Sex after menopause: keeping the heat after the hot flashes

Mood changes, hot flashes, and weight gain may be reminiscent of your teen years, but for women in their late 40s and early 50s, it’s not puberty that comes to mind — it’s menopause.

In addition to ending your menstrual cycle and signaling the end of your childbearing years, menopause can come with some heavy stigmas, particularly about how it impacts your sex life. The truth is that while some side effects may disrupt your previously successful sex life, there are ways to have safe, pleasurable sex no matter your age. It’s all about learning to adapt to your changing body.

Read on for a complete guide to navigating sex after menopause.

Table of Contents

How menopause impacts hormones

Menopause consists of before, during, and after stages, otherwise known as perimenopause (before), menopause, and postmenopause (after). There are a number of hormonal changes that women will experience both peri- and postmenopause, though symptoms may vary from person to person.

Perimenopause

Perimenopause is the menopausal transition when your ovaries make less of the estrogen hormone. It can begin anywhere from four to eight years before experiencing a final menstrual cycle, first beginning with changes in lengths of time between cycles, and ending one year after having a final period.

Estrogen production drops slowly throughout perimenopause. This drop in estrogen can lead to vaginal changes, such as vaginal atrophy, that can make sex painful. This is also what causes physical side effects like hot flashes — when blood rushes to your skin’s surface, causing you to feel warm and flushed.

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Menopause

You’re considered to be going through menopause when you have not had a period in over a year. This means that your ovaries have stopped releasing eggs altogether, and have stopped producing much estrogen.

In addition to continued vaginal dryness and hot flashes, many women going through menopause may also experience weight gain and mood swings, caused by shifting estrogen levels. Menopause symptoms can be experienced for 10 years or more.

Postmenopause

Postmenopause is the finalreproductive phase after menopause, usually confirmed when you’ve gone without a period for 12 consecutive months. Your doctor can help you determine when you’ve entered this phase of life by examining your bloodwork for certain reproductive hormones.

Hormones tend to stabilize in postmenopause, and many women discover that their hormone-driven menopause symptoms (such as hot flashes) can lessen or even disappear.

Ways menopause affects sex drive

Yes, menopause may affect your sex drive, but perhaps not through directly impacting your libido — in fact, a loss of libido was not a commonly reported symptom in a recent study of peri- and postmenopausal women. Rather, a host of outside factors can feel as though they’re conspiring together to make sex less pleasurable for you.

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Insomnia and sleep troubles

Physical side effects of menopause, like night sweats, coupled with mental health effects, such as depression, can all lead to sleep problems. Insomnia and trouble sleeping can impact all areas of your body and your life, from work to your sex life.

Mental health concerns

Many women find themselves experiencing depression in peri- and postmenopause, with women who previously experienced depression being at the highest risk.

Though the link between depression and menopause is still under investigation, it’s theorized that some women are more vulnerable to the hormonal shifts that happen during menopause — meaning they are at higher risk to become depressed due to changing estrogen levels.

Depression experienced during menopause can affect women’s libido and desire to have sex. Diagnosis and treatment of depression should be managed by a mental health professional.

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Vaginal changes and discomfort

Menopause causes a reduction in blood supply to the clitoris and lower vagina, which can lower the amount of sensation women feel during intercourse. The clitoris can also become less sensitive postmenopause, which can drastically reduce the amount of pleasure women experience during sex.

Vaginal discomfort refers to any sensation of pain, burning, or itching experienced in the vagina. This can make penetrative sex difficult for many women, and can lead to an overall negative view of sex.

One of the post common causes of painful sex for women in midlife, vaginal atrophy, is directly attributed to menopause, as it occurs following the drop in estrogen experienced during menopause. This condition leads to 17–45 percent of postmenopausal women reporting that they find sex painful, otherwise known as dyspareunia.

Vaginal atrophy causes the vagina to become thinner and drier (meaning less lubricated and stretchable), and may also shorten and become tighter at the opening. This can lead to feelings of tightness, pain, or soreness. It’s also possible for irritation or inflammation to occur over time, which can lead to tearing or bleeding of vaginal tissue.

Vaginal thinning and dryness are the most common causes of dyspareunia in women ages 50 and older. Vaginal atrophy can be helped by using lubrication during penetrative sex, and can be diagnosed and treated by speaking with your doctor.

There are other types of vaginal discomfort that are not directly related to menopause but are commonly seen in both peri- and postmenopausal women. These include:

  • Vaginismus: Involuntary spasms or muscle contractions in the perineum (the area between the vagina and anus), or the vaginal opening. This can make penetrative sex difficult and painful, as additional symptoms can include burning or stinging.
  • Vaginitis: Can be caused by vaginal atrophy, a yeast or bacterial infection, or irritation from hygiene products like soap. Symptoms can include painful urination, vaginal discharge, burning, itching, or swelling of the vulva and/or vagina.
  • Urinary tract conditions: Includes bladder infections, irritation, inflammation, irritation of the urethra, sensitivity to latex condoms, and a prolapsed bladder (the dropping down of the bladder into or outside of the vagina).

Diagnosis and treatment options for these conditions should be discussed with your gynecologist or primary care physician.

Can you orgasm after menopause?

A big misconception people have about sex after menopause is that women cannot orgasm. While no studies have been able to link a reduction in orgasms or libido to menopause directly, many outside factors can lead to a reduction in sexual activity and interest for postmenopausal women.

This can mainly be attributed to hormonal changes that affect the vagina. This includes changes like the clitoris becoming less sensitive postmenopause, which is likely due to reduced estrogen levels and changes in the nervous system, along with other reductions in the sensations and pleasure you may be used to experiencing in perimenopause. This can sometimes extend to orgasms, which may take longer to achieve or become less intense.

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4 ways to increase intimacy and maximize pleasure during menopause

Menopause shouldn’t signal the end of having safe, enjoyable sex. Though there may be new factors to consider when having sex postmenopause, you should feel comfortable and confident when being intimate. Below, you’ll find four ways to increase your feelings of intimacy and maximize your pleasure when navigating sex postmenopause.

Address any discomfort

Any discomfort during sex should be addressed straight away so that sex can be pleasurable for both parties. Vaginal pain and dryness, both symptoms experienced during menopause, can be a big factor in making sex less comfortable for women, and should be addressed with your partner.

This ensures you are both on the same page about how sex is going for you, and can help you come up with solutions on how to move forward. This can include lubricant or discussing other options with your doctor.

Get tested

Especially if you’re exploring a sexual relationship with a new partner postmenopause, you should consider discussing and getting tested for STIs together. This can ensure you are both on the same page regarding your health and sexual history, even as you age.

Once you both know your status, you’re able to freely explore an intimate relationship built on trust and communication. Consider an at-home lab STI test for both men and women to help you get on the same page.

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Explore different methods of intimacy

Intimacy doesn’t have to be synonymous with penetrative sexual intercourse. There are many other ways to have an intimate relationship, especially if you are experiencing a mind-body disconnect during sex (when the mind wants sex but your body does not cooperate).

Some different ways to experiment with intimacy can include:

  • Oral sex
  • Explicit conversations or games
  • Erotic massage

Exploring new, additional ways of being intimate outside of intercourse can also strengthen an emotional connection between partners, and ensure both parties are experiencing pleasure.

Discuss treatment options

Vaginal dryness or pain during sex is not something that should be ignored. If you’re frequently experiencing these symptoms during sexual intercourse, or have noticed a lack of interest in sex, you should speak with your healrhcare provider about possible treatment options. This could include medications and hormonal or physical therapies.

Menopause doesn’t have to signal the end of having good sex. Through proper education, listening to what your body is telling you, and knowing what can help you feel good, you can continue to keep the heat even after the hot flashes and hormonal changes.

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