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Menopause means your periods are over, but it definitely doesn’t mean your sex life is. Sure, the hormonal changes plus the fact that menopause is a life stage full of external shifts bring on a range of changes that may make sex…well, challenging. But here’s the thing: Your sex life might be different than it used to be, but if it’s something you want, it can still be fun, hot and charged up.
The first step? Learning a bit more about the female libido and some of the forces that affect it as women age.
Your Sex Drive After Menopause
Libido is defined most simply as physical sexual desire, the signs of which are physical changes like increased blood flow to your genitals, your breasts swelling and your heart rate and breathing speeding up. Many factors stemming from menopausal changes affect your libido. “In perimenopause, estrogen and other hormones are erratic from day to day,” says Julia Edelman, MD, FACOG, NCMP, a board certified gynecologist and certified menopause clinician in greater Boston and the author of Menopause Matters: Your Guide to a Long and Healthy Life. “There is often no predictable pattern. When estrogen is high, your sex drive may be enhanced, and when it’s low, your sex drive may be dampened.”
And there is a wide range of “normal” when it comes to your own baseline level of desire. Throughout their lives, some women are happiest with frequent sex, while others are just as happy with occasional lovemaking. Whatever was it for you before menopause, experts advise not putting pressure on yourself. Your sex life doesn’t have to be like anyone’s else’s, or like it was years ago. But if you’re not happy with your sex life or your libido given the changes that come with age, there are definitely things you can do to improve it, says Dr. Edelman.
Consider Your Hormones
Menopause (which is defined as having had no periods for a year) means a lower level of estrogen, and this can affect libido. And not only that, but according to data from Johns Hopkins Medicine, lower levels of estrogen can also make it harder for you to have an orgasm.
There are treatments that can help. Options include:
- Hormone therapy. This is an effective, FDA-approved treatment for many symptoms of menopause, consisting of either estrogen-only therapy or estrogen plus progestogen. Though HT hasn’t been proven to specifically increase libido, it can help with pain during sex (more on that below), so it may help you feel more into it. You and your doctor can discuss if HT is right for you, given your health history. Generally, HT is used for three to five years, according to the North American Menopause Society.
- Other forms of prescription estrogen, such as a topical estrogen cream, or a ring or suppository. If your vaginal tissue is dry and this is affecting your desire because of lack of sensation (or pain — see below), these can help ease that symptom.
- Supplemental testosterone might be an option, though it’s important to discuss this with your physician. A study by Australian researchers found that it may be helpful in increasing libido for some postmenopausal women, but there are some potential downsides and that more research on the topic is needed.
Don’t Suffer Through Painful Sex
During menopause, intercourse can get a whole lot less fun, due to sensations that may range from sandpapery discomfort to knife-like pain. Know that you don’t have to just muscle through pain — and that you’ve got company. The North American Menopause Society reports that 17% to 45% of postmenopausal women find sex painful. This comes back to hormones: when estrogen levels crash, vaginal tissue thins out and gets drier. Fortunately, there are treatments for this as well, says Lauren Streicher, M.D., the medical director of the Northwestern Medicine Center for Menopause.
First of all, prescription estrogen in any form can help; it builds up and strengthens vaginal tissue, says Dr. Streicher. Then: Consider lube, lube, and more lube. If you’ve never used a lubricant, don’t be shy or feel weird about it — you can find options in any pharmacy or online. A water- or silicone-based lubricant will make penetration and intercourse easier.
Vaginal moisturizers, like Replens, can really help, too — they’re different from lubricants in that they encourage the vaginal cells to draw water in, rather than simply make the vaginal canal more slippery, says Dr. Streicher.
Other advice from Harvard Medical School includes:
- Keep up with Kegels. If you’ve never done them: Tighten the muscles you would use if you were trying to stop urine, hold for two or three seconds, then release. Do this 10 times, five sets a day. This helps strengthen the pelvic floor, as well as encourages circulation to the area, which can help with arousal, according to Memorial Sloan Kettering.
- Communicate. Tell your partner if your libido is lower, or if sex hurts. Talk over solutions together, and brainstorm ways that you can both get what you want and need, without anyone hurting.
- Consider changing up your usual menu of sexual options — like, less focus on intercourse. Some thrusting might be fine, but maybe not prolonged thrusting, for example. Stroking and touching can be a great alternative. All in all, it’s a good time to experiment with other things — who knows, you may discover some new go-to activities.
Take Care of Yourself
Changing hormones can have an impact on your mental health, too — you could find yourself experiencing mood swings, or more serious depression. Maybe you look in the mirror and don’t recognize your body if you’ve put on some weight.
Focus on these points to feel better:
- Get real about how much sleep you’re getting. “Over decades of caring for women in menopause, I never met a woman with a good sex drive who sleeps poorly, gets too little sleep, or wakes up tired,” says Dr. Edelman. If you’re too freakin’ tired to want sex, you’re more likely to experience pain or discomfort, since you won’t be fully aroused. Make a plan to cut off caffeine at noon – it really helps. Also, consider melatonin — an analysis by a group of international researchers found that taking 3mm before bedtime can help women in menopause sleep more soundly.
- Seek professional help if you feel depressed. Don’t hesitate to look into therapy and treatment. Our guide can help you find the best therapist for you.
- Talk to your partner about what you need. Expressing your feelings about what’s hard for you at this time of your life can bring you closer, and help the other person understand what you’re going through.
- Know you’re beautiful inside and out. Your body is always changing, and this is just the latest round of that. But you can still be kind to it – work on appreciating your body now and always.
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Recapture the Fun
Adding some toys to up the spice and excitement – this can be great for your sex life during menopause. You can try using a vibrator, if you haven’t already: In a 2020 study, 488 women used vibrators both with their male partners and alone and reported greater sexual satisfaction overall than women who just used a vibrator solo.
The Bottom Line:
It’s so important to be real about how you feel, and to be good to yourself during this time in your life. Resilience is always a smart skill, and it’s especially helpful now — the ability to adjust to the changes menopause brings to your life can make you feel better about yourself overall, and that has a positive effect on your sex life. “This capability enables women to adapt to change, resist the negative effect of stressors, and return to normal function more quickly after adverse events,” says Stephanie Faubion, MD, MBA, internist at the Mayo Clinic in Jacksonville, Florida and medical director of the North American Menopause Society.
Also, remember the positive things about sex during menopause! No more period-stained sheets, no more pregnancy concerns, hopefully no more toddlers interrupting you…sounds pretty good, right? Enjoy the new freedom this time brings — you deserve it.
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