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Katie: Welcome to the "7 Domains of Women's ÑÇÖÞ×ÔοÊÓƵ," the 7 Domains of Midlife. I'm Dr. Katie Ward. I'm a professor in nursing and a practicing nurse practitioner, a nationally certified menopause specialist, and also a PhD candidate in anthropology. And I am joined today by our usual host, from obstetrics and gynecology, and my dear friend.

And so today we're going to talk about the social domain of menopause. This is a place where there's sort of no one-size-fits-all conversation. There are certain things that are predictable about menopause and certain things that are not. So the social life can be fairly broad-ranging conversation.

I think for some people, this time in life can be incredibly freeing. So whether you're in a long-term relationship or a long-term friendship, or just back out on the dating scene, for a lot of people, it's a time of newfound freedom and exploration.

For other people, it can be a little bit of a challenging time of feeling like they're stuck in a place that they don't want to be, but not quite sure how to get out of that.

So we're going to kind of talk about all of these things.

I mean, I think I see patients in all different kinds of situations. Certainly, I have patients who are in a long-term relationship, and the midlife, the menopause is changing the dynamics in that relationship. Maybe sex is becoming a little bit less accessible, or maybe it's painful. This can be an issue sometimes for both partners.

And then there are some of the other issues we've talked about on previous episodes around maybe you're just feeling a little bit more irritable or edgy or not sleeping as well, and your partner's presence in the bed is bothering you.

So I do see people who are in long-term relationships where they're feeling a little more vulnerable in that space. Lots of things maybe aren't working as well as they have. And so that's one aspect, is talking to people about how they find connection, and how do you keep desire going in a long-term relationship?

Kirtly: Well, I think one of the most common reasons that women in their late 50s and 60s aren't regularly sexually active is the absence of a willing and capable partner. So we always say, "Oh, well, if you're not having sex in midlife, it must be women," but in fact it's often because women either don't have a partner, they're unpartnered at the time, and maybe they're looking for a new partner, maybe they're not, or that their own partner is having his or her own difficulties either with sexual intimacy or they're having their own midlife issues, and they just can't bring it to the table and really work it on it as a couple. It's a difficult time, I think.

Katie: It is. I talk about this both with my patients and with my friends, that all relationships need really good communication. So there's a lot you can fix with lubrication and communication in midlife.

I think what we don't talk about as much is that men are going through some hormone changes as well. They're maybe not as dramatic as . . . they're not as sudden or finite. So men are making less testosterone, but it's a little bit more gradual.

But for the male partner, if women are in a partnership with a male, they may have some intermittent changes in their sexual function, and that creates some anxiety. And that whole dynamic of having anxiety, performance anxiety for males, or is intercourse going to hurt for females, then both people start kind of avoiding that and you end up in a cycle where there's a lot of avoidance. So communication, I think, is the key here.

Kirtly: Yeah, and once you get into a cycle of just not being as frequent as you were in your encounters, you drift off into it and it doesn't become a habit anymore. And as much as you don't want it to be that way in a long-term relationship, often sex becomes a habit that you lose in midlife because you're not driven by your own sexual needs, just your own pacemaker of sexual needs, either yours or your partner's.

And when you're not driven by that, it becomes . . . What's your habit? You always used to do Saturday or whatever, and then you're not, and it ends up being a change in a life way. People don't think about it or they say, "This is just normal," and it might be just normal for you.

And having been myself in a 50-year relationship, I think that one of the ways to be successful is to set the expectation bar very low. It's a terrible thing. When people say, "Gee, how did you manage to be with the same guy for so long?" I say, "Well, at first I picked well, and I set the expectation bar really low, and I told him where it was so he wouldn't trip on it." So here are my expectations. Here it is right here so you can see it, and I'll tell you when I think I'm getting something or not getting what I want.

And when it comes to intimacy, it's a complicated issue. Some people want to keep it moving, some people don't, and some people just . . . It's just, "I don't want it with this person anymore," because they are not connected to this person anymore, and it's time to move on. Then you've got a midlife person who would like to be mated, would like to be partnered, and then you've got to go out and find a partner. Oh my god, don't do that. I wish the best for everybody. Maybe I'll be 80 and doing that.

Katie: Yeah, so let's move on to that scenario. I think . . .

Kirtly: Let's move on.

Katie: Well, there are a couple possibilities. Certainly I have a few friends and a number of patients who the midlife is the beginning of a new renaissance in their relationship and they're really having a great time, and for other people where intimacy becomes a little less about sex and more about companionship.

But there are some interesting statistics about the midlife where it's one of the times where women are most likely to initiate a divorce. So I think that there is something about reaching that point in your life where you're a little more certain of yourself, and perhaps a little bit more financially secure, and your ÑÇÖÞ×ÔοÊÓƵren aren't quite so needy that if it's not a good relationship that it might be time to move on.

And so there's some interesting information about when women are the partners initiating a divorce. There may be that, that people are leaving the relationship.

And then certainly, there's probably . . . I think it's about a third of people over 50 are on dating apps and looking to meet somebody else, whether they were ever married or recently divorced. But dating at this period of time can be really rewarding and some people meet the love of their life. I have other patients who reconnect with their high school sweetheart on Facebook at age 70.

Kirtly: At their 40th reunion or something. A long time to tell you had a crush.

Katie: Rekindle a relationship that they'd always dreamt about. So I think anything is possible. But dating, let's talk about dating a little bit, because it is an interesting world out there of dating when you're in the midlife.

Kirtly: Oh, gosh. I think I'd be so anxious that I . . . First of all, I'm a surgeon. I pick A or B, maybe C. One, two, or three. And having many options as a surgeon, it's like, "Forget that." I would narrow down my options to some tiny little thing. I can make decisions well, but don't give me too many choices.

Katie: Right? The paradox of choice. There's interesting research on that. If you walk into a jeans store and they only sell one kind of jeans, odds are you're going to be happy with that one pair of jeans. But if there are a hundred different types and you try them all on, your satisfaction with any of them goes down.

So I think that is one of the challenges about online dating, is that you keep swiping because maybe there's going to be something better if you keep looking. So narrowing down the choices.

Kirtly: The FOBO, fear of a better offer. You keep swiping because maybe there's something else out there, but . . .

Katie: But I think for women . . . And there is some interesting research on this. For women who are out there dating on the apps . . . as my younger generation people tell me. These are called as "you're on the apps." Women are a little bit more likely to have a negative experience out there, and those negative experiences can range from being the target of a scam, a financial scam, or a relationship scam, or getting sent unwanted pictures, or being confronted with unwanted offers. So there's a steep learning curve for women who are getting out on the dating market.

There's actually an interesting researcher out there who . . . I think she's dating herself, but this has become her area of study, is what's the language of being on a dating app and how do you construct a profile that attracts the kind of people that you are interested in and also repels the people that you're not interested in?

So she's actually created a whole Facebook group for . . . Her demographic started out primarily as midlife women, but I think it's expanded to younger women about really how to leverage these algorithms.

And I think that's another thing that people should understand when they're out using the apps, is that it's a machine that's there actually to make money. It's really not there to . . .

Kirtly: Not even eHarmony? I thought eHarmony was going to find my next soulmate if I needed one.

Katie: Yeah, and I think Hinge, that's their tagline. It's there to be deleted. So they get you. They hook you that way by telling you they exist to help you find the love of your life, but really, their power move is to keep you coming back.

And so I think in some ways the apps sort of exist to get you to log on, shop around, get fed up with the whole deal, get off, give up for a while, and then come back and try again.

Kirtly: Oh, no. It's like getting a car that falls apart or your computer becomes obsolete. They link you up with someone that you're guaranteed to fall apart within two years, so you'll come back and do it again. Is it built-in obsolescence into the AI of this machine? "We're going to set you up with a person you want, but it'll only work for two years and then you have to come back and do it all over again."

Katie: Exactly. I don't know if it's that intentional, but I do think that there's a little bit of . . . You stop paying money if you find your soulmate, right? So the guys or the gals, anybody on the ads for these apps always looks a little bit better than the actual content.

There's a little bit of a learning curve of figuring out how . . . and that's what this researcher I was talking about, is, "Don't take these things personally. If somebody is not a match, block them and force the machine to show you more people." So there's a lot to have to learn about how to use these apps in a savvy way that helps you find the people you want.

Kirtly: But I feel so bad about blocking somebody, like I might hurt their feelings. I could see I would have a very difficult time if I was forced to . . . I don't want to block somebody because I might hurt their feelings. I don't know.

Katie: Yeah, I think it's a good thing you don't have to date in this market.

So that's a good segue into something else I wanted to talk a little bit about, which is for individuals who are out dating in the second half of their life, you might not have to be so concerned about pregnancy anymore because that is one of the hallmarks of being menopausal, is that the pregnancy is not a concern, but you do have to be concerned about sexually transmitted infections.

And I feel like a little bit in my hat as a clinician that negotiating condom use can be a little bit more awkward for somebody that's been in a long-term relationship where that wasn't something they had to worry about and now is meeting new partners. It's thinking about the risk for sexually transmitted infections. It's something we've been talking about in the public health sphere, that we're seeing an increase in sexually transmitted infections even in assisted living.

Kirtly: Oh, yeah. I think because that's "only young people get those diseases," whether it's warts or whether it's something else. And the manifestation of these diseases often is a little bit different because, particularly for women after menopause, they're a little less likely to get cervical cancer, but they still could get warts and they're horrified.

And I thought, "Well, gee, can we talk a little bit about condoms?" It's not something that they feel comfortable initiating a conversation about with their partner. They figure if someone's got tested for AIDS, that was fine. That's good enough. It's like, "Oh, gosh."

Katie: Yeah, and depending on your age, you might be past the age where you can get the HPV vaccine. People under 45 can get that covered by your insurance, but if you're over 45, it's a very expensive vaccine. Although it is available, and I would encourage patients who are out there dating to maybe think about paying the money for it because it could be worth getting.

But you're right, figuring out how you negotiate condom use. And so that means if I'm dating, I have condoms and I have them available and I carry them with me.

I think that can be a tricky thing or something just important to talk about.

There's another interesting phenomenon for women in particular, since we're talking about the 7 Domains of Women's ÑÇÖÞ×ÔοÊÓƵ, that sometimes women fall in love with somebody totally unexpected. So that's another thing I see, again, both in my patients and in my friends and colleagues, is that women who considered themselves straight and were in a heterosexual relationship and had ÑÇÖÞ×ÔοÊÓƵren find themselves falling in love with a female partner.

That's a whole interesting phenomenon where these are people who didn't necessarily always identify as gay or queer or any of the other sort of vocabulary around that, but they fall in love with a person, and the gender isn't exactly what matters. It's the person they fall in love with. And so I think that's another interesting experience that's waiting for some folks out there.

Kirtly: Absolutely. I think many people that I've known who were looking for someone because of a death or because of a divorce, it's the person they were looking for. Yeah, they'd like to have someone who's gorgeous and fit and strong and young and slim, but they're really looking for a person, and that person can come in different forms.

This refers to the movie "Book Club," in which all the members of this book club have a resurgence in their love lives in an unexpected way in their 60s and later. So it's fun because they were really looking for a person.

Katie: Right? And the other thing I think we were talking about in a previous episode was that you know yourself a little bit better and you're a little bit more confident as you get through the other side of the menopause transition and the midlife. And I also see women whose sex life really blossoms in that second phase of life where they're a little bit more willing to ask for what they want from a partner and a little bit more willing to . . .

I think, again, that's a dynamic that sometimes people learn. So you get in a relationship when you're young and you have one particular dynamic. And I've seen that a lot, where the sex in that relationship wasn't great, and out of concern for hurting somebody's feelings or not having the vocabulary to discuss it or even the permission to have become fluent in the language of your own sexuality . . .

Kirtly: Yeah. As you go around the world, there are many cultures in which women are not expected to be sexually active, and this is a part of their life where their sexual life is now moved aside. And traditionally, in some eastern cultures, men had concubines or they had women that they took their sexual lives to, but their wives originally ran the family, but that wasn't expected to be part of their life anymore.

So from culture to culture, when one talks about midlife and sexuality and menopause, it is difficult to find the language. Even if we're all speaking English, we're not always speaking English culture.

I think as a clinician, or even as we talk about it on a podcast, our listeners may come from a culture where the whole business about a blossoming sexuality at 60 or 55 is like, "What are they talking about? That's not what we do." Or maybe they do and they just don't talk about it.

So I think it's trying to know what is normal. And I think the range of normal is so huge. It's more not "What is normal?" but it's "What are you hoping for? What are you hoping for in your relationships or in your relationship with a romantic partner? Do you want one at all? And how does that work in a different culture?"

Katie: I think there is that, and I think for . . . We talked about dating and it's possible that you don't find your person on an app or anywhere else, and you sort of get to a place where it's going to be okay to be alone. I think lots of people resolve that in a way where they're very happy with that and they start investing more deeply in their friendships, or if they have ÑÇÖÞ×ÔοÊÓƵren and grandÑÇÖÞ×ÔοÊÓƵren, that becomes really the focus of their time and attention.

But there really is what the surgeon general has called an epidemic of loneliness and isolation. And I think we really became increasingly aware of that during COVID where we couldn't see each other.

And it's an issue that gets compounded by a lot of other kinds of situations: physical disability, health issues, socioeconomic issues, being marginalized from any kind of racial or minority group or being LGBTQI+, living in a rural area. There are lots of things that begin to compound that loneliness, and aging is one of them, just the ability to get out and go places.

And so I think there are a lot of things that we need to start to think about around, as a society, "How do we address those problems?" There are many of them, but I think one that's particularly important to talk about is our reliance on social media.

We are a world now kind of walking around spending a lot more time looking at our screens and maybe a lot less time checking on our neighbors or checking on our family and friends.

And I think both individually we need to be looking at how do we create and maintain those connections, but also as a society. What are the structural things that are contributing to people feeling alone and isolated in the world?

Kirtly: Well, one of my happiest visions is a group of 55- to 65-year-old women together just hooting it up. I mean, it's maybe seven women around the table and maybe they're doing nothing. In the olden days, there used to be quilting. So older women would get together to quilt, and then there was bridge. Or even people who came from lower socioeconomic statuses would sit on their stoops with their girlfriends who are of the same age, the old grandmas, and they would just be laughing and laughing.

That's what I want for myself. That's all I want for my beloved friends. I want them to be with their girlfriends and just having a hoot. How do we institutionalize that? How do we begin to create that?

Katie: Creating the community and that space. And it's a structural problem, how we live and how we move about the world and the places we join. I think for each of us individually, again, it's one of those things of thinking about how do you create community and how do you get into groups of like-minded people where the portal is not your phone or Facebook, but these are people in real life that you can spend time with?

I think for all of us, it's cultivating those friendships, investing in them, and making the time to . . .

I have this memory of my mother when she retired, she and a group of women that she worked with, they all packed off and went to Disneyland. That's one of my favorite pictures of her. I mean, I guess she wasn't really that old now that I think about it, but she seemed old and her friends. They were all about a similar age riding the log flume in Disneyland and . . .

Kirtly: Exactly.

Katie: . . . enjoying being retired.

Kirtly: I think I had this vision of smaller towns where you didn't have to walk so far and everybody knew each other's business and people say, "Oh, that's so awful," but in fact, small towns are often where people do know when someone hasn't shown up at the grocery store or someone hasn't shown up for a while.

And maybe it's people's church service, some kind of source of social get-together, because often after the Sunday service, there's a get-together for coffee and people just laugh and have coffee or gossip. I mean, that's what grannies were made for, right? We're supposed to sit around and laugh and gossip.

And how we bring that into our lives in some way . . . I'm not saying everybody has to gossip, but how you bring it into your life so that you have those connections with people that you can laugh with is really important.

Katie: I think it's a . . . maybe it was a greeting card. It was on a slide, when you were giving talks, Kirtly, that has this girl watering a row of flowers.

Kirtly: All her own little mentees or her girlfriends. You've got to water your girlfriends. If you want to have friends, you've got to water them a little bit. You just do.

Katie: Yeah. I mean, I think of the nursery rhyme of making new friends, but keeping the old.

Kirtly: Oh, yeah.

Katie: One is silver and the other is gold.

Kirtly: Silver and the other is gold. Oh, gosh. Wow, that's a great . . . We should sing that together, but maybe not right now.

Katie: You don't want to hear me sing.

Kirtly: Oh, I like to sing a pretty song. I won't.

Katie: Yeah, you were going to be Barbra Streisand.

Kirtly: I was, but I didn't quite have the voice for it. Too bad.

Well, as we finish up, I think the time for midlife is to think about your intimate connections and your person, your single person. Get closer to your sibs if you can because often we were so busy, we let our sibs go. I know in my life I was so busy and now I'm closer to my sibs than ever. And we visit more than ever. And my girlfriends, Katie, you mean more to me than ever.

Katie: Aw.

Kirtly: These are really important things in our life.

Katie: Yeah, that's the analogy, right? Water your garden and take good care of those important relationships. We touched on this a little bit, but it's important to look at the relationships that are not serving you and not feeling stuck in those either. So I think it's that time in the midlife of tending to yourself and figuring out what is the garden you want to cultivate.

Kirtly: Nobody sends Christmas cards anymore. It used to be I could count on who the people were I was wanting to get in touch with by my Christmas cards, and now people don't do that except me. And even I didn't do it last year very much.

How do you reach out, not necessarily electronically, to have a giggle or to laugh or hear what's important to people? I think that's a critical mission for anybody who's entering midlife, is to look at their garden of friends and start watering them. Prune the ones that don't serve you, but take really good care of your pretty flowers and do the best you can to keep them alive and growing in your life.

Katie: Thank you for joining us the "7 Domains of ÑÇÖÞ×ÔοÊÓƵ" and this special midlife edition, and in particular this episode on the Social Domain of Midlife.

Kirtly: And stay tuned because we'll be doing the other parts of the domains. You can listen to our podcast anywhere you get your podcasts, or at womens7.com. Thanks for listening, and stay tuned because we've got more on being in the middle of your life.