For years, many people have believed that a woman’s sex life ends after menopause. That simply isn’t true. Menopausal and postmenopausal women can enjoy sexual intimacy for years to come. But it may take a bit more effort. A better understanding of the changes that occur with menopause — along with adjusting approaches to intimacy — can help women rediscover their sexuality.
During menopause, your body stops producing reproductive hormones and no longer ovulates. Some women are happy about the idea of not having periods anymore, while others may feel a bit mixed or bittersweet about it. Some are excited not to need birth control, but hold on — don’t throw it out yet! You should keep using birth control until you have been period-free for at least 12 consecutive months. Otherwise, you could still get pregnant. In fact, many women experience a resurgence in fertility just before menopause.
After menopause, decreased estrogen levels lower sex drive and sexual pleasure. Lower estrogen causes vaginal tissue to become thinner, dryer and less elastic, which can make intercourse painful without adequate lubrication. Furthermore, weakening of the pelvic floor muscles can make sexual pleasure more difficult as well as leading to urinary incontinence.
For many women, a silicone-based or water-based lubricant is a good first step. But there’s another important tip to keep in mind: Slow down. A longer arousal period and slower penetration gives the vaginal tissue more time to get ready and stretch gently. Alternatively, non-penetrative sexual activities, or “outercourse,” may be more comfortable.
If you’re experiencing mild urinary incontinence, pelvic floor exercises such as Kegel exercises may be helpful. Talk to your doctor about how to do these exercises properly to get the full benefit.
Menopausal hormone therapy (MHT), sometimes called hormone replacement therapy, is the primary way healthcare providers treat the symptoms concerning sexual function after menopause.
MHT encompasses different hormone combinations available in many forms and doses. Estrogen alone is used if a woman has had her uterus removed. If a woman still has her uterus, a combination of estrogen and progesterone — or progestin, a synthetic version of progesterone — are used together to lower the chances of the uterine lining thickening or cancer developing in the uterus.
A woman can undergo estrogen MHT with a pill, skin patch, vaginal suppository or cream, implant, shot, or vaginal ring. Progesterone and progestin can be taken similarly in a pill, patch, suppository or shot, and also with an intrauterine device or gel.
As with any medication, there are risks and side effects associated with MHT. Talk to your healthcare provider at Riverview Health to see whether MHT is a good idea for you — and if so, what forms and doses may be a good fit.
Remember: Whatever your stage of life, sex is always optional. You don’t have to do anything that makes you feel uncomfortable. Sensual non-sexual activities such as massages can also help you and your partner feel intimate without causing you discomfort.
Has it been a while since your last check-up, or do you need a new physician? Call us at 317.565.0535 to request an appointment.
Sources: NIA.NIH.gov, nwhn.org, ACOG.org
