Your Love Life After Menopause: 4 Things You Need to Know

Because knowledge is power.

Menopause leads to various changes, most notably, your period stops and you are no longer able to have children. But other bodily changes that take place during menopause can affect your love life. Menopause gets a bad rap when it comes to sex, but let us be the first to tell you: your love life can be awesome during this time (and some women even report that their sex life gets better).

A very common concern we hear from women entering menopause is: “Will I still want sex after menopause?” Quickly followed by “Will everything work the same?”

There’s been so much disinformation out there about this stage of life, and so many defeating messages thrown at women. No wonder we are discouraged and confused. It’s time to change that, with up-to-date research, and proactive steps any woman can take to continue advancing her sexual health. If you want sex in your fifties and beyond, don’t worry: with the correct hormonal insight, you can absolutely work with your body to have it.

Below are the four most common questions we hear about menopause and your sex life, and the latest science answering those questions.

Will my desire plummet after menopause?

OK, time for some real talk: it might. Jane E. Brody, writing for the New York Times, notes that some women experience reduced sexual desire, have difficulty getting aroused, and experience pain during intercourse due to vaginal dryness linked to menopause.

But, it doesn’t have to stay that way permanently. Proper pain management can lead to increased desire for sex and more intercourse. It’s worth noting that everyone’s life situation is unique — some women have had a hysterectomy by this age, for example. Other medical conditions like hypertension, diabetes, depression, cardiovascular disease, and even osteoarthritis can affect sexual functioning according to Endocrinology & Metabolism Clinics of North America. Medications can also interact with sexual health, so it is important to talk to your doctor. 

Hormonally-speaking, what typically tends to happen is this: your estrogen levels drop sharply at menopause, and your testosterone levels decline slowly and steadily with age. These are two of your most critical sex hormones, so this change can definitely affect your drive. While we tend to focus heavily on estrogen changes during menopause, it is important to note that testosterone is the hormone closely linked to libido. So check this out: according to Brody, “Testosterone levels in women decline by about 50 percent between the ages of 20 and 45, and the amount of testosterone produced continues to decline gradually as women age…For some women, the increased ratio of testosterone to estrogen that occurs after menopause gives their sex drive a boost.” (Our emphasis added.)

So a “plummet” isn’t inevitable. But for most women, lower levels of estrogen will have an affect on desire and arousability. This is why the key to a healthy sex life is hormone health, and to be more specific, hormone balance. Estrogen is always doing a delicate dance with your progesterone, so tackling estrogen or testosterone directly may not be best for everyone, if you’re trying to boost your sex drive. 

The research into hormone replacement therapy has been mixed. Research into whether estrogen replacement therapy and combined estrogen and progesterone therapy can improve libido and sexual arousal indicates that hormone replacement therapies are generally not effective (Endocrinology & Metabolism Clinics of North America). But researchers in several randomized double-blind placebo controlled studies (written about in Endocrinology & Metabolism Clinics of North America) found that testosterone treatment was able to improve sexual desire and sexual functioning in some post-menopausal women. And according to American Family Physician, if you’ve been diagnosed with atrophic vaginitis (characterized by thinner vaginal walls, decreased vaginal lubrication, and increased risk of urinary tract infections) estrogen replacement could be beneficial, but the dosage would need to be determined by your doctor. Every woman’s needs are different, and care should be taken because estrogen replacement carries a slight increased cancer risk.

When it comes to lowered libido, it is important to keep in mind that there are many causes for low libido, not just menopause. Improving communication with your partner, making time for sex, and symptoms of depression (or depression medication), or other psychological changes that come along with getting older might contribute to lowered libido. According to Medical News Today, menopause can bring about psychological changes including anxiety, irritability, fatigue, depression, and more. If you’re worried that menopause might impact your libido, keep this in mind. According to Self, some women experience higher sexual satisfaction after menopause (many women feel liberated by not having to worry about getting pregnant). 

Can I orgasm after menopause?

You sure can! It may take a little longer or require different physical stimulation, but don’t worry: your orgasm doesn’t suddenly disappear.

According to the Journal of Women’s Health, Issues and Care, the female orgasm isn’t connected to reproduction. The Healthy also reports that orgasm isn’t estrogen-dependent, meaning you can have low estrogen levels and still have an orgasm. This is good news because it means that orgasm shouldn’t be affected by menopause. Now, let’s talk shop. Orgasm involves the contraction and release of the pelvic muscles. The orgasmic experience can vary from individual to individual and even across orgasmic experiences. As we age our pelvic floor can weaken. Because orgasm is linked to the contraction and release of the pelvic muscles, improved muscle tone could potentially improve your orgasm. This is where kegel exercises could come in handy.  

The much-hyped “pink pill,” Addyi, was supposed to help women in this department, but according to the most recent research published in Healthline, when the FDA analysed three trials to test the effectiveness of Addyi, only about 10 percent of women experienced improvement in their sex lives. Another drug, called Vyleesi has been approved by the FDA. The response to Vyleesi was higher; 25% of women reported increases in sexual desire. But Vyleesi has some downsides. It needs to be taken by injection about 45 minutes before sex, and it can also lead to nausea, vomiting, and headaches, which can obviously interfere with sex.

If you’re finding orgasm harder to achieve, Addyi probably isn’t the best route. And, if you’re looking for a “female Viagra,” the unfortunate reality is that one simply does not exist. Viagra deals with the mechanical issues of erectile dysfunction, while female sexual dysfunction is often more complex.  

It’s worth looking at what factors could be contributing to decreased blood flow to your genitals: drugs to lower blood pressure, for instance can delay or prevent orgasm, while antidepressants — especially SSRIs — can also make orgasm tough to achieve.

But medication aside, some of the most helpful solutions for orgasm are easily accessible. Here are some ideas from Harvard Health Publishing — clinical trials have demonstrated that each of these may be helpful in stimulating arousal and orgasm:

Zestra. A massage oil that creates a sensation of warmth throughout the genital area, Zestra increased desire, arousal, and satisfaction in 70% of the women enrolled in clinical trials required for FDA approval. It is available over the counter for around $10.

Eros Clitoral Therapy Device. Eros increases genital blood flow by applying a gentle vacuum to the clitoris. In one clinical trial, 90% of women reported an increase in sensation, and 80% reported increased sexual satisfaction. Available only by prescription, it costs around $250.

Vibrators. There is no dearth of these devices, none of which requires FDA approval, so there aren’t a lot of studies demonstrating their effectiveness. In one of the few clinical trials—a 2016 study of 70 women who had difficulty becoming aroused or reaching orgasm—two-thirds of participants reported increased vaginal lubrication, orgasm, and genital sensation after using a vibrator for three months.”

Finally, keeping your pelvic floor strong can also help improve your orgasm. According to the Iranian Journal of Nursing and Midwifery Research, strong pelvic floor muscles can improve stimulation and orgasm. Kegel exercises can improve pelvic floor muscle strength which can lead to increased blood flow to these muscles, which also improves sensation. 

Can I still get pregnant after menopause?

We’ll keep this short and sweet: it’s possible, but not likely.

Menopause is defined by not having a period for 12 months straight, which means that during perimenopause — when your period is phasing out — ovulation can still occur. There are medical interventions currently being explored to help women conceive during perimenopause, too: in a 2018 study, where four menopausal study participants were injected with platelet rich plasma, all four produced an egg capable of being extracted for fertilization. And an older study examined the use of melatonin to restore menstruation in perimenopausal and menopausal women and the results were promising, though not conclusive.

This is all to say that without help, it’s pretty unlikely. But do be careful and use precaution at the first onset of menopause, if pregnancy is not your goal. If pregnancy is your goal and you are concerned you may be hitting menopause, options like I.V.F. may offer hope. 

Will my sexual organs change after menopause?

Lowered estrogen levels do contribute to a change in your vagina: notably, thinner walls, less elasticity, and more dryness. This is simply a sign, though, that your body is transitioning into no longer being fertile – not a sign that you have to stop sex altogether. According to Self, these changes can lead to pain during sex. Fortunately, there are treatment options available. 

How to treat these symptoms? Over the counter options like vaginal lubricants and moisturizers are available at your nearest drugstore; on the other end of the spectrum are laser treatments that restore lubrication and elasticity to the vaginal and vulvar tissues, like the Mona Lisa or FemiLift treatments. But keep in mind that diet and supplementation both play a significant role in your estrogen levels: we love the “dietary first aid” options Dr. Laurie Steelsmith discusses in this VitaCost article. Here’s what she says for estrogen:

“Certain foods can appreciably enhance your body’s natural ability to create friendly estrogen and reduce unfriendly estrogen. Cruciferous vegetables—such as broccoli, broccoli sprouts, and cauliflower—may increase your friendly estrogen metabolism, thanks to their high levels of indole-3-carbinol (a phytochemical that can enhance hormonal health). High cooking temps can destroy indole-3-carbinol, so be sure to eat them raw or lightly steamed. Other top options? Seaweed, seeds, sesame, flax, rosemary and salmon.”

Women who are concerned with dryness can apply a lubricant daily, just like they would a moisturizer, explains Everyday Health. Application of a moisturizer may be a good alternative for women who cannot use estrogen replacement therapies, and for those who may not want to use a lubricant right before sex.

Vaginal dryness is a mild symptom of menopause, but women often suffer in silence when they experience more serious symptoms. Pelvic organ prolapse, according to the U.S. Department of Health & Human Services is a more serious condition that can occur when the pelvic floor weakens, resulting in organs like the bladder, uterus, or rectum to press against the vagina or to fall out through the vagina. One in five women are affected by this condition, and while it can happen after childbirth in younger women, hormonal changes during menopause can increase a woman’s risk of pelvic organ prolapse. Harvard Health reports that in women over 50, about half of women experience pelvic organ prolapse, with menopause noted as a risk-factor. Treatment for pelvic organ prolapse can include performing pelvic floor exercises to strengthen the pelvic floor or surgery. 

When it comes to the physical symptoms of menopause, silence can delay treatment. According to Endocrinology & Metabolism Clinics of North America, only 7% of women suffering from vaginal dryness reported symptoms to their doctors. Harvard Health reported that many women are afraid to discuss the symptoms of pelvic organ prolapse with their doctors. This is unfortunate, because more severe vaginal dryness can often be treated with prescription estrogen creams, tablets, and rings. There is even an option for breast cancer survivors who can’t take estrogen, dehydroepiandrosterone (Intrarosa). Water-based and silicone lubricants can also help and are available over the counter. Everyday Health notes that oil-based products can cause yeast infections or other problems. Kegel exercises (pelvic floor exercises) may also help maintain pelvic muscle strength in the vagina, improve pelvic organ prolapse symptoms, and according to the Iranian Journal of Nursing and Midwifery Research, increase “sexual self-efficacy” (translation: better sex). 

Finally, according to the journal Menopause, unlike other symptoms of menopause like hot flashes, vaginal dryness, itching, and painful intercourse can increase with time.The good news is that for about half of women who report these concerns, symptoms can resolve on their own without the need for estrogen therapy.

The Bottom Line

When it comes to sex after menopause, every woman is different. But if you are experiencing symptoms of menopause, there are fortunately options out there, and sometimes small daily choices can make a huge difference. According to the U.S. Department of Health and Human Services, some easy things you can do to stay healthy and maintain a healthy sex life as you approach menopause include:

  • Getting and staying active
  • Get enough sleep
  • Quitting smoking and avoiding drugs and alcohol
  • Give yourself more time to get aroused during sex (it takes time), and make plans to have sex more often (when it comes to sex after menopause many experts tell women to “use it or lose it;” women who more regularly have sex or masturbate are less likely to develop symptoms of atrophic vaginitis)
  • Do your pelvic floor (Kegel exercises)
  • Use lubricants
  • Talk to your partner about what you like and don’t like and about concerns you might have.
  • Talk to your doctor or counselor if you are concerned about changes to your sex life due to menopause or due to emotional changes you may be experiencing (treatments may be available)

After menopause, your sex life might look different, but it doesn’t have to disappear. With a strategic approach, you can enjoy healthy sexuality well into this chapter of your life.

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