Menopause
Menopause typically occurs between 49 and 52 years of age. The majority of women have their last period between the ages of 48 and 55. The average age of the last period in the United States is 51 years, in the United Kingdom is 52 years, in Ireland is 50 years and in Australia is 51 years. In India and the Philippines, the median age of natural menopause is considerably earlier, at 44 years. The menopausal transition or perimenopause leading up to menopause usually lasts 7 years (sometimes as long as 14 years).
Hormone replacement therapy
The maintenance and improvement of quality of life during the menopausal period is at the core of estrogen and progestogen-based HRT. Both HRT and estrogen replacement therapy (ERT) have been shown to enhance sexual desire in a significant percent of women; however, as with all pharmacological treatments, not all women have been responsive, especially those with preexisting sexual difficulties. ERT restores vaginal cells, pH levels, and blood flow to the vagina, all of which deterioration are associated with the onset of menopause. Dyspareunia (due to vaginal dryness) appears to be the most responsive component of menopausal women’s sexuality to ERT. It also has been shown to have positive effects on the urinary tract and atrophy and may initially improve libido or sexual sensitivity. Other improvements in areas such as sexual desire, arousal, fantasies, and frequency of coitus and orgasm have also been noted. However, the effectiveness of ERT has been shown to decline in some women after long-term use. A number of studies have found that the combined effects of estrogen/androgen replacement therapy can increase a woman’s motivational aspects of sexual behaviour over and above what can be achieved with estrogen therapy alone. Findings on a relatively new form of HRT called tibolone — a synthetic steroid with estrogenic, androgenic, and progestogenic properties — suggest that it has the ability to improve mood, libido, and somatic symptoms of surgically menopausal women to a greater degree than ERT. In various placebo-controlled studies, improvements in vasomotor symptoms, emotional reactions, sleep disturbances, somatic symptoms, and sexual desire have been observed. However, while this is and has been available in Europe for almost two decades, this has not been approved for use in North America at this point.