Navigating sex after menopause

While some women will go through menopause with little more than slight inconvenience, others will find themselves with the “classic” menopausal symptoms. Think hot flashes, night sweats and more. But what about sex after menopause?

In addition to ending your menstrual cycle and signaling the end of your childbearing years, menopause can come with some heavy stigmas, particularly about how it impacts your sex life. While some side effects may disrupt your sex life, it’s possible to have safe, pleasurable sex no matter your age. It’s all about learning to adapt to your changing body.

“Many women have preserved sexual function after menopause with robust sex lives,” says Dr. Corinne Yarbrough, an internal medicine doctor with Sharp Rees-Stealy Medical Group.

Understanding menopause and its effects

Menopause typically occurs between the ages of 45 and 55, marking the end of a woman's reproductive years. The body undergoes significant hormonal changes, primarily a decrease in estrogen and progesterone production.

Your estrogen takes a nosedive during menopause — defined as when you haven’t had a menstrual cycle in 12 months — and the years leading up to it, called perimenopause. “During menopause, the ovaries shut down, producing little to no estrogen. As a result, ovulation stops and monthly bleeding stops as well,” Dr. Yarbrough explains.

These hormonal shifts can lead to various physical and emotional symptoms, such as hot flashes, mood swings and sleep disturbances. It can also have a big impact on sexual function. 

The impact on sexual health

The hormonal fluctuations that accompany menopause can affect a woman's sexual function. Here are some common sexual issues women may experience during and after menopause:

• Vaginal dryness: Reduced estrogen levels can result in a thinner and less lubricated vaginal lining. “The body's ability to make lubrication naturally declines, which can lead to discomfort and pain during sexual intercourse,” Dr. Yarbrough says.
  

• Decreased libido: Loss of sex drive can be caused by a number of different things. Changes in hormone levels can affect a woman's desire for sex, leading to a decrease in sexual desire or arousal. If sex is painful, this can also lower sex drive. Additionally, hot flashes and night sweats can frequently disrupt sleep, and poor sleep can impact libido.
  

• Painful intercourse: Vaginal dryness and thinning of the vaginal tissues can make intercourse painful or uncomfortable. “When the body withdraws from estrogen, the vaginal walls and the vulva atrophy, or shrink,” Dr. Yarbrough says.
  

• Changes in orgasm: Some women may experience changes in the intensity or frequency of orgasms.

Keeping the heat after the hot flashes

While menopause can bring challenges to your sex life, it shouldn’t signal the end of having safe, enjoyable sex. “When a woman has loss of sexual function with menopause, the first thing to look at is why,” Dr. Yarbrough says.

If the issue has to do with pain, oftentimes from poor lubrication or atrophy, there are a few options that can help. Over-the-counter vaginal lubricants can supplement natural lubrication during sex. “There are good water-based lubricants, and coconut oil may also work for you,” Dr. Yarbrough suggests.

Vaginal moisturizers can also help. These products are different from lubricants because instead of sitting on the skin’s surface, they are absorbed by the skin, which can help with moisture loss.

If lubricants and moisturizers aren’t enough, prescription vaginal estrogen therapy can provide relief. Vaginal estrogen used a couple times per week is safe and effective, Dr. Yarbrough says. Unlike oral hormone therapy, it does not increase risk of breast cancer or uterine cancer.

When it comes to decreased libido, it’s important to address factors that may be causing it. If night sweats or mood swings are impacting your sex drive, there are treatments that can help. There are also medications available that can treat low sexual desire.

“The answer isn't one size fits all,” Dr. Yarbrough says. “Each situation is a little bit different, so the approach to treatment needs to be tailored to the individual.”

Menopause and beyond

Loss of libido, vaginal dryness and uncomfortable sex does not have to be a given when it comes to aging. It’s possible to continue having a healthy and fulfilling sex life during and after menopause. 

Remember that every woman's experience is unique, and it's essential to prioritize your physical and emotional well-being during this transition. It’s also important to recognize that a woman who loses sexual function or interest in sex is under no obligation to receive treatment.

If you are concerned about how menopause is affecting your sexual health, talk with your doctor about treatment options.

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