Menopause and Sexual Health: Navigating Changes as You Age

Menopause occurs when a woman has gone one full year without a menstrual period, averaging age 51 in the United States. According to the American Sexual Health Association, the transition involves hormonal shifts that can affect sexual health and vaginal lubrication, though many women report increased confidence and sexual pleasure during this stage.

The process happens when the ovaries stop producing an egg every month and cease the production of hormones, specifically estrogen and progesterone, which regulate ovulation and menstruation. The American Sexual Health Association notes that while menopause is a normal part of aging when it occurs after age 40, it can happen earlier due to surgical interventions like hysterectomies or medical treatments such as chemotherapy and radiation.

Menopause that occurs before age 40 is classified as premature menopause, regardless of the underlying cause.

How does perimenopause differ from menopause?

Perimenopause is the gradual transition period leading up to menopause. The American Sexual Health Association states that the ovaries do not stop functioning abruptly but slow down over time. During this phase, menstrual periods may become unpredictable, but ovulation still occurs.

Because the ovaries are still functioning, pregnancy remains possible during perimenopause.

What are the common symptoms of the transition?

Symptoms often appear well before the one-year anniversary of the final period and vary in intensity. The American Sexual Health Association lists several physical and emotional changes associated with the transition:

• Hot flashes and sleep disturbances
• Vaginal dryness and decreased fertility
• Irregular menstrual periods
• Mood swings
• Increased abdominal fat and thinning hair
• Loss of breast fullness

Despite these difficulties, some women report feeling stronger and more energized post-menopause. The American Sexual Health Association attributes this to a reduction in child-rearing responsibilities and the elimination of pregnancy-related stress during sexual activity.

How does menopause affect sexual health and libido?

The loss of estrogen can decrease blood supply to the vagina, which often results in vaginal dryness. According to the American Sexual Health Association, this can make intercourse uncomfortable or painful. Some women may also find they are less sensitive to touching or are not as easily aroused.

Libido does not decrease for all women. Some report an increase in sex drive because they no longer fear pregnancy and have more time for intimacy. The American Sexual Health Association notes that other factors, including depression, poor sleep, medications, and relationship stress, also influence sex drive independently of menopause.

What treatments are available for vaginal dryness?

The American Sexual Health Association recommends water-soluble lubricants for use during sex. It warns that non-water-soluble lubricants can weaken latex condoms.

Vaginal moisturizers, which are absorbed into the skin and applied every few days rather than just before sex, are another option. For those who do not find relief through lubricants or moisturizers, the American Sexual Health Association suggests discussing low-dose vaginal estrogen with a healthcare provider.

This prescription therapy is available as vaginal tablets, rings, or creams to restore the health and functioning of vaginal tissue.

When should a woman see a healthcare provider?

Preventive health care is necessary during both perimenopause and postmenopause to manage conditions associated with aging. The American Sexual Health Association advises women to see a provider if they skip a period to rule out pregnancy via medical history, pelvic exams, or pregnancy tests.

Immediate medical advice is required if a woman experiences vaginal bleeding after menopause has occurred.

Regarding alternative medicine, the American Sexual Health Association states there is very little scientific evidence to support herbal treatments or dietary supplements for menopause symptoms. They advise consulting a provider before using these products, as they can interfere with other medications.

Additionally, the American Sexual Health Association emphasizes that the risk of sexually transmitted infections (STIs) does not end with menopause, and safer sex practices remain necessary.

For broader sexual difficulties, options include hormone replacement therapy, counseling, or referrals to specialists in sexual functioning.