Why have I suddenly lost my sexual desire?

DEAR DOCTOR K: I'm a woman in my mid-50s. Lately I haven't been able to become sexually aroused. What could be wrong?

DEAR READER: Sex is complicated, but you probably already know that. Sexual desire surely resides in the head, but other parts of the body can affect desire as well. In particular, the genital organs communicate with the brain. Likewise, the brain communicates with the genital organs. Desire in the brain causes changes in the pelvic organs. Perceiving these changes can, in turn, enhance sexual desire.

Am I in perimenopause?

DEAR DOCTOR K: I am in my early 40s. Over the past several months, my periods have become less regular. Sometimes my flow is lighter than normal; other times it's heavier. Is this perimenopause?

DEAR READER: It could be, though you're a bit young. As a woman approaches menopause, periods often become irregular. A woman is said to be in menopause after she has gone for one full year without periods. The transition into menopause is called perimenopause. This phase begins when a woman notices changes in her cycle, usually in her mid-40s. It ends with menopause. Perimenopause usually lasts three to five years -- but it can take as few as two years or as many as eight years for some women.

Does vaginal estrogen cream pose a risk to my heart health?

DEAR DOCTOR K: Vaginal estrogen cream cures my vaginal dryness. But I hear estrogen is risky for the heart. Should I be concerned?

DEAR READER: Basically, I wouldn't worry. Here's why. Vaginal estrogen cream is one form of hormone therapy (HT). HT is estrogen taken alone or with other female hormones to treat the symptoms of menopause. "Systemic" HT involves hormones that enter the blood and travel throughout the body. It is the most effective treatment for postmenopausal hot flashes and vaginal symptoms, including vaginal dryness.

How long might hot flashes last?

DEAR DOCTOR K: Recently you wrote about a patient who was still having hot flashes in her early 70s, long after menopause. I'm in my 60s, and I still have them. How long might they last?

DEAR READER: Following the publication of that column, I got many letters with questions like yours. These letters also described what it is like to suffer from hot flashes. One reader recalled driving with her parents on a bitter cold winter night. Suddenly, her mother had a hot flash. It was so bad that she "turned the heater off, opened the car windows and stuck her head out the window. My father asked her what the heck she was doing."

What can I do to relieve uncomfortable hot flashes?

DEAR DOCTOR K: What can I do to relieve uncomfortable hot flashes?

DEAR READER: Yesterday I discussed new research showing that menopausal hot flashes can last for much longer than the "several years" the textbooks say they are supposed to last. We are beginning to understand why women in menopause (and sometimes for years after) get hot flashes. There is a center in the brain that is constantly measuring the inner temperature of our bodies. For example, body temperature rises on a hot day, or when we exercise. When the brain center thinks the body needs to cool off, it causes little blood vessels near the skin to open wide.

How long can I expect hot flashes to continue?

DEAR DOCTOR K:I just experienced my first, full-blown menopausal hot flash. It was awful. How long can I expect hot flashes to continue?

DEAR READER: Your question reminds me of a patient I saw when I had recently finished my training. (Believe it or not, I was even younger then than I am now.) She said she had come to see me because of hot flashes. Then she said: "I had heard about hot flashes since I was a girl, and I thought I knew what to expect. But you can't really imagine it until you've experienced it."

Can you discuss how menopause might affect my sex life?


I have recently entered menopause. Can you discuss how menopause might affect my sex life?

DEAR READER: As a woman approaches and enters menopause, her ovaries gradually make less and less of the hormones estrogen and progesterone. The drop in these hormones -- of estrogen in particular -- can affect how a woman experiences sex. Estrogen stimulates the growth of breast tissue. It maintains blood flow to and lubrication of the vagina. The decline and eventual end to estrogen production provokes a host of symptoms. These include hot flashes, fatigue, vaginal dryness and loss of libido. Many of these changes can have unwanted effects on a woman's sex life.

Does menopause cause weight gain?

DEAR DOCTOR K: Does menopause cause weight gain?

DEAR READER: In the United States, women typically go through menopause between 47 and 59 years of age. And the average woman gains about one pound per year around the time of menopause. Not surprisingly, we tend to assume that menopause causes weight gain.

What can I take to ease my hot flashes?

DEAR DOCTOR K: I have terrible hot flashes. My doctor no longer recommends hormone replacement therapy because he says it has heart risks. Is there anything else I can take?

DEAR READER: Hot flashes are a common symptom of menopause. They probably result from changing hormone levels. My patients describe them as a sudden, intensely uncomfortable onslaught of heat. They are often accompanied by a rapid heartbeat, headache, nausea or dizziness.

I had a period after 5 years of menopause– is this normal?

DEAR DOCTOR K: I thought I entered menopause five years ago, but now I seem to be having a period again. Is this normal?

DEAR READER: A woman is considered to be in menopause once it has been one year since her last period. Once menopause begins, vaginal bleeding is not normal. Post-menopausal bleeding (PMB) can happen for many reasons. It may result from infection or injury. Non-cancerous growths such as polyps and fibroids can cause PMB. So can bleeding disorders or use of blood thinners.