Let's Talk About Sex After Menopause

Most women go through two major hormonal shifts in their life: puberty and menopause. And while everyone from school health classes to movies to books talk about the changes that happen during puberty, menopause isn’t really discussed as much. Something that’s talked about even less? Sex after menopause. “We were all born in 1950,” Joan, 70, says. “This is not something that people talk about. I mean, more than we used to, certainly. But not much.” But before we dive into what you can expect about post-menopausal sex — and what you can do about it — let’s do a quick definition of terms. First, many people say “menopause” or “going through menopause” when they actually mean “perimenopause.” Menopause isn’t a process, but a fixed point: It’s when a woman’s period has officially stopped, forever. Perimenopause, on the other hand, is the the transition from being fertile to no longer being fertile. It’s the period of time where your period gets irregular and you might experience mood swings, hot flashes, and other side effects of estrogen and testosterone dropping as your body gets ready for a new phase of life. Menopause also comes with other physical changes that can alter people’s sexual function, says Dr. Serena McKenzie, sexual medicine specialist and medical advisor to Rory, the digital health clinic for women. “It is important to know that vaginal dryness, pain with intercourse, or lowered libido can be symptoms of menopause, and easily fixed if you make it a priority to establish care with a menopause medical provider,” Dr. McKenzie says. “Women also commonly experience emotional changes with menopause such as depression or anxiety that can impair intimacy and enjoyment of life,” so “it is important to seek talk therapy, make healthy lifestyle changes, and see a medical provider to address mood problems as well.”

“Open communication about how our body, emotions and sexual preferences may evolve with menopause is critical to a satisfying intimate relationship."

For my mom, one unexpected side effect of perimenopause was that, after a life of being a sexual person, she just wasn’t anymore. “I really lost my libido during it,” she says. “And I kind of knew that could happen, but I didn’t really think it would happen to me. Sex became somewhat distasteful. All of a sudden I just feel like, ‘Ugh, animals do this.’” Dr. Leslie Meserve, Chief Medical Officer and co-founder of CurieMD, a telehealth platform for menopausal women, says that loss of libido isn’t uncommon for people going through perimenopause. “A lot of women are taught that intimacy and sexual desire withers away in midlife,” Dr. Meserve says. “While low libido is a common side effect of perimenopause and menopause, it is manageable.” So how do you manage it? Let’s take a look at some expert tips about sex during perimenopause and after menopause.

Learn the difference between vaginal moisturizers and vaginal lubricants

You’ve probably heard of lube, but are you familiar with vaginal moisturizers? Yup, you heard that right: Just as the skin on your face loses elasticity, so does the skin on your vulva. And regularly applying a vaginal moisturizer can make all the difference when it comes to comfort. ““For women who have decreased sexual desire because of pain during intercourse, one solution is vaginal moisturizers, which help restore the loss of moisture and keep vaginal pH levels low—leading to a healthy vaginal lining and elasticity of tissues,” Dr. Meserve says. For a moisturizer to be effective, “repetition is key”— they should be used at least two to three times per week. “Vaginal lubricants can also be used at the time of sexual activity by applying to the vaginal opening and to the partner,” Dr. Meserve says. “This reduces friction during penetration and can decrease pain and discomfort.”

Keep communication open

Whether it’s a loss of libido, a “distaste” for sex acts that you used to like, or just a need for a bit more lube, it’s important to communicate with your partner about what’s going on. Talking about sex is really difficult for a lot of people, but it can be much more painful to suffer through sex that you hate—or that literally hurts you. “Talk to your partner about what works for you when it comes to intimacy,” Dr. Meserve says. “Your partner isn’t a mindreader, so it’s important to have open discussions about the actions that bring you pleasure.” And just as your sexual needs and desires change over time, so too do your partner’s. So be open to up what they might be going through as well. “Open communication about how our body, emotions and sexual preferences may evolve with menopause is critical to a satisfying intimate relationship,” Dr. McKenzie says. “I recommend couples both make intentional efforts to say small things often throughout daily life to stay connected, as well as prioritize bigger chunks of time for one-on-one time together outside busy life schedules to reconnect and build new habits for intimacy that best fit midlife changes.”

Consider hormone therapy

Because a big part of perimenopause and menopause is a drop in both estrogen and testosterone—the two main “sex hormones”—hormone therapy can really help even out some of the sexual issues people experience during this time. “Hormone Therapy (HT) can help restore estrogen levels to roughly 10 to 25 percent of what they once were,” Dr. Meserve says. “While estrogen will never return to 100 percent, this bump can have amazing stabilizing effects.” And hormone therapy isn’t just a pill. For sexual benefits, it can be applied right to the vulva and vagina. “Transdermal or vaginal estrogen helps increase vaginal lubrication, blood flow, and sensation and arousal,” Dr. Meserve says. “The veins, arteries, and nerves in the pelvic area all have estrogen receptors and many women experience the benefits within weeks.”

Practice safer sex

Some people go through menopause without a monogamous partner or maybe a long-term relationship ends after menopause. For those people, Dr. Meserve says: Don’t forget the condoms. “Even though you can no longer get pregnant, you can still contract sexually transmitted infections,” Dr. Meserve says. “Use barrier methods, such as condoms, until you and your partner have been screened for HIV, Hepatitis C, chlamydia and gonorrhea. I always tell my patients they can make things interesting and have a romantic dinner where they exchange their blood tests and share STI status.” Finally, if you’re in the throes of perimenopause and having a really rough time, remember: It will end. And your sex life, if you work at it, might even end up better than before. “Sex between still keeps growing and changing,” Joan says. “As part of our relationship, I think we’re better at communicating and I’m better at communicating sexual things.” And better communication, we all know, almost always lead to better sex.