Menopause and perimenopause can really throw a wrench in your sex life. From a lower libido to vaginal dryness to even outright pain, intercourse can be a lot less fun. Add in the other potential symptoms of menopause, like hot flashes, mood changes, and bladder problems, and you’ve got the perfect storm. It’s not just that sex becomes less appealing or enjoyable, but also that you feel less desirable and your self-esteem drops.
Unfortunately, many women aren’t prepared for the multitude of side effects and symptoms that go along with perimenopause and menopause. Older generations don’t always feel comfortable sharing, and doctors don’t make time to talk about it. Fortunately, however, there are many effective ways to cope with the impact of menopause on intimacy. Here are some ways to manage common issues and keep your love life going strong at any life stage.
1. Medications and Supplements
During perimenopause and menopause, your body experiences major changes in hormone production. Your ovaries stop producing as much of the sex hormones estrogen and progesterone, which are responsible for many reproductive functions. As a result, your libido may lower, and the blood supply to your vagina may be reduced. You could experience less natural vaginal lubrication, have more difficulty orgasming, or not be able to orgasm at all.
The drop in hormones and lower blood supply can also cause vaginal tissue to become thinner and more fragile. The lack of estrogen can decrease the elasticity and flexibility of the vagina and urethra. Your pelvic floor muscles may get weaker, while hormonal changes can lead to an imbalance of healthy bacteria in the vagina and bladder. Not only can these cause pain during sex; they can also make you more vulnerable to bladder issues like incontinence and UTIs.
The standard treatment for all of these symptoms is usually some type of hormone replacement therapy. Hormonal (estrogen) creams, applied directly to the vagina, are most common, followed by oral hormone medications. There’s also growing interest in hormone pellets, which are implanted under the skin. Vaginal moisturizers like Via and Luvena can help with hydration, while drugs like Osphena can thicken vaginal tissue. If you’re having more frequent UTIs than usual, a UTI supplement may help you get ahead of them.
2. At-Home Care and Communication
Whether or not you seek medical treatment for the sexual impact of menopause, there’s also a lot you can do at home to make a difference. For instance, you may be able to improve some of your symptoms by improving your diet and lifestyle habits. You can also take steps to promote good vaginal health by improving your hygiene. For example, wearing cotton underwear and washing with only water could help prevent infections caused by changes in your vaginal microbiome.
During menopause, your body changes a lot, and different types of touch and connection may become more or less appealing. It may help to experiment with new routines, like sex toys, erotic books or videos, and sensual baths and massages. Talk openly with your partner, if you have one, about what you’d like to try and what might improve your levels of arousal. If you experience pain during penetrative sex, choose positions that let you control the depth, speed, and/or angle.
It may be helpful for some women to keep having sex (alone or with a partner) even if your libido is lower than usual. Regular sexual activity could help maintain vaginal elasticity and lubrication levels, and prevent more serious problems like clitoral atrophy. Devices like Eros, a clitoral vacuum, could help with lubrication, sensation, and sexual response. Cardiovascular exercise can also improve blood flow to the clitoris, preserving or restoring sensations.
3. Counseling and Mental Health Treatment
Sometimes, the physical changes associated with menopause aren’t the entire battle. In many women, hormonal and emotional changes can lead to a lower libido, self-esteem problems, or more. In the worst cases, mood changes associated with menopause can lead to depression and other serious mental health issues. They can cause low energy, irritability, difficulty concentrating, or even pervasive sadness.
Mental health changes can directly lower your libido, or else make it much more difficult for you to enjoy sex. You may have trouble focusing or staying present in the moment, or may get into more conflict with your partner than usual. An increase in anxiety could also cause you to feel a lot more stressed about problems that didn’t bother you as much before. In all cases, the end result is the same: even if your body is primed for sex, your mind just isn’t.
To cope with the psychological symptoms of perimenopause and menopause, you may wish to seek counseling or therapy. Modalities like cognitive behavioral therapy can help target stress, depression, anxiety, and other mental health issues. CBT can also help with sleep, if insomnia and other sleep problems are making it harder to enjoy an active sex life. In some cases, antidepressants or other medications might help resolve the mental health symptoms affecting your intimate life.
You Deserve an Enjoyable Sex Life
Despite extensive attention to maintaining and restoring male sexual function, female sexual function — as most other aspects of women’s health — remains under-researched. While options are improving, in this case, it often pays to do a little digging into your options. Remember, a healthy, active sex life is still achievable during menopause and for many decades beyond. You deserve to keep enjoying and exploring your body no matter your age or life stage.
