Menopause doesn’t mean the end of a satisfying sex life. Learn ways to help you navigate this change.
There are so many changes that can happen to your body during menopause that can, in turn, greatly impact your quality of life. One such shift for many is how easy and pleasurable it is to have sex. But sex after menopause isn’t doomed — particularly when incorporating certain lifestyle strategies and, in some cases, medical intervention.
Why Sex Changes After Menopause
Declining levels of the sex hormone estrogen during menopause can open you up to experiencing a lot of physical and emotional symptoms, such as hot flashes and night sweats. Sex may also become more painful and less appealing because of issues like vaginal dryness, changes in vulvar and vaginal tissue, and reduced libido.
While not everyone notices these changes, most people who go through menopause struggle with at least one aspect of sexual desire or sexual function related to menopause, says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause in Chicago. “This is so multifactorial,” she notes.
While symptoms vary from person to person, some of the common physical and emotional changes during menopause that can affect your sex life include:
Vaginal Dryness Reduced hormone levels can make your vaginal tissue drier and thinner. This can make sex uncomfortable or painful.
Reduced Sex Drive A reduction in hormone levels may also dampen your sex drive. Arousal may also take longer.
Exhaustion Night sweats can interfere with your sleep and make you feel tired.
Mood Swings Emotional changes can cause stress and irritability.
Beyond these factors, life changes that can happen around the same time as menopause may also wreak havoc on your sex life. These include things like children leaving home, adult children living at home, changes in your romantic relationship, or caring for aging parents.
5 Tips for Better Sex After Menopause
One factor to consider regarding improving your sex life after menopause? Ensuring you’re doing what you can to manage specific menopause symptoms that may hamper your ability to get in the mood or enjoy yourself in bed. With that in mind, you’ll find five tips below to help improve your postmenopausal sex life.
1. Hormone Replacement Therapy
Hormone replacement therapy (HRT) can go a long way toward reducing menopause symptoms like night sweats and hot flashes, improving sleep, and boosting your mood. “Hormone therapy with estrogen is a well-established treatment for menopause symptoms,” says Anna Kirby, MD, an obstetrician and gynecologist at UW Medicine in Seattle.
HRT can also help increase your libido. “Low libido is a problem that a lot of people experience, and it can happen for a lot of reasons,” Dr. Streicher says. HRT is one way to address this problem. However, if you still aren’t in the mood after trying HRT, this might be because other issues worth addressing are negatively impacting your libido, such as pain during sex or lack of sleep, Streicher adds.
HRT can have risks for some people, so talk to your doctor about whether it’s right for you.
2. Topical Estrogen
Hormone replacement therapy on its own may not do enough to improve your sex life, especially if sex is painful, Dr. Kirby says: “Patients who are taking systemic hormone therapy with estrogen can usually benefit from adding topical vaginal estrogen as well.”
She adds that topical estrogen in the vagina — whether it’s a cream, tablet, or ring — is safe for almost every woman and can be used even in combination with systemic hormones to ease other menopause symptoms like night sweats.
Patience is key, however, because it can take several months of using vaginal estrogen to determine whether it helps enough to make a positive difference in your sex life after menopause.
“Vaginal estrogen can thicken vaginal tissue and restore elasticity, both of which can make sex less painful and more enjoyable,” Kirby explains. “It can take several months to make the vaginal tissues less sensitive, so I recommend women try it for at least three months before determining if it helped or not.”
3. Moisturizers and Lube
Many moisturizers and lubricants you can get at the drugstore can also help make penetrative intercourse and other sexual activities more comfortable. The advantage of these is that you don’t need a prescription, and you can try a variety of options until you find one that works best for you.
Lubricants work best if they’re applied before sex. Streicher says products made from silicone are more slippery and comfortable than water-based options, which can be more irritating.
You can also use long-acting vaginal moisturizers to help reduce vaginal dryness and painful intercourse. Like moisturizers you use for dry skin elsewhere on your body, vaginal moisturizers work best when applied daily.
“When you think about all the changes that happen in terms of sexual function [as a result of menopause], vaginal dryness is the one I hear about the most,” Streicher says. “Lubricants and moisturizers can go a long way."
4. Sex Toys and Masturbation
All of the changes menopause brings can render components of sex you used to find pleasurable less effective.
One challenge is that as you age, it can take longer for blood to fill your genitals, making you less sensitive to touch and making it harder to experience sexual pleasure and orgasm. Activities that increase blood flow to your vagina, whether it’s masturbating or using sex toys, can help increase sensitivity and pleasure during sex.
5. Good Communication
Good communication with your partner is good for your sex life at any age, but it’s especially important during times like the menopausal transition, when your body is going through changes that alter how sex feels.
Often, a lack of desire is at least in part connected to relationship issues or physical and emotional changes that both you and your partner may be experiencing as you age, Streicher says.
Libido and physical shifts aside, it’s even more likely that you’ll lose interest in sex after menopause if you’re not able to talk to your partner about why sex is painful or less thrilling than it used to be.
When it comes to intercourse, talking to your partner about different positions that let you control penetration can be one way to help make sex more pleasurable. Date nights and doing things to improve communication outside the bedroom can also be good for your sex life.
“Part of this conversation is redefining what sex means to you,” Streicher says. “In your twenties everything might be about intercourse and orgasm. Sexuality may not look the same after menopause, and you may have a new normal. But that doesn’t need to be a bad thing, and you can still have a satisfying sex life.”
How to Talk to Your Doctor About Sex After Menopause
Your partner isn’t the only person with whom you should discuss sex after menopause. You should also talk to your doctor about all the menopause symptoms you’re experiencing and any changes you experience in your ability to have or enjoy sex.
The first thing you need to know is that not all primary care doctors or gynecologists are experts in managing menopause symptoms, Streicher says. It’s a good idea to see somebody who is willing to discuss and prescribe hormone replacement therapy because this is a good indication that the doctor is able to treat menopause specifically.
If you feel awkward bringing up the ways menopause has messed with your sex life, you’re not alone. Less than half of women experiencing menopause symptoms talk to their doctor about it, according to the University of Michigan National Poll on Healthy Aging.
Seeing a doctor who uses an intake questionnaire that includes detailed questions about menopause symptoms and sexual health can make it much easier to bring up these issues during your appointment, Kirby says. These questionnaires can give your doctor an idea of what’s bothering you and help start a conversation about treatment options.
“I think one of the biggest barriers to talking about sex is the worry that nothing can be done to improve it, so knowing that there are treatments might give you the confidence to bring it up, even if it feels awkward and difficult,” Kirby says.
The Takeaway
Hormonal changes during menopause can make sex painful and also interfere with your libido.
Treating common menopause symptoms like night sweats and vaginal dryness can boost libido and make sex less painful.
Try new things in the bedroom, and talk honestly with your partner about ways you can have a healthy and satisfying sex life after menopause.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Kara Smythe, MD, has been working in sexual and reproductive health for over 10 years. Dr. Smythe is a board-certified fellow of the American College of Obstetricians and Gynecologists, and her interests include improving maternal health, ensuring access to contraception, and promoting sexual health.
She graduated magna cum laude from Florida International University with a bachelor's degree in biology and earned her medical degree from St. George’s University in Grenada. She completed her residency in obstetrics and gynecology at the SUNY Downstate Medical Center in Brooklyn, New York. She worked in Maine for six years, where she had the privilege of caring for an underserved population.
Smythe is also passionate about the ways that public health policies shape individual health outcomes. She has a master’s degree in population health from University College London and recently completed a social science research methods master's degree at Cardiff University. She is currently working on her PhD in medical sociology. Her research examines people's experiences of accessing, using, and discontinuing long-acting reversible contraception.
When she’s not working, Smythe enjoys dancing, photography, and spending time with her family and her cat, Finnegan.
Lisa Rapaport is a journalist with more than 20 years of experience on the health beat as a writer and editor. She holds a master’s degree from the UC Berkeley Graduate School of Journalism and spent a year as a Knight-Wallace journalism fellow at the University of Michigan. Her work has appeared in dozens of local and national media outlets, including Reuters, Bloomberg, WNYC, The Washington Post,Los Angeles Times, Scientific American, San Jose Mercury News, Oakland Tribune, Huffington Post, Yahoo! News, The Sacramento Bee, and The Buffalo News.
