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Sex After the Menopause: What Changes?

The information provided herein does not constitute an expert or medical advice, nor intended to replace such advice.

Sexual Health

Written by Dr. Andrea Pinto MD - Written on September 21, 2021

Menopause is a perfectly normal time during a woman’s life… but that doesn’t mean that it’s comfortable for everyone. Your body goes through many changes during menopause, and some of those changes can affect your sex life. However, there are also many things you can do to make it easier to continue to enjoy sex during menopause and beyond.

Keep reading to learn more about what changes about sex after menopause at STDWatch.com.

Sex after the menopause: the changes

Menopause is defined as the time after a woman hasn’t had a period for 12 straight months, according to the National Institute on Aging. Perimenopause is the time period that leads up to menopause in which women are already experiencing the transition to menopause, and it can last anywhere from 7 to 14 years. Most women enter menopause around the ages of 45 and 55 years old.

Common symptoms during menopause and perimenopause include:

  • Hot flashes
  • Night sweats
  • Cold flashes
  • Urinary urgency
  • Vaginal dryness
  • Difficulty sleeping
  • Mood swings
  • Irritability
  • Dry skin, eyes, and/or mouth

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Let’s talk a bit more in depth about how menopause can affect sex, specifically.

Lower libido

According to Johns Hopkins Medicine, decreased estrogen levels during menopause and perimenopause can have a significant effect on your sex drive. During menopause, many women find that they have a harder time getting aroused, and they may become less sensitive to intimate contact.

Menopausal women can also have difficulties reaching an orgasm or feel a lack of interest in having sex.

Painful intercourse

This side effect of menopause doesn’t affect every woman out there, but it’s still quite common. According to the Mayo Clinic, dyspareunia affects anywhere from 20 to 30 percent of postmenopausal women who aren’t receiving hormone (HRT). Dyspareunia can manifest as superficial pain (upon penetration), deep pain (during thrusting), or both. 

Similarly to the changes in libido, painful sex during menopause is a result of hormonal changes. Lower estrogen levels can cause vaginal atrophy, in which the vaginal tissue becomes less elastic and more fragile. Vaginal atrophy, also known as atrophic vaginitis or the genitourinary syndrome of menopause, can also decrease your production of natural lubrication when you’re aroused.

These factors increase the risk of pain, bleeding, or tearing during sex. This can result in fear or anxiety surrounding sex, which can make the situation worse.

Sleep and mood changes

As we mentioned above, menopause can have a negative effect on your sleep quality and overall mood. As the Office on Women’s Health states, night sweats can also make it harder for you to get a good night’s rest. And if you’re not sleeping well, it’s easy to see how sexual desire may not be a priority.

Menopause can also lead to mood changes and irritability, even increasing your risk of depression. All of these changes can keep your mind away from sex, hindering your ability to feel aroused and enjoy your sexuality.

Ways to make sex better after menopause

Hormone replacement therapy (HRT)

As its name suggests, HRT contains hormones that are meant to restore your hormonal levels during menopause, which helps decrease the symptoms that result from this imbalance. HRT can also protect you from different health risks during menopause.

According to the Cleveland Clinic, HRT can contain estrogen or a combination of estrogen and progesterone. Typically, combined estrogen/progesterone HRT is recommended for patients who still have their uterus, since taking estrogen alone can increase your risk of endometrial cancer.

HRT comes in different presentations, including:

  • Oral pills
  • Vaginal creams
  • Vaginal tablets
  • Vaginal rings
  • Vaginal inserts
  • Topical sprays
  • Topical patches

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In addition to HRT, a medication called ospemifene has been FDA-approved to treat dyspareunia during menopause.

Increase intimacy with your partner

These changes don’t mean that you should give up on sex after menopause. Sex is just as much about intimacy as it is about physical pleasure, and there are many things you can try to boost intimacy in your relationship. This can help you feel more comfortable and decrease anxiety surrounding sex. Helpful tips include:

  • Communicate your emotions and experiences with your partner
  • Set realistic expectations around sex
  • Use lubricant during foreplay and intercourse
  • Try new positions
  • Lengthen the foreplay
  • Enjoy romantic activities and dates together

When to see a doctor

In general, it’s important to seek medical guidance during perimenopause and menopause. Certain health risks increase after a woman has gone through menopause. Your healthcare provider can help you assess these risks according to your family and personal history, and determine what you can do to stay healthy.

Your doctor could also recommend certain lifestyle changes and treatments, such as hormone replacement therapy, in order to make your everyday life more comfortable during menopause.

Keep in mind that menopause doesn’t mean that you can’t get an STD anymore. Unless you’re in a strictly monogamous relationship where both partners have been tested for STDs, you still need to use condoms during sex and get tested for STDs regularly.

It can be scary to realize that you’re entering menopause — after all, menopause causes changes that can affect your body and emotions, and you may feel like your sex life won’t be the same. But thanks to certain lifestyle changes and treatments, you can still enjoy a full life — including sex! — long after going through menopause.



Dr. Andrea Pinto Lopez

Dr. Andrea Pinto Lopez

Mar 25, 2022

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