As your body approaches menopause, you step into an unfamiliar realm of physical and emotional changes that impact everything—from your health and hormones to your menstrual cycle and sex life.
Before we go any further, let's first explore the definition of menopause.
According to the National Institute on Aging, menopause is defined as the point in time when you have not had your menstrual period for 12 months in a row .
Because your hormone levels shift as you get closer to menopause, you may notice that your sexual experiences and sex drive also undergo various changes.
In this article, we'll look at how your sex life and libido may alter during perimenopause (the years leading up the menopause) and menopause. We'll also explore how you can improve your sexual wellness after menopause.
How Does Menopause Affect Libido?
Not every menopausal or perimenopausal person will experience a reduced sex drive. However, studies have shown that the prevalence of low libido is significantly higher in post-menopausal people than in people who have not yet undergone menopause .
So if you've noticed a lower sex drive upon reaching menopause, remember that you are not alone. It is a common complaint from people approaching menopause.
Some research suggests that changes in hormone levels may contribute to decreased sexual libido. During this time, the levels of estrogen, a sex hormone, begin to fluctuate before plummeting, which may lead to changes in your libido and your ability to become sexually aroused .
Physical changes to your body may also impact your sexual enjoyment and experience, so your sexual desire may take a hit. We'll explore them in the section below.
How Can Menopause Affect Your Sex Life?
Perimenopause and menopause are associated with a rise in sexual problems. This may be due to several possible reasons, such as the following:
Lower sexual satisfaction
Menopause may be linked to a lower sexual response, problems with orgasm, and a reduction in the sensitivity of the genitals. Some research suggests that dropping estrogen levels in the body may contribute to this .
Apart from that, the changes your body and mind undergo during perimenopause may also impact your ability to have pleasurable sex.
Physical symptoms of menopause
As you journey toward menopause, you may begin experiencing symptoms such as hot flashes, night sweats, and loss of bladder control (incontinence). All these symptoms may diminish your quality of life and directly or indirectly affect your sex life .
Nonetheless, not all people will experience these symptoms. And those who do may not necessarily find them troublesome enough to affect their quality of life or sexual enjoyment .
Mood and mental health-related symptoms in menopause
Irritability, mood swings, and sleep disturbances are common as a person approach menopause. Plus, as you enter this stage of life, your risk of mental health conditions, such as anxiety and depression, may also increase. This can affect how much you crave and enjoy sex .
Some people may also experience lower self-esteem and decreased confidence, which could impact their desire to have sex .
Discomfort and pain during sex
Vaginal dryness and soreness around the time of menopause are considerably common. Some people may also notice their vaginal muscles tightening when sexual penetration is attempted—a condition known as vaginismus. Due to all these reasons, sex can feel very uncomfortable and, at times, even painful .
The drop in estrogen levels is yet again believed to be the culprit responsible for causing vaginal dryness and soreness .
That's simply because this hormone plays a role in maintaining the collagen, elasticity, function, and structure of the genital tract. On top of that, estrogen also regulates the pH and moisture levels of the vagina, keeping your vaginal tissues well-protected and lubricated .
Hence, a long-term drop in estrogen levels in menopause can change the structure and function and reduce blood flow to your genital tract. This leads to symptoms of vaginal dryness and painful sex after menopause .
How To Improve Your Sex Life After Menopause
It is perfectly normal to be concerned about how your sex life will change after menopause. Perhaps, you may be wondering how to deal with these problems as you approach this unfamiliar stage of life.
Fortunately, most of the problems related to sex after menopause can be effectively managed with simple lifestyle changes or treatment. So, rest assured that good and enjoyable sex is still very achievable, even as you step into menopause!
The following sections will explore how you can enhance your sexual health after menopause.
How to increase sex drive after menopause
Hormone replacement therapy (HRT) may help to relieve symptoms of menopause, such as hot flashes and night sweats. If these symptoms are troublesome enough that they decrease your desire to have sex, improving these symptoms may, in turn, give your sex drive a boost .
Apart from that, research has also looked into the possible role of androgens, which are sex hormones, during menopause. The short-term use of testosterone patches together with oral estrogen therapy to improve sexual desire and arousal is still being investigated .
Your doctor will be able to determine if any of these hormonal treatments are suitable and safe for your case. Alternatively, they may recommend non-drug interventions, such as counselling, sex therapy, or couple therapy. These therapies may help you explore the root causes and barriers that hinder you from desiring and having sex .
You may ask your health professional for advice on how to stay healthy. They may be able to recommend modifications and changes to your diet, exercise, or lifestyle suitable for this stage of life.
How can I treat vaginal dryness due to menopause?
There are various ways to tackle vaginal dryness from menopause, such as the following:
- Vaginal lubricants: Vaginal lubricants and moisturisers are usually the first-choice treatment option for vaginal dryness. You may opt for a water-soluble lubricant such as KY Jelly. Keep in mind that you can still get pregnant in the years leading up to menopause, so an oil-based lubricant may not be suitable if you rely on condoms for birth control .
Oil in the lubricant can damage latex - the material that condoms are made out of. Thus, it increases the chances of a condom breaking.
- Vaginal moisturiser: Moisturisers help to retain water, which is then released into your vagina, resulting in enhanced hydration. This also helps to mimic vaginal secretions and provides quick relief for dryness. Their effects may last around 2-3 days, longer than vaginal lubricants .
- Vaginal estrogen therapy: This hormonal therapy may bring about various benefits—from improving vaginal dryness and reducing pain during sex to restoring optimal vaginal pH and maintaining the healthy balance of microorganisms in your vagina .
- Ospemifene: This oral medication is taken once a day. Ospemifene may be recommended if vaginal estrogen therapy isn't suitable for your case. Research suggests that it can effectively combat vaginal dryness and help with pain during sex .
While it is possible for this medication to lead to an increase in hot flashes (which is the most common side effect), ospemifene is generally well-tolerated.
However, this medication should not be used by people who have an undiagnosed case of uterine bleeding. Moreover, it’s also contraindicated in people who have an estrogen-dependent neoplasia (tumour), which includes breast cancer as well.
Do I still have to worry about STDs during menopause?
Yes, it is important to practice the necessary measures to prevent the transmission of sexually transmitted diseases (STDs), even if you're in the perimenopause or menopause stage of life.
Some people may not prioritise the use of condoms with sex as the likelihood of getting pregnant is extremely low after menopause. However, you can still get an STD as long as you are sexually active.
Here are some ways to keep yourself safe and reduce your risk of an STD infection:
- Use a condom when having sex.
- Get yourself screened or checked for STDs occasionally, even if you do not have any symptoms. Not all individuals with an STD will experience symptoms from the infection.
- If possible, request that your potential sex partner gets an STD check.
- Limit your number of partners or practice monogamy (a relationship where both you and your partner exclusively have sex with each other and no one else). Of course, this may not be suitable or preferable in every case. It is also important to remember that this method may reduce the risk of transmission but does not completely eliminate that risk.
When to See a Doctor for Menopause-Related Sexual Problems
If changes to your sex life are beginning to affect your mental health or your relationship with your partner, seeking a safe space to discuss your concerns with a trusted healthcare professional is the best step to take.
You may also wish to get the following symptoms checked out, especially if they are causing you distress :
- Pain while having sex
- Problems with lubrication, arousal, or orgasm
- Lack of interest or desire for sex
- Involuntary or painful contractions of the vaginal muscles when penetration is attempted (vaginismus)
Depending on your symptoms, your doctor may recommend therapy, counselling, or medications.
Speaking to a doctor about sexual issues can feel embarrassing or scary, but getting appropriate treatment can help enhance your sex life, relationship, and mental well-being.
- What Is Menopause? (n.d.). National Institute on Aging. Retrieved 22 October 2022, from https://www.nia.nih.gov/health/what-menopause
- West, S. L. (2008, July 14). Prevalence of Low Sexual Desire and Hypoactive Sexual Desire Disorder in a Nationally Representative Sample of US Women. Archives of Internal Medicine, 168(13), 1441. https://doi.org/10.1001/archinte.168.13.1441
- Shifren, J. L. (2022, October). Patient education: Sexual problems in females (Beyond the Basics). Up to Date. Retrieved 23 October 2022, from https://www.uptodate.com/contents/sexual-problems-in-females-beyond-the-basics
- Nazarpour, S., Simbar, M., & Tehrani, F. R. (2016b, August). Factors affecting sexual function in menopause: A review article. Taiwanese Journal of Obstetrics and Gynecology, 55(4), 480–487. https://doi.org/10.1016/j.tjog.2016.06.001
- Eden, K. J., & Wylie, K. R. (2009, July). Quality of Sexual Life and Menopause. Women’s Health, 5(4), 385–396. https://doi.org/10.2217/whe.09.24
- Hope, M. E., Farmer, L., McAllister, K. F., & Cumming, G. P. (2010). Vaginismus in peri- and postmenopausal women: a pragmatic approach for general practitioners and gynaecologists. Menopause international, 16(2), 68–73. https://doi.org/10.1258/mi.2010.010016
- Scavello, I., Maseroli, E., Di Stasi, V., & Vignozzi, L. (2019). Sexual Health in Menopause. Medicina (Kaunas, Lithuania), 55(9), 559. https://doi.org/10.3390/medicina55090559