Are Changes in Sexual Functioning During Midlife Due to Aging or Menopause?

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Are Changes in Sexual Functioning During Midlife Due to Aging or Menopause?

Journal article abstract

By: Lorraine Dennerstein

Date: September 2001

Source: Dennerstein, L., E. Dudley, and H. Burger. "Are Changes in Sexual Functioning During Midlife due to Aging or Menopause?" Fertility and Sterility. 2001;76(3): 456-460.

About the Author: Lorraine Dennerstein is the chief investigator of The Melbourne Women's Midlife Health Project, a study of Australian-born women who have made the transition through menopause. She is the director of the Office for Gender and Health in the Department of Psychiatry at the University of Melbourne in Melbourne, Australia. From 1988–1993, she served as director of the department of psychological medicine at Mercy Hospital for Women, also in Melbourne. The professor is the former and first female president of the International Society of Psychosomatic Obstetrics and Gynecology. Professor Dennerstein is on the editorial board of three international journals and has authored more than twenty books. Her research interests include gender and mental health.

INTRODUCTION

Women often face a significant decline in sexual function during their midlife years. As a woman grows older, the female menstrual cycle (period or menses) slows down and eventually stops, an event called menopause. This typically occurs between ages forty-five to fifty-five. This transition disrupts the balance of hormones in the female body. The woman begins to produce less of the hormones estrogen and progesterone.

Menopause is a time of transition, and can be grouped into three phases. Perimenopause, the first phase, is when the menstrual cycle begins to slow down. Some women may notice changes; others may not. Perimenopause can begin as early as ten years before actual menopause. Menopause is an event and refers to the date a woman's menstrual cycle ceases. A woman is said to reach menopause when she has not menstruated within twelve consecutive months and no other reason can explain the absent menses. On average, menopause occurs naturally around age 51.2, according to the American Menopause Foundation. Menopause is sometimes called the "change of life." Postmenopause is the time after menstruation has stopped, and lasts the rest of a woman's life.

Medical research has suggested that hormonal changes in menopause negatively impact sexual interest and contribute to vaginal dryness, vaginal pain, and arousal difficulties. However, there has been some question whether these symptoms are due to menopause itself, or a combination of aging and the cessation of menstruation.

The following abstract outlines Dennerstien's 2001 study, which points to both aging and the menopausal transition as a contributor to at least a temporary decreased sexual response for both a menopausal woman and her partner.

PRIMARY SOURCE

ABSTRACT

OBJECTIVE: To determine whether changes in women's sexual functioning during midlife are due to aging or menopause. DESIGN: Prospective, observational study. SETTING: Population-based sample assessed in own homes. PATIENT(S): Four hundred thirty-eight Australian-born women aged 45-55 years and still menstruating at baseline. One hundred ninety-seven were studied for effects of the natural menopausal transition. Control group A (n = 44) remained premenopausal or early perimenopausal for 7 years. Control group B (n = 42) remained postmenopausal over 5 years. INTERVENTION(S): Nil; questionnaires and blood sampling annually. MAIN OUTCOME MEASURE(S): Shortened version of the Personal Experiences Questionnaire. RESULT(S): By the late perimenopause, there was a significant decline in the factors we had derived of sexual responsivity and total score, and there was an increase in the partner's problems factor. By the postmenopausal phase, there was a further decline in the factors sexual responsivity, frequency of sexual activities, libido, and in the total score, and a significant increase in vaginal dyspareunia and partner's problems. Sexual responsivity significantly declined in both control groups. CONCLUSION(S): Sexual responsivity is adversely affected by both aging and the menopausal transition. Other domains of female sexual functioning were significantly adversely affected when the women became postmenopausal. The relationship with the partner and his ability to perform sexually is adversely affected by the menopausal transition.

SIGNIFICANCE

Lorraine Dennestein, chief investigator of the Women's Midlife Health Project at the University of Melbourne in Melbourne, Australia, followed hundreds of women through the menopausal transition, documenting the biological and psychological changes they experienced along the way. Dennestein established the Project in 1991 because of a lack of adequate Australian data regarding the impact of menopause and aging on a woman's sexual functioning. The Project is the first to follow a population of women through this phase of life while rating their sexual function and linking it to body chemistry. Researchers involved in the Project have published a number of papers regarding sexual health, mood, and hormonal changes.

For the study, Professor Dennestein and her team conducted surveys every year for thirteen years, questioning the women's sexual patterns, feelings for their partners, and vaginal problems such as dryness and pain during intercourse. Most studies show that most aspects of a woman's sexual function decrease with age and decline further with the advent of menopause. The Melbourne project found that a woman generally becomes more symptomatic as she moved toward menopause, and that her sexual function can significantly decline with the transition through menopause. As the women in the study reached menopause they reported less sexual activity, greater decreases in arousal, a drop in sexual interest, and an increase in vaginal dryness and pain. Hot flashes increased in the late perimenopause phase, a symptom that the researchers theorize could impact a woman's desire to have sex.

The study also revealed that problems in a woman's romantic relationship, including changes in her partner's health and status, could instigate sexual dysfunction and override hormonal effects. This finding emphasizes the fact that partner relationships and psychology have powerful effects on midlife sexual function. While mood changes are said to be a common symptom of menopausal women, those who participated in the study did not report any significant mood changes during the menopausal transition.

In the United States, Australia, and Western Europe, the number of women either entering menopause or who are post-menopausal is steadily increasing, as women of the post World War II "baby boom" generation (those born between 1946 and 1964) approach and pass age fifty. With life expectancy also increasing, the average woman will now spend over one third of her life after menopause. Women of the baby boomer generation, who were responsible for the sexual revolution of the 1960s and the women's movements of the 1970s, are remaining vocal about their sexual issues as they age. The American writer Gail Sheehy noted in her book The Silent Passage: Menopause, "As the pacesetters among baby boom-generation women discover menopause on their horizon, they will bring it out of the closet."