Shifting hormones during the menopause transition can reshape your sex life. But, a fulfilling sexual journey is still yours to discover if you can understand the changes, embrace new possibilities, and navigate this chapter with practical tips and open communication with your partner and provider.

How the Menopause Transition Affects Sex

Women often experience a natural decline in sexual desire as they approach menopause due to hormonal shifts, especially due to lower estrogen and progesterone.

Lower estrogen levels can lead to vaginal dryness and thinning, shortening of the vagina, and tightening at the opening, all of which can lead to pain or discomfort during sex. (1)

Falling estrogen levels trigger menopause symptoms like hot flashes, night sweats, sleep disruptions, irritability, weight gain, and more. These changes and symptoms impact libido and sexual esteem and satisfaction, both directly and indirectly, says Dr. Alyssa Dweck, obstetrician/gynecologist and chief medical officer at Bonafide Health, a brand of over-the-counter women’s health products.

Additionally, it’s believed that low progesterone levels can impact sex by reducing libido and orgasmic response. (2)

Solutions and Treatment Options

Navigating the sexual changes of menopause can feel daunting, but there are solutions and treatments to help you rediscover pleasure and intimacy.

Lubricants and Moisturizers

Vaginal lubricants, water-based and silicone-based, can help with dryness, facilitating intercourse and enhancing pleasure, says Dr. Dweck. Over-the-counter vaginal moisturizers are also available for long-term relief from dryness. (3)

And, there are hormone-free vaginal suppositories that contain hyaluronic acid and may provide relief from vaginal dryness. Hyaluronic acid occurs naturally in the body and helps the skin to retain water.

Hormone Therapy with Estrogen

Hormone treatments for vaginal dryness include low-dose estrogen vaginally inserted creams, tablets, or rings (3).

Systemic hormone replacement therapy (HRT) raises estrogen levels throughout the body, not just the vagina. It can be an effective option for managing a range of menopause symptoms, including genitourinary syndrome of menopause (GSM, formerly known as vaginal atrophy), hot flashes, and night sweats. HRT contains higher doses of estrogen than low-dose estrogen vaginal products and comes in various forms: pills, patches, topical applications, and a high-dose estrogen vaginal ring. (4)

Before considering hormone treatments, talk to your healthcare provider about the benefits and risks, your symptoms, and your medical history.

Testosterone Therapy

Testosterone therapy, although not FDA-approved (Food and Drug Administration) for women, can help improve libido and orgasm potential, says Dr. Dweck. Side effects include acne and facial or body hair growth. The North American Menopause Society (NAMS) cautions that testosterone products for men have testosterone levels that are inappropriate for women (2). Off-label use for women is approximately 1/10 of the dose used in men (2). Before considering an off-label medication, it's crucial to discuss the potential risks and benefits with your healthcare provider.

Non-Hormone Prescription Medications

Talk to your healthcare provider if you’d like to explore non-hormone prescription medications for sexual health. Ospemifene is an oral, non-hormonal prescription medication for treating moderate to severe vaginal dryness and painful intercourse (5).

To boost sexual arousal, Viagra-like (sildenafil) medications and bupropion (an antidepressant) may be considered, according to NAMS. They’re not FDA-approved for this purpose, so it’s important to consult your healthcare provider before considering any off-label medication use. (3)

Strengthening the Pelvic Floor Muscles

Yoga involves many poses that can help strengthen the pelvis, and its relaxing effects can be a sexual benefit. It’s been shown to help with arousal, lubrication, orgasm, satisfaction, and pain. (6)

Kegel exercises involve contracting and relaxing the pelvic floor muscles to strengthen them, which can help with achieving orgasm (6). It's important to do them correctly. If Kegels are done incorrectly or with too much force, it could tighten the vaginal muscles too much and cause pain during intercourse (7). For optimal results with your pelvic floor muscle, seek guidance from a physical therapist specializing in pelvic floor therapy.

Pelvic floor physical therapy involves biofeedback and physical therapist-guided exercises. It encourages relaxation and strengthening of the pelvic floor muscles and can help address sexual problems by improving pelvic pain and urinary incontinence. (6).

Vaginal Dilators and Sexual Devices

Vaginal dilators, which come in a set of increasing sizes, are placed into the vagina to help stretch the vaginal tissue and treat tight vaginal muscles (8). They’re an effective tool to address vaginal shrinkage, and they train the brain not to anticipate pain with penetration, says Dr. Dweck.

Sexual devices such as vibrators and dildos can help with arousal and orgasm problems. They help increase blood flow to the genitals and can bring awareness to your sexual response. These devices and other erotic products can be used with a partner to spice up your sex life. (8)

Communication and Connection

Open and respectful communication with your partner is key when faced with sexual challenges. Create a safe space to share your concerns and nurture your connection. This doesn't have to translate to just sex; explore the magic of intimacy through massages, kisses, foreplay, pursuing shared interests together, and simply being there for each other without distractions. It’s also important to address any underlying psychological and relationship issues—sex therapy and counseling can help (9).

Healthy Living

Embrace a holistic approach to enhance your overall well-being:

• Regular exercise promotes optimal blood circulation, including to the genital area. 

• Limit alcohol as it may interfere with sleep, trigger hot flashes, and diminish arousal.

• Steering clear of or quitting smoking is crucial, as it not only impedes blood flow to the genitals but also poses numerous health risks.

• Nourish your body with a balanced and nutritious diet.

• Consider engaging in regular sexual activity to maintain vaginal elasticity and to encourage healthy blood flow. (5, 10)

By integrating these proactive measures and by openly discussing challenges with both your partner and healthcare provider, you can navigate your sexual health with resilience. What solutions have helped with your sex life? Let’s Talk About It.

Written By: Johna Burdeos

References

1. The North American Menopause Society. Vaginal Discomfort.

2. The North American Menopause Society. Androgens, Antidepressants, and Other Drugs on Which the Jury’s Still Out.

3. The North American Menopause Society. Effective Treatments for Sexual Problems.

4. The North American Menopause Society. Hormone Therapy.

5. U.S. Department of Health and Human Services | Office on Women’s Health. Menopause and Sexuality.

6. The North American Menopause Society. Yoga, Kegel Exercises, Pelvic Floor Physical Therapy.

7. National Library of Medicine | Medline Plus. Kegel exercises - self-care.

8. The North American Menopause Society. Sexual Devices.

9. The North American Menopause Society. Sex Therapy and Counseling.

10. The North American Menopause Society. Weight Loss, Exercise, and Healthy Living.