Menopause and Sex: Your Questions Answered

During perimenopause (the transition to menopause), your body reduces the amount of estrogen (a sex hormone) it produces. This can affect your mood, your body and your sex drive.

And while this process is entirely natural (an estimated 47 million women reach menopause each year!), it can be hard to know why things are changing and what is, or isn’t ‘normal’.

Let’s look at some of the most frequently asked questions about menopause and sex.

What happened to my sex drive?

Research shows that around 50% of women report low sexual desire during menopause.

This is largely due to the hormone changes you’re experiencing. As your body reduces the amount of estrogen (a sex hormone) it produces, your libido may also reduce.

But there are other factors at play. Women’s sex drive is not ruled by hormones alone. Our mood, body image, and sense of well-being can all influence our desire for sex.

Body image

Body image plays an important role in sexual desire and feelings of desirability.

For many women, perimenopause is a time when even the most confident of us can have our positive body image challenged. You may experience weight gain, a ‘thickening’ around the abdomen, an increase in facial hair and even thinning hair.

One small 2019 study found that women’s perception of their body changes had an impact on their sexual satisfaction. Women who felt self-conscious about their changing body reported poor sexual satisfaction, while women who had greater self-acceptance reported better sexual satisfaction.
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‍Hot flashes

Nothing says, ‘Don’t touch me!’ quite like the sudden onset of a hot flash. Around 80% of women experience hot flashes during menopause. For many women, they can be so intense, or frequent, that even the thought of intimacy becomes unpleasant.

They may also reduce the opportunity for sex. Women who experience hot flashes while they sleep (night sweats), may find themselves wanting to sleep in separate rooms. This may be because their partner’s extra body heat is enough to trigger a hot flash, or because they prefer a cooler room temperature to sleep in. Others may not want to disturb their partner as they throw blankets and sheets off and on through the night.

One important thing to keep in mind is that making your bedroom very cold, or spraying yourself with a cooling mist, won’t help you stop night sweats. The good news is there are other ways to reduce hot flashes through the night and improve your sleep.
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‍Fatigue

Beyond the physical discomfort from heat and sweat, hot flashes can also impact the quality of your sleep. A lack of sleep can lead to fatigue, and feelings of fatigue can have been shown to have a negative impact on libido.

For some women, the perimenopause years are some of the busiest of their life; they are time poor, juggling work, adolescent children, and concerns about ageing parents. There is very little ‘free’ time to rest, relax and recharge. Even if the fatigue from these competing responsibilities doesn’t impact their libido, the stress of juggling these priorities can still take its toll.
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‍Mood

Which brings us to mood. As we know, mood can be the great spark, or the great fizz, of a romantic moment.

Fluctuating hormones can also mean fluctuating mood. Remember mood swings during puberty? It’s the same process. Your body is adjusting to new hormone levels and that can make you feel anxious, sad, angry, and happy. Sometimes all within minutes.

Mood changes can also be compounded by all the other changes we’ve just mentioned⸺poor body image, bothersome hot sweats, and of course, fatigue.

While mood swings are a common symptom of menopause, women who have experienced depression or anxiety in the past are more likely to be affected, so it’s important to talk to your healthcare practitioner⸺there will be steps you can take to feel better.

What is going on with my vagina?

Shifting levels of estrogen during perimenopause can also produce changes to your vagina, and your vulva.

The vulva is your external genitals, and is made up of your clitoris, the opening to your vagina, the opening of the urethra and the labia. The labia are the folds of skin that you have outside your vaigina. It acts as a protective covering for your vaginal opening and has two parts: the outside layer (labia majora) and the inside layer (labia minora). The labia majora may start to lose its fatty padding during perimenopause and start to thin. At the same time, the labia minora may also thin, leaving the opening of the vagina, as well as the clitoris, more exposed to chafing and irritation.

The vagina refers to the internal canal, where penetration can happen during sex. Before menopause your vagina is elastic, with many folds, in order to stretch during sex and child birth. As your estrogen declines, the walls become thinner, less elastic, and drier.

This is known as Genitourinary Syndrome of Menopause (GSM) or vulvovagina atrophy. And while it is thought that 50 to 70% of post-menopausal women experience some level of GSM symptoms, it is also thought to be seriously underreported and underdiagnosed.

Topical hormone creams can help reduce feelings of dryness and discomfort, as can personal lubricants. It’s also important to have regular pap smears and check ups to ensure there are no other causes of your vaginal symptoms. It’s entirely normal to talk to a GP or OBGYN about these symptoms⸺this is what they’re here for!
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Why is sex during menopause hurting?

Up to 45% of women experience dysapareunia (painful sex) during menopause.

One cause of pain is small tears in the vagina, caused by a combination of thinning vaginal walls and a lack of lubrication. Pre-menopause, the Bartholin glands that are positioned in the labia minora produce lubrication when you are aroused, but once again, as your estrogen levels change, these glands produce less of these secretions.

While good lubrication is important at any stage of your sex life, it is even more important during and post-menopause as thinner, less elastic vaginal walls are more susceptible to injury, tearing and bleeding.

Thankfully, there are things you can do to improve vaginal comfort and lubrication:

Hormone creams

Topical estrogen creams, or vaginal rings containing estrogen can help improve overall lubrication.‍

Personal lubricants

‍Vaginal moisturizers can help relieve dryness sensations of GSM by trapping moisture in the vaginal tissues. These aren’t appropriate for sexual use.‍

Water-based lubricants

‍Water-based lubricants are safe to use during sex and with condoms. Make sure you lubricate both yourself, your partner and any sex toys.

‍Silicone-based lubricants

As with water-based lubricants, silicone-based lubricants are safe to use during sex and with condoms. The only downside is they may stain sheets, so consider laying down a towel.

Lubricants to avoid include any that contain petroleum jelly, or things you may find at home such as olive oil or body moisturizers, as these can increase the risk of infection.

If you are lubricating generously and still finding sex is painful, make sure you talk to your healthcare practitioner, as there may be another cause, such as a shortening of the vaginal canal associated with GSM.

Does sex help menopause?

A little known fact is that having more sex may actually help alleviate some of the vaginal symptoms, and even delay the start of menopause.  A ten year study found that women who had sex, at least once a week were 28% less likely to experience menopause symptoms than women who had sex less than monthly.

One school of thought that is regular penetrative sex, or even masturbation with penetration can help keep your vagina feel good for longer through increased blood flow, and toning of vaginal walls.

There are also a number of other health benefits to having regular sex that may have a flow on affect to reducing bothersome menopause symptoms such as hot flashes.

Regular sex has been shown to:

• Improve heart health
• Lower blood pressure
• Reduce anxiety
• Improve sleep

Do I still need to use birth control?

Yes! While pregnancy is less common during perimenopause, it is not impossible. Birth control is recommended until you have ceased your periods for at least 12 months. Even if you have not had a period for a few months, it is still possible to fall pregnant.

The 2018 National Vital Statistics Report showed that in the US, there were 959 births to women aged 50 and over, and 0.9 births per 1,000 women aged 45 to 49.

When considering birth control during perimenopause It’s important to consider which is most appropriate for you (and your doctor can help with this decision). While some hormonal oral contraceptives can provide additional benefits such as more regular periods, they come with an increased risk of blood clots and heart disease for women over 40. They may also mask signs of menopause and may result in menstrual-style bleeding after menopause.

Other options may include:

• Condoms
• Diaphragm plus spermicide
• Intrauterine devices (IUDs)
• Vasectomy (for men)

Irregular periods during perimenopause can make it difficult to know when you are ovulating, for that reason the rhythm method, otherwise known as natural family planning, isn’t recommended.

How can I make sex better during menopause?

Making sex more enjoyable during menopause is a team effort. Your body may respond differently to how it used to, and it’s important to communicate these changes to your partner.

Getting the mood right

If you are experiencing hot flashes, make sure your room is at a consistent, mild temperature. Too hot or too cold may trigger sweating of the non-sexual kind.

Take your time

It may be that you need more time to feel aroused, this is a great excuse to extend foreplay and have some non-penetrative fun.

Lubricate!

As we’ve already discussed, lubrication for you and your partner is vital for ensuring your pleasure.

Find your place

‍Positions you once loved may not be comfortable for you now, especially if you’re experiencing symptoms of GSM, or prolapse. You may find it’s more comfortable for you to be on top, controlling depth and pace.

Exercise your vagina

The more active your vagina is, the stronger it will feel, the better your orgasms, and the more comfortable sex will be. ‘Exercising’ your vagina doesn’t just mean sex with a partner. You can strengthen your vaginal walls with daily Kegel exercise or using a vibrator (with lubrication!) several times a week to encourage blood flow in and around the vagina.

And while penetration is one form of sex, if that doesn’t feel right for you, there are many other ways to share intimacy with your partner, such as oral sex, massage, or using a clitoral vibrator.

Manage your symptoms

Many symptoms of menopause, such as GSM, mood swings, and hot flashes can be managed with hormone replacement therapy, and natural remedies such as hypnotherapy.

What’s sex like after menopause?

If sex isn’t a great experience for you right now, fear not; research suggests that sexual satisfaction in women increases with age. The majority of women in a 2012 study into post/menopausal health (aged around 67 years old) stated that they could achieve orgasm most of the time or always.

For some women, menopause can see a renewal in their sex drive without the fear of pregnancy. The postmenopause time of life can also see a change in life pressures and a renewed focus on intimate relationships. Children may now be grown and out of home, work pressures may be reduced, and more time for self-care can all contribute to a re-energized sex life.

The Wrap Up

The relationship between menopause and sex, can feel complicated. Sexual desires, and sexual experiences, can all be affected by changing hormones. Lowering estrogen levels can affect mood, physical appearance, vaginal health, and sex drive. Fortunately there are things that can improve libido and make sex pleasurable including: hormone creams, lubrication and open communication with your partner and your doctor.