Sex and Menopause

• Although menopause may have some negative effects on sexual function, this is not always the case.
• Each woman's experience of menopause is unique; not all women have the same symptoms or experience symptoms with the same degree of severity.
• Decreases in estrogen levels after menopause can cause a decrease in libido.
• Vaginal dryness is another symptom of menopause that can have an impact on sexual function.
• Hormone therapy and water-soluble lubricants are two ways to help relieve vaginal dryness associated with menopause.
• Other symptoms of menopause, such as trouble sleeping and mood swings, can also interfere with enjoyment of sexual activity.

Just as every women experiences menopause differently, women may or may not experience changes in sexual function after menopause. Since estrogen levels are lower after menopause, some women may notice that their libido, or sex drive, is decreased. Low estrogen levels can also lead to a decreased blood flow to the vagina, resulting in difficulty with lubrication or in dryness which that can make sexual intercourse less pleasant and painful for many women.

Not all women report negative changes in sexual function after menopause. For example, some women may find sex to be more pleasurable without the fear of unwanted pregnancy or without the potential stresses of having small children.

A decrease in estrogen levels is the hallmark of menopause, and this change in hormone level can cause a number of different symptoms. Not all women experience all the characteristic symptoms of menopause, but some women may have more severe symptoms than others. In addition to vaginal dryness and decreased libido, menopause can be associated with other troublesome symptoms that can affect sexual drive and function. Examples of these symptoms include the following:

• Difficulty sleeping
• Hot flashes
• Headache
• Mood changes
• Stress
• Anxiety
• Depression
• Bladder control issues
• Night sweats
• Weight gain

These symptoms alone are sufficient to affect sexual function in many women.

Estrogen therapy (ET) is available for women to treat symptoms of menopause, although due to some health risks (see below), not all women choose to take estrogen therapy. Estrogen, in pill, patch, transdermal spray, or gel form; is the single most effective therapy for troubling symptoms of menopause. Because ET alone can cause uterine cancer (endometrial cancer), a progestin drug is typically given together with estrogen in women who have a uterus (those who have not undergone a hysterectomy) to eliminate this increased risk. Hormone therapy has been shown to have other risks, including small but significant risks of stroke and heart disease. Because of these risks, women who have no major menopausal symptoms may choose to avoid hormone therapy (HT) altogether. Most doctors agree that hormone therapy, when used for symptoms of menopause, should be used in the lowest effective dose and for the shortest time period of time possible.

Estrogen is also available for use in the treatment of vaginal dryness as an isolated symptom. Topical estrogen is available in the form of creams, vaginal rings (devices that secrete estrogen locally within the vagina for up to three months), and vaginal tablets. These products are inserted directly into the vagina, and they can help relieve some of the symptoms of vaginal dryness and discomfort. Water-soluble lubricants (such as K-Y jelly, K-Y Silk, liquibeads, etc.) can also be effective in the relief of vaginal dryness. Estrogen administered vaginally is given in very low doses, and it is not associated with the risks of systemic (for example, bloodborne) hormone therapy such as that given to treat hot flashes and other widespread menopause symptoms.

As discussed above, the use of systemic hormone therapy or vaginal estrogen therapy can diminish vaginal dryness and decrease any discomfort associated with sexual intercourse. Water-soluble lubricants can also help overcome vaginal discomfort. Some women find that relaxation techniques, sensual massage, masturbation, or changing positions during coitus can heighten their sexual experiences. For women or couples who are struggling to understand and accept the changes in sexual function that may accompany menopause, counseling can be an option. Talk with your partner about the changes that are happening to your body. Some couples try counseling on an individual basis or as a couple.