Fat, cranky sex. Doesn't sound all that great, does it? The truth is, these three things-your weight, mood, and your sex life-are crucial elements of a great life at any age, but especially now that you're in the best years of your life. And they are the three elements that, when improperly calibrated, can cause a perfect storm. Face it: Your hormones, metabolism, blood flow, and mood aren't what they used to be. What you need is a Great Life Makeover.The Great Life Makeover does for your mind, body, and love life what a beauty makeover does for your appearance. And Dr. Daniel A. Monti and Dr. Anthony J. Bazzan are the experts who perform these makeovers. Dr. Monti, a specialist in psychiatry and couples' counseling, and Dr. Bazzan, a specialist in aging and hormones, lay out a practical, comprehensive, and detailed guide for midlife couples wanting to reboot their love life, rebalance hormones, and remedy the mental and physical issues that make midlife more difficult than it should be.Addressing the three hot-button issues with a focus on diet, fitness, and stress reduction, The Great Life Makeover offers a program that can dramatically improve your health, relationship, and overall quality of life and prevent other problems from cropping up in the future.

The Great Life Makeover
Weight, Mood, and Sex

Chapter One

When Sex Stops Feeling Good For Her

Her

"He's got the libido of an 18-year-old, and I don't. Sometimes I feel dead below the waist, I try to get turned on, but nothing happens. And when we do have sex, it can hurt."

Him

"She doesn't want to have sex as much as I do. But even when we do, she's not really enjoying it. I love her. I want things to be better."

Nancy, an attractive 52-year-old artist, had been divorced for ten years before moving in with her fiancé, Robert, a very youthful 58. But what should have been a joyful time was marred by disagreements over sex. Specifically, he wanted it every day, and she didn't. For Nancy, having sex once or twice a week was more than enough. Even then, she had to really, really push herself before she felt sexually turned on. Sex wasn't always a struggle for Nancy. But like so many women in the midst of menopause, Nancy was experiencing physical and emotional changes that were making sex the last thing on her mind.

Nancy is not alone in finding that sex is not all it should be for women in midlife. A 2007 study of menopausal women revealed that 54% of the women surveyed reported a decrease in sexual activity after menopause. Almost half of all women said that they avoided sex because of physical discomfort. About three-quarters of the women surveyed were in committed relationships and believed that sex was important. What was particularly telling was that less than half of the women in the study were not satisfied with the amount of sex they were having.

We see this phenomenon among midlife women in our practice. They know that sex is important for a relationship, and they would love to be having sex more, but obviously they feel limited by their physical symptoms. And who can blame them? If sex causes more pain than pleasure, most women—or men for that matter—would want to opt out.

She suffers in silence

At one time, women who suffered from sexual symptoms caused by menopause found an easy solution in HRT. Love it or hate it, HRT—yes, even those synthetic hormones we don't like—worked well for many women in terms of preserving sexual function. But now that HRT has fallen into disrepute, many women—and even their doctors—feel that women have no choice but to suffer through these symptoms. That's assuming that women even talk to their doctors about intimate issues; several studies suggest that they avoid potentially embarrassing topics. And so do their doctors.

Despite its bad rep, hormone replacement is still a viable treatment for women who are suffering during menopause or who want to avoid the symptoms associated with hormone depletion. We describe bioequivalent hormones for both women and men in Chapter 9, "Hormone Makeover," and we talk about the nonhormonal and over-the-counter solutions in Chapter 6, "Sex Makeover."

This begs the question, what is a "normal" menopause versus one that requires treatment? Insomnia, hot flashes, and mood swings are all normal symptoms; yet, they can affect women very differently depending on their lifestyles. For example, a woman who gets up early every morning to get to work will be more upset about losing sleep than another woman who works at home and can nap during the day. A woman who has low libido will be more concerned about her lack of sex drive if she has a partner who is very amorous than a woman who is alone or is with a man who is not all that interested. To a large extent, menopause is a subjective experience.

In comparison with men, women find that the transition to midlife is much more complicated. Most midlife men experience a gradual decline in the production of their primary hormone, testosterone. For some men, the drop in testosterone is so gradual that they hardly know it's happening. A healthy man can often stave off many of the physical changes that have become associated with aging, including ED and loss of libido. And if these problems do occur, they're usually not that difficult to fix.

Women, however, are another story. Perimenopause, the years leading up to menopause, and menopause itself (the cessation of menstruation), cause many physical and emotional changes that can put a strain on a couple's relationship.

The drop in the two hormones that regulate the menstrual cycle, progesterone and estrogen, can be quite abrupt and erratic. At the same time, women are also losing testosterone, which, as you will see, is as vital for their health and well-being as it is for men. These fluctuations in hormones can make a woman feel miserable. Furthermore, the anatomical changes that occur after menopause can make sex uncomfortable, if not painful.

Some lucky women sail through these years without experiencing significant discomfort. And many women discover that over time, as their bodies adjust to their new postmenopausal state, the symptoms that were driving them crazy disappear. Free from the fear of pregnancy and from the duties of raising children, some midlife women say they feel happier and sexier than ever once their hormones settle down. But many women need some additional help to navigate through these years.

What happens during menopause?

In the not too distant past, menopause coincided with what we would call old age. At the turn of the past century, the average woman didn't make it past 50. Today, the average woman lives many decades beyond menopause and wants to live those years in a healthy, vital body with a sharp, active mind. But that's not what nature intended for women.

Women may not like to think of themselves solely in terms of their reproductive role, but nature views it differently. Women's bodies are designed to maintain optimal health throughout the childbearing years. Once women move out of their prime reproductive years, their body systems begin to wear down one by one. This is true for both men and women, but since women are the ones who the bear the children, they are hit harder.

The Great Life Makeover
Weight, Mood, and Sex. Copyright © by Daniel Monti. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

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Excerpted from The Great Life Makeover: Weight, Mood, and Sex by Daniel A. Monti, Anthony J. Bazzan, Carol Colman
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.