Brunilda Nazario, MD
Some women with rheumatoid arthritis sail through menopause without a care while others experience a full menu of menopause symptoms: hot flashes, insomnia, mood swings, weight gain. Menopause can also increase symptoms of RA, such as joint pain and fatigue.
There is actually a slight rise in new diagnoses of rheumatoid arthritis in women around the onset of menopause. Experts think this -- and the fact that menopause can aggravate RA symptoms -- are probably related to the body’s drop in estrogen, which is believed to affect RA. That may also be why pregnant women -- who have higher levels of estrogen while they're expecting -- may see their RA symptoms get better for a while.
Whether you've lived with RA for a while or just been diagnosed, menopause can pose new challenges to sex, intimacy, and overall well-being. You may feel that because menopause signals the end of fertility, it also means the end of sex. But women with RA can have a thriving sex life well past menopause. Work closely with your doctor, talk honestly with your partner, and try these strategies to help you move smoothly through this life passage.
One of the first symptoms of menopause that many women experience is vaginal dryness. And it can be a special problem if you have Sjögren’s syndrome, a condition often seen with RA that includes eye, mouth, and vaginal dryness as well as fatigue and achiness. Vaginal dryness can make sex uncomfortable or even painful.
“Your rheumatologist or gynecologist can advise you on various lubricants that might be helpful,” says Linda Russell, MD, assistant attending physician in rheumatology at the Hospital for Special Surgery and assistant professor at Weill Cornell Medical College in New York. You may need to try different over-the-counter lubricants or moisturizers to find the right one for you. Staying sexually active also helps reduce vaginal dryness.
Do certain foods seem to aggravate your RA symptoms? Some women may find that foods trigger their hot flashes, too. You may want to avoid or cut back on spicy foods, alcohol, and hot beverages if you’re having hot flashes.
Some medications may also trigger hot flashes. Evista (raloxifene), for example, is sometimes prescribed during menopause or postmenopause to prevent or treat osteoporosis. It belongs to a class of drugs known as selective estrogen receptor modulators, or SERMs.
“If a woman is put on a SERM for their bones, it can exacerbate hot flashes,” says Nathan Wei, MD, clinical director of the Arthritis and Osteoporosis Center of Maryland. If you’re burning up, talk to your doctor about switching to another medication for bone health.
Some women feel less interest in sex during or after menopause. That's true for some women even without RA. But living with RA can also stifle your libido. For example, if you take high doses of steroids to control inflammation, it may cause you to gain weight -- which in turn could make you feel less interested in sex.
Worrying about pain during sex can kill desire too. And your partner may hold back from sex out of fear of hurting you.
Swollen and painful joints can put a damper on having sex, and menopause and aging can increase joint pain and stiffness in some women. “For women who have relatively severe disease, finding a comfortable position for intercourse may be challenging,” says Wei. “In some instances, when pain is especially severe, a woman may not even feel like having intercourse.”
Russell suggests that you and your partner visit your rheumatologist together to discuss changes in intimacy caused by RA and menopause. “It’s important for both people in the relationship to know that just as it may be difficult to, say, vacuum with RA, it can be difficult to have sex,” she says.
If you’ve had a long relationship with your rheumatologist, you’re probably comfortable enough to bring it up. But if you’d rather talk about sex with someone else, “Tell your doctor that you’d like a referral to someone you can talk to about how to handle your disease with respect to your marriage or relationships,” Russell suggests.
Talking to a professional can also open up discussion between you and your partner. Discussing sex openly is critical, experts say. It gives you both a chance to air your fears and feelings, and can make your relationship stronger.
There are also some strategies you can try to make intimacy more pleasurable.
New positions and methods of stimulation can ease pain and may wake up a tired sex life, too. To ease pain during intercourse, try kneeling on a pillow with your upper body resting on a chair, and your partner entering from behind. Lying on your side may also work well for some couples.
Try new forms of stimulation to get things going. A warm bath or shower together can be sensual and soothing. Massage, fondling, and stroking may get you in the mood if you find it difficult to get aroused. So can sexual fantasies. For some women, that may even be enough sometimes, and you can bring your partner to a climax in other ways.
Planning for sex is a popular strategy for people with RA. It lets you pursue intimacy during a time of day when you’re generally free of pain and fatigue. You can also schedule your pain-relief medication so it kicks in then.
Strategies such as these may make intimacy more pleasurable. And in turn, enjoying sex can take you out of your RA pain.
Menopause can increase fatigue, which you may already be feeling thanks to your rheumatoid arthritis. If that’s the case, the only thing you may want to do in bed is sleep. Menopause can also lead to insomnia, another problem for some women with RA.
“If you feel particularly fatigued, you should work with your doctor to make sure your RA is being controlled as best as possible with various medications,” Russell says. “And then you really need to listen to your body. It’s OK to take a nap in the day if you’re tired or need a rest, and you should try to get a good night’s sleep.”
But getting your body moving also helps with sleep. “A regular exercise program should be prescribed for insomnia since it has multiple benefits besides aiding sleep,” Wei says.
“A woman with RA can either work with her doctor or a physical therapist to work out a good exercise program for her, based on her pain areas or deformities,” Russell says. “And of course, weight-bearing exercise is also very important for osteoporosis, which is already a risk for people with RA.” Just don’t work out right before bedtime or it may keep you awake.
Other tips: Wei suggests trying melatonin supplements, which may help with sleep, or talking to your doctor about a mild prescription sedative.
Depression is about twice as common in people who have rheumatoid arthritis as in people who don’t. It’s not uncommon to feel depressed by RA pain or by not being able to do some things that you used to do.
Menopause can also bring on or increase depression. Some women, with or without RA, find that it takes a toll on their self-image, making them feel old, less attractive sexually, and insecure. Often those feelings pass. But if you’re worried about depression or you're having severe menopause symptoms, you may want to talk to your doctor about antidepressants.
The benefits of antidepressants go beyond relieving sadness and anxiety: They may reduce menopausal symptoms such as hot flashes as well the pain of RA. They are not a substitute for your RA medication, however. And some antidepressants may reduce your libido, so talk to your doctor if this is a concern.
One of the keys to having a healthy sex life during menopause and beyond is taking care of your overall health. Eating well, keeping your RA symptoms under control with medication, and getting enough vitamins and minerals are essential.
So is exercise. Try to walk, do water aerobics, yoga, or some other exercise 30 minutes a day. It will help reduce stress, which can cause your RA to flare up, and keep your joints flexible. It helps prevent weight gain and protect against heart disease and osteoporosis, both increased risks for women with RA and for all women after menopause.
Menopause may be a good time to try yoga, if you haven’t before. It has shown promise in promoting joint health and emotional well-being, as well as reducing hot flashes.
The many benefits of exercise can also enhance self-image -- and that’s good for anyone’s sex life.
SOURCES: Nagamine, R. et al. Modern Rheumatology, September 2001; vol 11(3): pp 230-233.Mayo Clinic: “Menopause,” “Exercising with arthritis: Improve your joint pain and stiffness.”North American Menopause Society (NAMS): “Menopause Basics.”Linda Russell, MD, assistant attending physician in rheumatology, Hospital for Special Surgery; assistant professor, Weill Cornell Medical College, New York.Arthritis Foundation: “Fetal DNA and Remission in Pregnant Women with RA,” “Alternative Therapies Overview,” “Walking.”Nathan Wei, MD, FACP, FACR, fellow, American College of Rheumatology; clinical director of the Arthritis and Osteoporosis Center of Maryland, FrederickUniversity of Washington Orthopaedics and Sports Medicine: “Sex and Arthritis.”American College of Rheumatology: “Sex and Arthritis.”Musculoskeletal Report: “RA Doubles Risk for Depression, but Rheumatologists Seldom Notice."Harvard Health Publications: “Depression and pain."National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): “What People With Rheumatoid Arthritis Need to Know About Osteoporosis."Brigham and Women’s Hospital: “Rheumatoid Arthritis Raises Heart Attack Risk.”Johns Hopkins: “Yoga for People with Arthritis."
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