When Desire Fades: The Growing Need for New Approaches in Sexual Medicine

Written by: Lennard M. Goetze, Ed.D & edited by: Marilyn Abrahamson (editor of INSIGHTS Magazine)

 Foreword

In today’s rapidly evolving healthcare landscape, the intersection of mental health, hormonal wellness, and sexual health is receiving long-overdue attention. As traditional medical approaches often fall short in addressing the complex, deeply personal challenges faced by individuals experiencing sexual dysfunction, integrative medicine offers new avenues for healing.

Dr. Barbara Bartlik, a distinguished psychiatrist, sex therapist, and leader in integrative medicine, has dedicated her career to bridging these disciplines. Through decades of clinical experience, academic teaching, and active participation in leading medical symposia, Dr. Bartlik advocates for comprehensive, evidence-based approaches that treat the whole person—not just isolated symptoms.

In the following feature, Dr. Bartlik highlights emerging trends in sexual health, the alarming decline in libido and testosterone, and the growing influence of modern lifestyle factors on intimacy and relationships. Drawing upon both conventional and integrative strategies, she makes a compelling case for why new solutions are urgently needed—and how integrative, functional medicine can help fill that gap.

Integrative Solutions for Sexual Wellness  (Part 1): Beyond the Prescription Pad

Dr. Bartlik highlights the ongoing need for more effective, evidence-based solutions for sexual problems in both men and women. While two medications for low sexual desire are now approved for premenopausal women—a significant achievement—these treatments have been slow to gain widespread acceptance and are notably not covered by insurance for postmenopausal women, a demographic that urgently needs support.

She notes that while medications such as Viagra and related drugs offer benefits, they are not a universal answer. The fact that approximately half of prescriptions for these medications go unrefilled underscores the need for innovative, integrative, and personalized approaches to sexual health care.

Disconnected: Why Couples Are Having Less Sex — and What to Do About It
Before summarizing integrative therapies, Dr. Bartlik reviews prevalent sexual health concerns that demand new solutions. Chief among them is low libido, a common sexual complaint that has long been the most frequently reported issue among women. Contributing factors include relationship difficulties, busy schedules, restrictive cultural or religious backgrounds, concerns about physical appearance, menopausal symptoms, vaginal pain, and the lasting effects of cancer and its treatments.

She references Rosemary Basson’s model of the female sexual response, which suggests that many women do not typically experience spontaneous sexual desire. Instead, desire often emerges in response to a partner’s initiation. However, if male partners are experiencing their own issues, including diminished libido, this dynamic can become further complicated.

Studies show that the frequency of sexual activity among both married couples and individuals in relationships has declined to historic lows, a trend exacerbated during the COVID-19 pandemic and persisting in its aftermath.

Stress and Screens: How Modern Life Is Eroding Intimacy
Men, too, are experiencing lower libido rates than in previous generations. Dr. Bartlik attributes this trend to a combination of factors: anxiety, mood disorders, stress, shifting social roles, economic pressures, sedentary lifestyle, and the use of medication. These factors contribute to a reduction in testosterone levels and decreased interest in forming intimate relationships.

Increased access to alternative sexual outlets such as online pornography has also altered interpersonal dynamics—men don’t desire real women as much as they used to, which is very distressing to women. Excessive screen time through exposure to content that is not explicit also takes away from time that would otherwise be spent on social or sexual engagement. While younger individuals may gravitate toward video games, older adults often turn to television and streaming media, further diminishing opportunities for connection.

Testosterone in Freefall: What It Means for Men, Women, and Relationships
A particularly concerning issue Dr. Bartlik addresses is the significant decline in testosterone levels among men. She cites research indicating that a 22-year-old man today has an average testosterone level equivalent to that of a 67-year-old man in the year 2000. Overall, testosterone levels have dropped more than 20% over the past two decades—from an average of 600 ng/dL in 2000 to approximately 450 ng/dL in 2018. Currently, one in four men over the age of 30 has clinically low testosterone.

Alongside this, sperm counts have declined by 60% in the last 40 years, with male infertility on the rise. Dr. Bartlik underscores that testosterone is essential not only for sexual health but also for mental well-being, affecting mood, anxiety, sleep, self-esteem, vitality, and overall energy.

Modern Intimacy in Crisis: The Integrative Medicine Perspective
While previously mentioned factors play a role, Dr. Bartlik notes that other contributors of particular interest to the integrative medicine community merit further exploration. By considering hormonal health, nutrition, lifestyle habits, environmental exposures, and the psychosocial landscape, integrative practitioners have an opportunity to develop new, personalized, evidence-based therapies that address the complex, interconnected challenges of sexual health in the 21st century.

ABOUT DR. BARTLIK

Dr. Barbara Bartlik is an integrative psychiatrist and sex therapist known for her holistic approach to mental and sexual health. She earned her medical degree from the Albert Einstein College of Medicine and completed a residency and fellowship at NYU. Early in her career, she trained under Dr. Helen Singer Kaplan, a pioneering sex therapist, and later worked at Weill Cornell Medical College. Dr. Bartlik’s interest in integrative medicine grew from personal health challenges, leading her to adopt dietary changes, remove mercury dental fillings, and use nutritional supplements—experiences that significantly improved her well-being. These transformations inspired her to incorporate integrative practices into her psychiatric care, emphasizing nutrition and addressing deficiencies to enhance mood and health, often reducing the need for psychiatric medications.

She is particularly focused on sexual health, noting the negative impact psychiatric medications can have on sexual function. By combining psychiatric care with holistic strategies, Dr. Bartlik helps minimize medication reliance while improving mental and sexual well-being. A board-certified expert in integrative medicine, she frequently presents at prominent conferences and advocates for better solutions in sexual health, particularly for postmenopausal women.

GO SHAME-FREE! SEXUALITY IS A MAJOR INGREDIENT OF OUR HEALTH AND WELLNESS

The Women’s Professional Health Network is proud to introduce Jennifer Wiessner, LCSW, CST a Certified Sex Therapist, Sexual Wellness Consultant, Educator, and Entrepreneur dedicated to promoting healthy, shame-free conversations about sexuality. As Maine’s only female AASECT-certified Sex Therapist in 2012, she paved the way for a growing network of professionals in her state. In 2023, Jennifer was honored with the Maine Family Planning Significant Contributor to Sexuality Education award for her continued advocacy and education.

Jennifer’s mission is to reduce shame around sexual health and empower individuals, families, and providers through compassionate, accessible education. She specializes in sex therapy for all orientations, sexual medicine issues, and later adolescent care, alongside offering one-time, non-therapy consultations across the U.S.

Passionate about community impact, Jennifer created Raising Sexually Healthy Children, workshops for parents, educators, and providers, and co-founded Girls on Fire, an annual empowerment event for young women. She regularly educates medical and mental health  providers, medical students, school and camp staff on integrating sexual health into holistic care.

Jennifer offers virtual, in-home, and office-based consultations and workshops, believing that through open, informed conversations, we can replace shame with celebration — one person, one family, one community at a time.

 

FROM THE SOURCE:

Jennifer Wiessner, Sexual Wellness Consultant

From Maine Magazine/Photo: Myriam Babin

I have been called to the deeply resonant work of sexuality for 15 years as a licensed clinical social worker and an AASECT certified sex therapist and sexual health consultant. I believed many years ago when I had small children that if I could help parents of young children communicate about bodies, boundaries, healthy touch, sexuality, pleasure, consent, I could change the world because then an entire generation of children would grow up with less shame, more knowledge and pride in their bodies. I continue that work today alongside my couples and sex therapy practice, my sexual health consultations, lecturing and raising sexually healthy children workshops. Yes, I know I do many things, but it's because sexuality has an intersectional thread in every aspect of our humanity. My passion about sexuality and sexual health is like breathing for me because it's so integral to all of us and yet so suppressed and misunderstood, especially for female bodied people, causing women to relinquish precious energy and self-love.

Our sexuality intersects with every aspect of our wellbeing, and yet has been overlooked by our culture, our care professionals, and even ourselves. Most people don't know that talking about sexuality with others, particularly our friends, can help us better understand sexual norms, like even knowing if we're treated well in a relationship, how do we know if we don't talk about it? Also, talking about sexuality with close friends can create more solid relationships and allies. If we talk about sexuality, there is likely little else we can't discuss and then we know who our support network is. It can also make it easier to talk to medical providers who often don't have the comfort or skillset to do so. Sadly, most of us don't like to talk about sexuality, especially if we feel like something has changed in it. Think perimenopause or menopause. As care providers, we need to have courage to change this for ourselves, for our patients and all the young women that come after us.

The reality is we are always changing and are always in transition, and as women, it is difficult to get accurate, actionable information on what is happening to our bodies and hormones from basically age 35 plus. My work in sexual health is multidimensional and includes providing emotional and functional support to patients alongside medical providers. I help adults, particularly women, to better understand their bodies, work through oppressive early messaging, trauma, bodily dysfunction issues, pain, arousal issues, struggles with intimacy and health conditions that impact intimacy with themselves and partners. What is important is that we get informed, have resources for our patients, and collaborate with providers who are skilled in sexuality and the female experience.

The lack of sexual education and body-positive role models weighs heavily on our psyche and dampens our sexual energy. The more we talk about it, the more we bring our sexuality and sexual health out of the oppressive shadows into the light of our everyday experience where it belongs. It is our birthright and a foundational aspect of our humanity. Two quotes I enjoy are: “Your body is not your art, it's your paintbrush" By Glennon Doyle and from Gloria Steinem: “Each individual woman's body demands to be accepted on its own terms." My work is to help each person, each woman, to realize the full and expansive breath of their sexuality on their own terms without shame as a backdrop. It's important to note that sexual shame or shame of any kind, is not our natural state.

It is not in our nature to feel ashamed of who we are as human beings. We are not born ashamed of ourselves. Shame of all kinds is learned and can severely limit us. Some have even called shame our biggest cultural of fear. Shame is like pine pitch; no matter how many times you wash your hands, it's still feels sticky. Sex therapy can help with the self-discovery and healing from the negative effects of shame can lead to a more fulfilling and authentic relationship with sexuality.

Our pleasure is our gift and to be celebrated. It is a life force that is powerful, and when harnessed, we connect to a deep sense of ourselves, our personal power, and can access greater health and creativity in our lives and in our work. My work and my passion is to help all people, particularly women, awaken this energy, connect to themselves, their work, creative endeavors and relationships, all increasing wellbeing. The ultimate goal for us is to support children and young women from the schoolroom, to the boardroom, to the bedroom. Anything less is faux-powerment. As medical and mental health providers, we can dismantle sexual shame, connect to the joy of our bodies, and create a world where every woman, from the womb through menopause and beyond, has access to the resources, support, and empowerment she needs to thrive.

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Contact: https://jenniferwiessnerhealthysexuality.com/

4/2025- Sexual Health Symposium / Mt. Sinai (feat. Dr. Barbara Bartlik)

FOR IMMEDIATE RELEASE

Dr. Barbara Bartlik Illuminates Integrative Approaches to Sexual Health at Mt. Sinai 2025 Sexual Health Symposium

NYC/ April 2025 - At the forefront of a rapidly evolving conversation on sexual wellness, Dr. Barbara Bartlik, one of New York Magazine's Best Doctors in Psychiatry and a nationally recognized leader in integrative medicine, delivered a featured lecture at “Symposium 2025: On Human Sexuality,” hosted by Mt. Sinai Medical Center. Her presentation, titled “Integrative Medicine Treatment of Sexual Problems,” offered a comprehensive exploration of contemporary solutions for sexual health issues affecting both men and women. The annual symposium, organized under the direction of Dr. Ahron Friedberg and co‐directors Dr. Vladan Novakovic and Jennifer Harper, M.Div., drew clinicians, psychoanalysts, and mental health professionals from across the country. Framed within a nuanced discussion on the complexities of human sexuality, the event sought to advance open, inclusive, and evidence‐based dialogues around topics too often marginalized by politics, social norms, and traditional medical models.

A Holistic Lens on Sexual Health, Dr. Bartlik’s presentation stood out for its integrative perspective, merging conventional psychiatry with emerging technologies and natural therapies. Her review addressed a spectrum of conditions, from common sexual dysfunctions and mood disorders to menopause‐related issues, pelvic floor dysfunction, and bladder health. She highlighted the importance of tailoring treatment plans that honor both the physiological and psychological dimensions of sexual wellness.

Among the therapeutic modalities discussed were the use of Viagra in women, sexually- enhancing nutritional supplements and creams, red light therapy, Pulsed Electromagnetic Field (PEMF) therapy, healthy lifestyle interventions, alongside established psychopharmacologic and psychotherapeutic approaches. Dr. Bartlik stated that testosterone levels in men are in steep decline, along with sperm counts and fertility. Urinary leakage is a major problem affecting over 70 percent of older women. Pharmaceutical and surgical solutions are woefully inadequate. 

Numerous technological advances effectively treat this condition but are not FDA- approved or covered by insurance, so the cost is out-of-reach for most women. “This is a major women’s health issue that needs immediate attention,” according to Dr. Bartlik. She emphasized the growing body of evidence supporting these techniques as adjunctive or alternative options, particularly for patients seeking non‐pharmaceutical interventions or those with treatment‐resistant conditions, “Sexual health is inseparable from mental health,” Dr. Bartlik noted during her lecture. “Our role as clinicians is to create space for individualized care — integrating the best of conventional medicine with scientifically grounded natural therapies.”

SHOWCASING AN EDUCATIONAL RESOURCE
In addition to her presentation, Dr. Bartlik highlighted her textbook, INTEGRATIVE SEXUAL HEALTH, a landmark contribution to the (Dr. Andrew) Weil Integrative Medicine Library published by Oxford University Press (2018). The book offers in‐depth clinical guidance for practitioners and positions itself as a leading reference in the intersection of sexual health, psychiatry, and integrative medicine. 

A THOUGHTFUL SYMPOSIUM FRAMEWORK
This year’s symposium took a reflective approach to the broader landscape of human sexuality. In his opening remarks, Dr. Friedberg spoke to the evolving discourse: “Human sexuality is complex, its expressions varied and often shaped by unconscious conflicts and cultural scripts. Our task is to bring these conversations into the open — not only to treat, but to understand.” 

The event also featured a distinguished lineup of speakers including Dr. Harold Bronheim, Dr. Mark J. Blechner, Christian Churchill, PhD, Dr. Vicente Liz Defillo, Martina De Giorgis, LCSW, Dr. Jennifer Downey, Dr. Elizabeth Grill, Dr. Monique Rinere, Dr. Phillip Luloff, covering topics from psychoanalytic interpretations of sexuality to reproductive mental health and the psychodynamics of sexual identity.

About Dr. Bartlik...

DR. BARBARA BARTLIK is a Manhattan‐based psychiatrist, integrative medicine specialist, and sexual health expert with over 30 years of clinical practice. She is widely recognized for her holistic approach to patient care, combining conventional treatments with evidence‐based natural therapies. A prolific author and educator, Dr. Bartlik continues to shape contemporary conversations around sexual health, psychotherapy, and integrative medical care.

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For more information about Dr. Bartlik and Integrative Sexual Health, https://drbarbaramd.com/

Media Contact: Lennard M. Gettz, Ed.D,  InterMedia Press / AngioInstitute- Phone: 516.603.1416 /Email: LG@321image.com

SEXUAL AND PSYCHOLOGICAL ISSUES WITH MENOPAUSE: By Barbara Bartlik, MD

The onset of menopause, typically in a woman’s early 50s, is a time of major physiological transition, due mainly to plummeting estrogen levels. The hormone estrogen, primarily produced in the ovaries, controls the female reproductive cycle and sexual response and affects all of female biology. Estrogen is anti-inflammatory and protects the bones, brain, gut, heart, joints, nervous system, and skin, so when a woman enters menopause, her whole system undergoes major changes. These changes lead to unwanted sexual changes, such as vaginal dryness, reduced lubrication, painful intercourse, orgasmic difficulties, and low libido. Estrogen is to women as testosterone is to men: with low levels of estrogen, women can lose interest in sex and have difficulty performing. If they become anxious or depressed, this, too, can impact their sexuality.  

The extent and severity of menopausal changes can vary significantly from woman to woman. Some may experience no mood changes, while others may experience low mood and even depression. Unhappiness and dissatisfaction can arise from physical changes and loss of fertility that accompany aging. Weight gain, graying hair, and wrinkles can negatively affect a woman's self-esteem..

Menopause is no longer synonymous with old age, but rather a time of transition and potential growth. With women now living at least one-third of their lives past menopause, many are prompted to make positive changes - increasing exercise, improving diet, giving up unhealthy habits, and making  psychological adjustments. Many women find themselves feeling empowered and better than ever, a state that anthropologist Margaret Mead referred to as “menopausal zest.” 

However, many women do experience deep depression that may require psychiatric medication; some require hospitalization for the first time in their lives. Rates of depression increase two-fold (Freeman, 2006). The reduction in estrogen decreases the feel-good neurochemicals dopamine and serotonin. For most women, there is a period when hot flashes interfere with the workday and also with sleep, which contributes to depression. Again, duration and severity vary widely. Many women experience a reduction in sexual feeling and interest related to hormonal changes, vaginal discomfort, disturbed sleep, and low energy. For some, this persists, but not for all. At the same time, their partner may be experiencing problems related to sexual functioning or midlife issues. These experiences are normal and shared by many women going through menopause. You are not alone in this new normal.

What can a woman do to minimize the psychological and sexual changes that accompany menopause? First and foremost, maintain a healthy lifestyle. Reducing alcohol intake, quitting smoking, regular exercise, and consuming a balanced diet can all offer benefits - these changes alone can often stop hot flashes and insomnia. Secondly, engage in stress-relieving practices, such as meditation, yoga, exercise, spending time in nature, enjoying music, and engaging in pleasurable hobbies. Seek support and guidance from specialists who can provide solutions. And finally, do not neglect your sex life and go into sexual retirement. Keeping it active can improve your psychological health, relationship, vaginal health, sexual competence, and vitality.  

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AUTHOR

DR. BARBARA BARTLIK is a recognized expert clinician and author in integrative medicine, psychiatry, and sexual health. She is in private practice in Midtown Manhattan and has treated men, women, and couples with a broad range of psychiatric and sexual problems for over 30 years. She sees patients both in the office and virtually. Dr. Bartlik is an editor of the book, Integrative Sexual Health, a volume in the [Dr. Andrew] Weil Integrative Medicine Library (2018). She takes a holistic approach to treatment, emphasizing lifestyle and nutritional strategies, and seeking to responsibly minimize the use of pharmaceuticals while optimizing health and well-being. Dr. Bartlik uses sophisticated laboratory tests to seek out underlying sources of inflammation that lead to medical and emotional problems and addresses them through diet, nutritional supplementation, and the elimination of toxins and other offending factors. For more information, visit her website: https://drbarbaramd.com/

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"I am so grateful for Dr. Bartlik for this powerful and deeply resonant article! I only wish I had come across something like it when I was 45. My perimenopause crept in silently and, for nearly a decade, drained the joy from my life in ways I didn’t understand at the time. I took the changes in my relationship and the diminishing spark far too personally, which created tension and took a toll on my self-esteem. It wasn’t until I turned 55 that I realized what I had actually been navigating all those years. That’s why this article struck such a chord—and why I would love to share it widely, especially with younger women. When we’re equipped with knowledge, suffering truly becomes optional. I especially appreciated that it didn’t just focus on the physical challenges (which are of course very real and important), but also highlighted the opportunity for transformation this time in life offers. Mental and emotional well-being are key pillars in my work with women in midlife, and it’s affirming to see these aspects so thoughtfully explored." - Sabine Gee - Midlife Health & Menopause Expert

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NAVIGATING CHANGES IN MIDLIFE
As women enter menopause and even many years prior in perimenopause, sexual changes begin to surface that can feel disorienting. Our culture is sex-saturated and yet sex-silent. With many adults having received little to no functional sexuality education while growing up, adults lack the support for open and healthy discussions surrounding the physical, emotional, mental, and sexual aspects of our well-being. Most medical and behavioral health providers lack the skills to comfortably address sexuality concerns.

As a certified sex therapist, I support women and couples navigating the changes of midlife, menopause and andropause (male equivalent of menopause). Most adults present feeling alone and fearful of the changes in libido and function. With few people they can talk to, they feel further disconnected from themselves and a partner. As many as 42 percent of women and 54 percent of men are not satisfied with their sex lives. Most people will experience sexual dissatisfaction at some point in their lifetime. Knowing we are not alone can encourage people to seek supportive therapy. Sex therapy can support individuals and couples to better understand the universal changes happening in midlife and beyond and how to better communicate about them and seek the medical and psychological support they need that can improve their sexual health. 

Beginning this process can include visiting the national directory for the American Association for Sex Educators, Counselors and Therapists (AASECT) and find a qualified professional in your state. aasect.org

Jennifer Wiessner, LCSW, CST

jenniferwiessnerhealthysexuality.com

The Promising Role of MDMA in Enhancing Relationships and Intimacy

By Barbara Bartlik, MD      /     Edited by: Regina Manser, Ph.D

3,4-methylenedioxymethamphetamine (MDMA), commonly known as Ecstasy or Molly, has gained attention for its potential therapeutic benefits, particularly in fostering emotional connections and enhancing intimacy. Initially popularized in the late 1980s at electronic dance parties, MDMA is currently undergoing Phase III clinical trials, the final stage before possible FDA approval as a treatment for certain psychological conditions. Early research indicates that MDMA can be effective in treating post-traumatic stress disorder (PTSD) in veterans and victims of sexual violence, with results suggesting that its benefits may be long-lasting. Additionally, individuals with autism, social anxiety, and anxiety linked to life-threatening illnesses have also experienced positive outcomes from MDMA treatment.

In some cases, individuals have described transformative experiences using MDMA, particularly in overcoming deeply ingrained feelings of shame. For many, this sense of emotional release can feel as though a significant burden has been lifted. Despite these promising findings, the FDA declined to approve MDMA for medical use in August 2024. As such, the substance remains illegal outside of research studies.

While MDMA's use in recreational settings—such as at raves—has earned it a reputation for being dangerous due to its potential adulteration with other substances, the drug itself, when used correctly, can be relatively safe. The risks associated with MDMA at raves often arise from the combination of dancing for prolonged periods, dehydration, alcohol consumption, and the presence of impurities in the substance. This can lead to serious medical incidents, such as cardiac issues and the need for emergency care. However, when used responsibly and in pure form, MDMA presents fewer risks compared to many other common substances of abuse. In a 2010 study by David Nutt published in The Lancet, MDMA ranked 17th in a list of 20 drugs of abuse, far lower than substances such as alcohol, heroin, and crack cocaine, which are considered far more dangerous.

MDMA is a stimulant that works by releasing norepinephrine, oxytocin, and serotonin in the brain, producing effects of euphoria, happiness, and intense emotional connection. Users often report a sense of warmth, a desire for physical closeness, and enhanced emotional openness, which can be particularly beneficial in the context of couples therapy. Unlike LSD, which can cause hallucinations and a loss of control, MDMA tends to promote effective communication and emotional intimacy. Many users describe a desire to cuddle or engage in intimate physical contact, which can lead to enhanced sexual pleasure, though some individuals may find that they are unable to perform sexually under its influence. For some couples, MDMA has facilitated new understandings and resolution of relationship issues, leading to strengthened partnerships, while others may decide to part ways amicably after gaining clarity about their relationship.

MDMA’s impact on relationships and intimacy demonstrates its potential as a powerful tool in couples therapy, especially in addressing sexual and emotional difficulties. Older adults, many of whom experimented with drugs during their youth, are increasingly using MDMA to foster personal growth and intimacy in their marriages, highlighting the substance’s transformative potential for those seeking to enhance their relationships.

Charley Wininger, a Brooklyn psychoanalyst, has chronicled his experiences with MDMA in his memoir, Listening to Ecstasy: The Transformative Power of MDMA. Along with his wife, Shelley, Wininger has explored the therapeutic potential of the drug, and the book provides practical guidance for those interested in using MDMA safely. The couple discussed their experiences in an interview on Dr. Tranquility's Valentine's Day podcast.

Currently, MDMA remains illegal outside of research studies, which has led to its use in underground settings. Some individuals combine MDMA with other substances, such as psilocybin mushrooms, to enhance their experiences. However, experts caution against using MDMA in combination with psychedelics, particularly for those without prior experience. MDMA and other psychedelics are notably more widely used in states like California compared to the Northeast U.S. As an empathogen, MDMA has the potential to help individuals process emotional challenges, forgive past hurts, and promote personal growth. Were it more widely available and legal, many people could benefit from its therapeutic uses. As such, ongoing research is crucial to determine whether MDMA can meet the criteria for FDA approval and become a recognized treatment option.

References:

•  Multidisciplinary Association for Psychedelic Studies (MAPS) – MDMA-assisted Therapy for PTSD

• This source provides detailed information about the clinical trials and ongoing research surrounding MDMA, particularly its use in treating PTSD in veterans and sexual trauma survivors. MAPS is a leading organization in researching MDMA as a therapeutic tool.

• Reference: "MDMA-Assisted Therapy for PTSD" MAPS website

•  Nutt, D., King, L. A., & Phillips, L. D. (2010). Drug harms in the UK: A multicriteria decision analysis. The Lancet, 376(9752), 1558-1565.

• This study ranks various drugs based on their harm to users and society.

Brain Health Coaching: A Science-Backed Approach to Managing Menopause-Related Brain Fog

Written by Marilyn Abrahamson, MA,CCC-SLP
Speech-Language Pathologist and Brain Health Educator

Menopause can be a transformative phase in a woman’s life, often accompanied by a range of cognitive and physical changes. Many women report experiencing “brain fog” during perimenopause and menopause—a frustrating and concerning combination of forgetfulness, difficulty focusing, and cognitive fatigue. These cognitive changes can adversely impact daily life, work performance, self-efficacy, and confidence.

While brain fog is often attributed to hormonal changes, research suggests that cognitive function can be improved through targeted brain health strategies, including brain training and adjustment of specific lifestyle interventions. Brain health coaching—a structured approach that incorporates cognitive exercises, personalized lifestyle modifications, and evidence-based compensatory strategies—offers a promising solution for women seeking to regain mental clarity and enhance long-term peak brain performance.

This article will explore the mechanism and scientific foundations of menopause-related brain fog, the role of neuroplasticity in cognitive resilience and cognitive reserve, the importance of focused attention, and the effectiveness of targeted memory strategies in mitigating cognitive decline during midlife.

UNDERSTANDING THE SYNERGY BETWEEN MENOPAUSE AND BRAIN FOG

Menopause-related brain fog is rooted in physiological changes. Research has shown that the decline of estrogen, a key hormone that supports brain function, can negatively impact cognitive performance. A study by Mosconi et al. (2021) revealed that perimenopausal women undergo metabolic changes in the brain, leading to alterations in energy production, memory function, and processing speed. This decline in brain metabolism may explain why many women experience mental sluggishness, difficulty retrieving words, and reduced concentration during menopause.

Furthermore, a systematic literature review by Weber, Maki, and McDermott (2013) found that perimenopausal women frequently report challenges in executive function—skills responsible for decision-making, problem-solving, and focus. These changes are likely linked to fluctuations in estrogen and progesterone, which play a role in neurotransmitter regulation and brain connectivity.

While these cognitive shifts can feel unsettling, they are not necessarily permanent. Research suggests that the brain remains capable of adaptation and recovery through neuroplasticity—the brain’s ability to reorganize and strengthen neural networks in response to cognitive challenges. This is where brain health coaching and training can make a meaningful impact.

The Science of Neuroplasticity and Brain Training

Neuroplasticity is the brain’s ability to form new connections, repair itself, and strengthen cognitive function in response to mental stimulation. Studies have shown that targeted cognitive training can enhance mental agility and improve key areas of cognition, such as attention, processing speed, and memory.

A review by Lustig et al. (2009) highlighted that cognitive training interventions can improve cognitive performance in aging adults by promoting neuroplasticity. Similarly, a large-scale study by Ball et al. (2002) found that structured brain training exercises led to measurable improvements in reasoning, memory, and processing speed among older adults. These findings suggest that even in the presence of menopause-related cognitive changes, engaging in brain training activities can help women maintain and even enhance their mental sharpness.

Brain training can take many forms, including memory exercises, problem-solving tasks, and attention-enhancing activities. However, to maximize results, brain health coaching integrates these cognitive exercises with lifestyle interventions that support overall brain function.

The Role of Focused Attention in Memory and Cognition

One of the most significant cognitive challenges reported by women experiencing menopause-related brain fog is difficulty establishing and maintaining attention. Focused attention is the brain’s ability to concentrate on relevant information while filtering out distractions. This skill is essential for formation of memories, problem-solving, and overall cognitive efficiency.

When attention is compromised, new information is not effectively recorded into memory, making it more difficult to recall later. Research has shown that lapses in attention, rather than actual memory deficits, are often responsible for forgetfulness in midlife women (Weber et al., 2013). Stress, poor sleep, and hormonal fluctuations further exacerbate these attentional difficulties, leading to increased mental fatigue, frustration, and concern.

Brain health coaching addresses these issues by incorporating attention-enhancing exercises, such as mindfulness meditation, deep focus drills, and dual-task training. These strategies help improve sustained attention, increase mental resilience, and enhance the brain’s ability to filter out distractions.

 

Targeted Memory Strategies to Overcome Brain Fog - While strengthening attention is essential, teaching targeted memory strategies is equally critical in helping women navigate brain fog. Memory strategies are cognitive techniques that compensate for lapses in attention and improve information retention. Research has shown that structured memory training can significantly enhance recall and cognitive performance in adults experiencing memory difficulties (Lustig et al., 2009).

Brain health coaching incorporates several effective memory techniques, including:

·         The Method of Loci (Memory Palace)- This technique involves associating information with specific locations in a familiar environment. Studies have found that spatial memory strategies enhance recall by leveraging the brain’s natural ability to remember places and visual cues.

Chunking Information - Chunking involves breaking information into smaller, meaningful groups. This strategy reduces cognitive load and enhances working memory capacity, making it easier to retain lists, numbers, and sequences.

Associative Memory and Visualization - Pairing new information with vivid imagery or meaningful associations helps anchor it in memory. Women experiencing menopause-related brain fog can benefit from using mental images to reinforce learning and recall.

 

·      Repetition and Active Recall with Spaced Retrieval - Spacing out review sessions and actively recalling information strengthens neural connections and improves long-term memory retention. Brain health coaching incorporates repetition-based learning to reinforce cognitive skills.

By integrating these targeted memory techniques with attention-enhancing practices, brain health coaching provides a structured framework for improving cognitive function and reducing the impact of brain fog.

 

The Role of Lifestyle Factors in Brain Health - Brain health coaching extends beyond mental exercises by incorporating key lifestyle habits that influence cognitive function. Scientific evidence suggests that exercise, sleep, nutrition, and stress management play a crucial role in brain health, particularly during menopause.

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Exercise and Cognitive Function - A study by Erickson et al. (2011) found that aerobic exercise increased the size of the hippocampus, a brain region critical for memory and learning. Regular physical activity enhances blood flow to the brain, reducing cognitive decline and improving attention.

 

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Sleep and Memory Consolidation - Research by Walker (2017) emphasizes that quality sleep is essential for memory consolidation and cognitive resilience. Implementing sleep hygiene strategies, such as maintaining a consistent bedtime and reducing screen exposure, can improve mental clarity.

 

Nutrition and Brain Support - The MIND diet (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) supports brain health by combining the Mediterranean and DASH diets, emphasizing brain-boosting foods like leafy greens, berries, nuts, whole grains, and fish while limiting unhealthy fats and processed foods (Morris, et al 2015). Rich in antioxidants and anti-inflammatory nutrients, it helps reduce oxidative stress, inflammation, and plaque buildup in the brain, lowering the risk of cognitive decline and Alzheimer's disease. By promoting heart health and stable blood sugar levels, the MIND diet enhances blood flow to the brain, supporting memory, focus, and overall cognitive function.

Smith and Blumenthal (2016) reviewed evidence linking the Mediterranean diet—rich in healthy fats, antioxidants, and lean proteins—to better cognitive aging. Nutrient-dense foods, such as fish, nuts, and leafy greens, support brain function and reduce inflammation.

 

         Stress Management and Mental Clarity

Chronic stress increases cortisol levels, which can impair attention and memory. Brain health coaching incorporates mindfulness practices, deep breathing techniques, and relaxation exercises to improve cognitive function.

Menopause-related brain fog is a common yet manageable challenge. While hormonal changes can impact cognitive function, the brain remains adaptable through neuroplasticity. Brain health coaching and training provide an evidence-based solution for women seeking to regain mental sharpness, improve memory, and enhance long-term brain health.

By integrating attention-enhancing exercises, targeted memory strategies, and brain-healthy lifestyle habits, women can take proactive steps to maintain cognitive vitality during menopause and beyond. With the right strategies, menopause does not have to mean mental decline—it can be an opportunity to build resilience and optimize brain function for years to come.

References

 

1. Menopause, Hormonal Changes, and Brain Fog

• Mosconi, L., Rahman, A., Diaz, I., et al. (2021). "Perimenopause and emergence of an Alzheimer's bioenergetic phenotype in brain and periphery." PLOS One. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247081
• Weber, M. T., Maki, P. M., & McDermott, M. P. (2013). "Cognition and mood in perimenopause: A systematic review and meta-analysis." Menopause 20(11), 1143-1153.

 

2. Neuroplasticity and Brain Training

• Lustig, C., Shah, P., Seidler, R., & Reuter-Lorenz, P. A. (2009). "Aging, training, and the brain: A review and future directions." Neuropsychology Review 19(4), 504-522.
• Ball, K., Berch, D. B., Helmers, K. F., et al. (2002). "Effects of cognitive training interventions with older adults: A randomized controlled trial." JAMA 288(18), 2271-2281.

 

3. Lifestyle Factors That Influence Brain Health

• Walker, M. P. (2017). Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner.
• Smith, P. J., Blumenthal, J. A. (2016). "Diet and neurocognition: Review of evidence and methodological considerations." Current Aging Science 9(3), 211-221.
• Erickson, K. I., Voss, M. W., Prakash, R. S., et al. (2011). "Exercise training increases size of hippocampus and improves memory." PNAS 108(7), 3017-3022.

·         MIND diet associated with reduced incidence of Alzheimer's disease - Martha Clare Morris, Christy C. Tangney, Yamin Wang, Frank M. Sacks, David A. Bennett, Neelum T. Aggarwal  https://doi.org/10.1016/j.jalz.2014.11.009

 

 

Why are Seniors Using CBD and Cannabis for Pain, Relaxation, and Sex?

Written by: Dr. Barbara Bartlik

With the legalization of cannabis, many people who would not dream of buying it illegally from a dealer are visiting local dispensaries or ordering from the internet. But buyer beware: there are many types of cannabis products and not all cannabis products are of equal quality and potency. First and foremost, does the product contain tetrahydrocannabinol (THC) or cannabidiol (CBD), or both? The main difference between CBD and THC is that THC produces a high, alters perception, and impairs cognition, whereas CBD does not. CBD is used mainly for its anti-anxiety, anti-inflammatory, pain-relieving, anti-seizure, and sleep-inducing effects. Medical marijuana (cannabis) reduces nausea and helps patients receiving chemotherapy for cancer. CBD balms and creams bring relief to aching joints and muscles. Many people rely on oral CBD to fall asleep and decrease anxiety. Some even use it to reduce symptoms of attention deficit hyperactivity disorder. 

(Photo courtesy of The Three Tomatoes)

Due to its relaxing properties, CBD can enhance sexual arousal and sensitivity to touch. THC can improve sexual functioning, too, but at higher dosages, it can cause anxiety or paranoia, which inhibits sexual arousal. The key is to find the best preparation and strain for you and your chemistry. Many find that CBD products containing some THC are more potent because the two ingredients work synergistically. There are few studies on the sexually enhancing effects of cannabis. About one third of people who use cannabis do so primarily for sexual purposes. One study showed that women experienced improved libido and orgasm and less sexual pain with marijuana (1). Men also report sexual benefits, but chronic users of marijuana can experience twice as much erectile dysfunction (2). So, women might derive more benefit from cannabis use than men. 

Cannabis can now be enjoyed in various forms, from smoking and vaping to indulging in caramels, chocolates, gummies, and even infused cooking oils that combine both THC and CBD. Oils can be used to make brownies and other treats. CBD oils and lotions can also relax muscles during a body massage. CBD sexual lubricants relax the muscles of the pelvic floor, increase natural lubrication, and reduce pain during intercourse. Therefore, they can help menopausal women with vaginal symptoms. Some CBD lubricants contain other botanicals (ashwagandha, cacao seed butter), essential oils (peppermint and black pepper), and amino acids (L-arginine and L-citrulline), thought to aid sexual arousal, and others contain tea tree oil to fight infection. Many of my senior citizen patients enjoy using CBD and cannabis to enhance their sex lives. They may have enjoyed using marijuana for sex in their youth, and they are rediscovering it now that it is easily obtainable. Like other sensual techniques, cannabis and CBD add pleasure and variety to the sexual experience.

Terpenes add a pleasant aroma and flavor to cannabis and affect its potency, a phenomenon known as “the entourage effect.” Two aromatic terpenes in cannabis are limonene (found in citrus fruits) and linalool (in basil and lavender). Limonene is thought to have mood-elevating, stress-reducing effects that counteract the sedative and anxiety-producing effects of THC. Linalool has stress-reducing, anti-microbial, immune-boosting action and has been postulated to enhance the parasympathetic (rest and digest) nervous system. This latter effect is conducive to good sexual function. 

Before incorporating cannabis into your routine, consider consulting a healthcare professional to ensure it's safe and appropriate for you. Cannabis can decrease sperm quality and reduce testosterone levels and erectile ability in chronic users. Individuals with certain psychiatric conditions such as bipolar disorder or schizophrenia can relapse on cannabis, due to the hallucinogenic effect of THC. Some individuals can become paranoid. Oil-based vaginal lubricants can sometimes make it easier for vaginal infections to take hold. They should not be used with latex and some other condoms, as they can degrade the condom material, risking pregnancy or STDs. Only polyurethane condoms are safe to use with oil lubricants. Lubricants containing CBD also come in water-based versions. More information about cannabis and sexual health can be obtained on Instagram at @joyLeafdispensaries, @drbartlik and Dr. Bartlik’s website, DrBarbaraMD.com.

References

1. Lynn BK, López JD, Miller C, Thompson J, Campian EC. The Relationship between Marijuana Use Prior to Sex and Sexual Function in Women. Sex Med. 2019 Jun;7(2):192-197. 

2. Pizzol D, Demurtas J, Stubbs B, Soysal P, Mason C, Isik AT, Solmi M, Smith L, Veronese N. Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Mens Health. 2019 Nov-Dec;13(6):1557988319892464.