It’s a common misconception that your sex life ends after the menopause. In reality, although your periods have stopped, you can still enjoy an active sex life, and many women even find that they have a renewed enjoyment for sex during this time of life.
That being said, there are also women who find that the physical and mental changes that appear as a result of the decline in estrogen and testosterone during the perimenopause and menopause can hamper their sexual activities. Some of these changes can directly affect sex, such as low libido, vaginal dryness and fatigue. Others are more nuanced, for example if physical appearance changes due to weight gain, reduced skin elasticity or even hair loss, this may result in reduced confidence and increased anxiety when it comes to being naked in front of a partner.
The perimenopausal and menopausal experience, especially with regards to sex, differs from woman to woman. However, there are some common issues that we often see amongst patients at our clinic, which hamper their sex lives.
1. Decreased libido
Approximately 50% of women say that their sex life is affected by mid-life changes, and one study revealed that hypoactive sexual desire disorder (HSDD), a disorder characterised by low sex drive, is as prevalent as 52.4% in naturally menopausal women (women who have gone through the menopause naturally, rather than as a result of surgery). The main cause of decreased libido is declining levels of testosterone and DHEA, which occurs in the perimenopausal and menopausal period. These hormone levels are further impacted by stress, which is common in mid-life due to demands in work and home life.
Women may also experience a decreased libido as a knock-on effect from other menopausal symptoms, such as hot flushes, anxiety, poor sleep, low mood and joint pain. Just one of these physical or mental symptoms is enough to take intimate time off the priority list.
Furthermore, relationship issues are a common cause of low libido, especially if both partners are stressed, have health issues of their own, or have simply lost passion in their relationship.
What’s the answer?
Communication is important between both you and your partner, and you and a qualified healthcare professional. When it comes to the latter, it is beneficial to undergo a complete analysis of your hormonal symptoms. Your consultant should run the appropriate investigations, provide you with a treatment plan, and advice on lifestyle changes that you can make to improve your wellbeing. In regards to communication with your partner, it’s important to talk about how the menopause makes you feel and how this is affecting your sex life. Couples counselling is a popular option for many people in relationships at this time of life, as a good counsellor will be able to make recommendations on what you can do to improve your partnership and sex life.
2. Vaginal dryness and incontinence
Estrogen is the key hormone for maintaining vaginal health and lubrication, so as estrogen production declines, the possibility of experiencing vaginal dryness increases. In fact, one study of 2,435 women going through the menopausal transition revealed that the prevalence of vaginal dryness increased from 19.4% between the ages of 42 to 53 years, to 34% between the ages of 57 to 69. It was stated that, ‘advancing menopausal stage, surgical menopause, and anxiety were positively associated with developing vaginal dryness, regardless of partnered sexual activity’.
As a result of vaginal dryness, skin in the vaginal area can become quite thin, sometimes resulting in tears during sex. This can be painful, in turn leading to decreased arousal. In addition, some women can experience recurrent thrush due to estrogen decline, as this also impacts the immune response in the vagina.
Estrogen receptors are located around both the uterus and the bladder area, therefore, during perimenopause and menopause, many women experience incontinence. A symptom of ‘stress incontinence’ is leaking urine when coughing, sneezing or even running. Some women experience ‘urge incontinence’, where they are desperate to go to the toilet, and if they don’t get there in time, they may have a leak.
Dryness and incontinence can be painful, uncomfortable, inconvenient and embarrassing, and are enough to discourage many women from having sex. However, these physical symptoms are straight-forward to treat, and do not have to affect your sex life.
What’s the answer?
Symptoms of vaginal dryness and incontinence can be effectively treated with vaginal estrogen cream. There is a range of these creams available under the NHS and from compounding pharmacies, like the one we use at The Marion Gluck Clinic. In the latter, testosterone can be added to certain formulas, which can improve arousal and sexual functioning.
In most cases, even women who have had breast cancer, for whom HRT is contraindicated, can still take vaginal estrogen in order deal with some of their menopausal issues. Tamoxifen, which is one of the medications in breast cancer treatment, can sometimes cause menopause like symptoms as it blocks estrogen receptors; however, vaginal estrogen creams are usually still safe to prescribe to these patients.
3. Low self esteem
Many menopausal women gain weight, experience skin and hair changes, and hot flushes – all symptoms which can affect self esteem. This may discourage intimacy, as it can, understandably, be difficult to feel confident in a body that may not look or feel the same as it was pre-menopause.
There is also another facet to the psychological impact of menopause: women may find themselves upset about the fact that the menopause signifies the end of their fertile period, or focus heavily on the negative associations surrounding ageing. We live in a society that celebrates youth, therefore, as women age they may feel that they are less valued or desired.
In addition, there are cognitive changes associated with perimenopause and menopause, such as brain fog, memory changes and loss of concentration, and this can affect everyday life. Careers may also be impacted – this is where many perimenopausal and menopausal women start to feel as if they aren’t as competent or as sharp as they once were.
What’s the answer?
It may take some time, but one way to deal with the psychological impact of menopause is to train your brain to embrace the changes. One particular study revealed that “women who had a negative attitude towards the menopause suffered much more from such symptoms than women who had a positive one. Moreover, women who were satisfied with their physical appearance experienced fewer troublesome symptoms. There was a significant association between high self-esteem and fewer menopausal symptoms. The higher the self-esteem, the lower the symptoms”. One example of training your brain to think positively about menopause is to practice gratitude for the benefits of ageing, such as gaining more wisdom and experience.
Another solution is to seek the right support. This could be in the form of a menopausal support group, a friend or several friends who are going through the same experience, or a counsellor.
Seven practical tips for enhancing your sex life
Equally important are the lifestyle choices that contribute to general wellbeing, as this is closely linked to libido. As we age, it becomes more and more imperative to focus on an anti-inflammatory diet, and regular and varied exercise (including cardiovascular, stretching and resistance training).
There are also supplements to consider taking to accompany a healthy diet, including herbal adaptogens, vitamins and minerals that can support women during the menopause and perimenopausal period. In addition, making time for active relaxation such as yoga, meditation, breathwork, or even going for a walk surrounded bynature will help to minimise stress, allowing for better hormone balancing.
Some other tips to improve your sex life during the perimenopause and menopause include:
Lubricants can be used for penetrative or non-penetrative sex, as well as solo use. They are ideal for increasing comfort for those who have vaginal dryness. There are a range of different formulas available, so make sure to research which one is best for you.
If you are worried that you have become disinterested in sex, the answer could be as simple as trying something new in order to increase excitement and pleasure.
Focusing on other types of intimacy
If you cannot or do not want to have sex for any reason, there are many other types of intimacy that can be just as stimulating. Physical intimacy doesn’t have to include sex, and instead can involve other forms of touching that may not even incorporate genitals. You may also wish to indulge in emotional, spiritual and intellectual intimacy with your partner.
A good exercise routine helps with hormone balancing, which can increase your libido.
Reduce alcohol consumption
A significant side-effect of alcohol consumption – especially regular or excessive – is decreased libido. Cutting down on alcohol will not only improve your health, but could also boost your sex life.
Communication with partner
As mentioned previously in this article, communication is the key to a good sex life. With any partner you should feel safe to communicate your intimacy needs, as well as listen to and understand theirs. This should help you become closer and more comfortable with your partner.
Hormone therapy, alongside healthy lifestyle changes, has helped many women feel like their pre-menopausal selves, including treating issues relating to sex. There are many forms of hormone therapy available to women going through perimenopause and menopause.
Dr Ghazala Aziz-Scott is a specialist in hormonal health at The Marion Gluck Clinic. The Marion Gluck Clinic is the UK’s leading medical clinic that pioneered the use of bioidentical hormones to treat menopause, perimenopause and other hormone related issues. Headed up by Dr. Marion Gluck herself, the clinic uses her method of bioidentical hormonal treatment to rebalance hormones to improve wellbeing, quality of life and to slow down ageing.