether any physical symptoms related to the menopause including your general mood, are having a negative impact on you and your partner.

If the answer is “yes” or even” maybe”, then you need to speak to your GP who can advise you on a range of  treatment options that are available to manage any symptoms.  Remember physical and emotional changes can have an impact on your quality of life and it is important that you get the help you need.

Making Changes – It is easy to blame our ‘other half’ for the woes that exist and you might have a very long list of all their ‘faults’ but it is important to ask yourself how do ‘YOU’ contribute to the relationship difficulties you have.

In order to move forward you need to communicate, which involves both talking AND listening. If you’re not happy, have you discussed this with your partner? If not, why not? Unless they’re clairvoyant it is impossible for them to know how you feel or what is wrong.

Also be prepared to listen to how they feel or what they want but remember they may see things very differently from you. You need to talk when you feel calm, perhaps go for a long walk together or for a meal in a restaurant; hopefully being in public will prevent the discussion from getting heated. When we are angry, it is impossible to listen, as our minds are preoccupied with formulating our next verbal attack, which can escalate into a game of ping pong with each of you bringing up every perceived injustice, insult or hurtful memory to throw at each other.

Talking to a relationship counsellor can be useful for some couples. Contact your local Relate Centre if you think an impartial outsider could help you communicate and negotiate the way to a better and more satisfying future together. And for those for whom ‘togetherness’ is not possible then Relate can also help you both navigate the bumpy road to separation.

And Finally… Emotionally and financially there is a lot invested in long term relationships and whilst making changes can be hard work, for some the end result will be rewarding. It can provide an opportunity to re-invigorate and re-energise yourself and your relationship. And remember, the greater emotional and relationship well-being a woman experiences the more this will contribute to her sexual enjoyment, as sexual pleasure is so much more than simply physical responses.  

So back to my original question is it time for HRT or husband replacement therapy? It’s a question only you can answer, whatever you decide ‘Good Luck’!

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This article was written by Angela Gregory – BA (Hons), PST Dip, CH Dip,COSRT acc.

Angela is the Lead for Psychosexual Therapy at the Chandos Clinic, a sexual dysfunction service for men and women with a wide range of sexual difficulties based at Nottingham University Hospital Trust. She works as a full-time Sexual and Relationship Psychotherapist and provides in-house training for both medical and nursing staff and regularly lectures at a national level.

She is currently the secretary of the British Society of Sexual Medicine. In 2013 she had work published in the International Journal of Gynaecology on ‘Sexual Problems in Older Women’ and a further two articles were published in 2014, one in the International Journal of Urological Nursing on ‘The Impact of Trauma on Sexual Functioning’ and the other entitled ‘Tales of the Un-erected’ in the Endocrinologist.

In 2015 she was involved in primary research looking at ‘Women’s experience of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus’ published online here.