Sex After Menopause: What To Expect

It’s normal to feel like menopause is affecting your sex life, but there are plenty of things you can do about it.

Sex After Menopause: What To Expect

Sex After Menopause: What To Expect

Sex After Menopause: What To Expect

Published
August 6, 2021
— Updated
Medically Reviewed by
8 minutes

Menopause is a natural event that every person who has ovaries will go through after a certain age. Average age at menopause is 51, but it may take place earlier, or later, for some people.(1) While menopause — the transition that takes place when you stop menstruating — gets lots of attention, many of the changes associated with menopause take place gradually over time. Everyone’s experience of menopause is unique; some people find that not much changes, while others go through significant shifts in many areas of their life. 

It’s normal to worry about how menopause might affect your sex life. Learning what to expect, though, as well as focusing on the many positives that come with growing older, can be empowering. Some people even find that they have the best sex of their lives after menopause.

How do hormones impact sexuality?

Our hormone levels change throughout our lives — not just during puberty and menopause. For example, most female-assigned people produce small amounts of testosterone, which drops over time; research has demonstrated that women in their forties have roughly half the testosterone levels of those in their twenties.(2) Levels of estrogen and progestin, the hormones responsible for reproductive function in women, change throughout the menstrual cycle, as well as during pregnancy and lactation.(3) During perimenopause (the years leading up to menopause, usually beginning in your late thirties or early forties), levels of estrogen and progesterone begin to decline, and drop even more after menopause.(4)

Many people who have periods notice changes that correspond with their menstrual cycle, like fluctuations in sexual desire, breast size and sensitivity, and vaginal lubrication.(5) Thinking of the changes you might experience during perimenopause and menopause as part of this continuum can be reassuring — after all, you’ve been navigating shifting hormone levels your whole life!

Here are some ways that the changes associated with menopause might impact your sex life, and tips for dealing with them:

Vaginal changes

A drop in estrogen during perimenopause and menopause can lead to lower levels of vaginal lubrication and cause the lining of the vagina to become thinner and less stretchy.(6) For some people, these changes can lead to discomfort or pain during sex and an increased risk of vaginal infections.

What you can do:

  • Good quality lube can do wonders to increase your comfort and make sex feel as good as ever. In fact, using lube can enhance pleasure and safety during sex for people of all ages.
  • Spending more time on foreplay and incorporating more kissing and sensual touch into partnered sex can give the vaginal muscles more time to relax and can increase comfort during penetration.
  • Taking the focus off vaginal penetration and focusing instead on oral sex, mutual masturbation, or sensation play, or even exploring kink, can be a great way to build intimacy and experience sexual satisfaction.
  • Hormone therapy may be an option for people experiencing vaginal changes due to menopause and can be an effective treatment for vaginal dryness and loss of elasticity.(7) Check in with a healthcare provider to discuss your options.

Pelvic floor changes

Reduced pelvic floor strength is a normal part of aging for most women.(8) This can sometimes result in fewer and less intense orgasms, pelvic pain, and lower desire for sex.(9)

There’s no connection between menopause and incontinence (trouble holding pee or poop). Having a weaker pelvic floor, though, can increase the risk of incontinence, especially if you’ve given birth or had certain surgeries.(10) If you struggle with incontinence, it might affect your sexual confidence and body image.

What you can do:

  • Pelvic floor exercises, like Kegels, can help to maintain vaginal muscle tone, and have been shown to be highly effective at managing incontinence.(11) There is also evidence that strengthening your pelvic floor can help to reduce pain during sex and enhance overall sexual satisfaction after menopause.(12)
  • Physical therapy can help to strengthen the pelvic floor, relieve pain, and reduce incontinence.(13)
  • Keep in mind that bodies of every age are unpredictable. Cultivating intimacy and good communication with your partner/s (and keeping a sense of humor!) can help you work through potentially embarrassing moments together.

Changes in libido

It’s totally normal for levels of sexual desire to fluctuate, no matter what your age. Every person is unique, and there’s no standard for how much sex you should be having or want to have. That said, reduced desire for sex is a common concern for people approaching menopause.

While there’s evidence that the hormonal changes that accompany aging for people with ovaries can lead to lower libido,(14) the relationship between menopause and sex drive isn’t clear-cut: Many factors influence sex drive, including relationship quality, physical health, and psychological wellbeing.(15)

If you’re consistently experiencing low libido and it’s causing you distress, it’s worth thinking about what you’re going through in all areas of your life: If you have a partner, do you feel safe, respected, and valued in your relationship? Are you dealing with stress, depression, anxiety, body image issues, or other mental health concerns? Has your health been impacted by an injury, illness, or recent surgery? Have you experienced a life-changing event, like retirement, a big move, the loss of a spouse, or kids moving out? 

In addition to general health and life events, cultural messages around aging and negative stereotypes about older women’s bodies can affect your self-confidence and sense of desirability.(16) If you’re partnered, you may be worried about your partner comparing the way your body looks now to the way it used to. If you’re interested in exploring intimacy with someone new, you may be self-conscious about taking off your clothes.

Getting to the bottom of what’s behind a change in sex drive can empower you to address the underlying cause — if you want to. For some people, having little or no desire for sex isn’t a problem.

There are currently no FDA-approved hormone therapies that have been shown to be effective at increasing sex drive for postmenopausal women.(17) But there are still many things you can try.

What you can do:

  • Masturbation is a fantastic way to connect with your body and discover what feels good to you now. Experimenting with different types of touch, trying new sex toys, and exploring erotica or porn can all be great ways to help you feel sexy, whether you’re solo or partnered.
  • Relationship counseling can be an effective way to ease communication with your partner/s and help you work together to cultivate deeper intimacy and greater sexual satisfaction.
  • Individual counseling can be helpful for those struggling with stress, anxiety, depression, and body image concerns.
  • Self-care practices such as exercise, taking part in activities and hobbies you enjoy, and nurturing relationships with friends and family can help to enhance your general wellness and free up more energy for sexual expression.
  • Doing physical activities that you enjoy and focusing on what your body can do rather than how it looks, as well as thinking critically about unrealistic ideals promoted in media and advertising, can be helpful in improving body image.(17)
  • Regularly checking in with a healthcare provider is a proactive way to stay healthy and make sure you don’t have any unaddressed health issues.
  • Having less interest in sex can be a natural part of the aging process; for many people, this isn’t a problem. Those who aren’t as sexual later in life may instead channel their energy into causes they care about, non-sexual intimacy, and other things that matter to them. 

The bottom line

For many people, menopause represents a significant change. In addition to the potential challenges, it can bring opportunities for deeper self-knowledge and exploration of what’s important to you. Some people find no longer having to worry about unplanned pregnancy or periods very freeing. However you experience the changes of menopause, you deserve to feel good about your body and experience pleasure.

Reviewed for Medical Accuracy

Emily A. Klein (she/her) is a freelance writer with deep interests in sexuality and health. As a student of cultural anthropology, she researched and wrote about kink, abortion, harm-reduction approaches to substance use in the LGBTQ+ community, and cross-cultural understandings of gender, sexuality, and the body. She has designed and implemented a sexual health curriculum for adolescent girls, worked with foster youth and those experiencing housing insecurity, and volunteered as an emergency first responder. Her writing has appeared in The Establishment, Edible magazine, The Seattle Lesbian, Slog, and elsewhere.

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References

1. Greendale, G. A., Lee, N. P., & Arriola, E. R. (1999). The menopause. The Lancet, 353(9152), 571-580. https://doi.org/10.1016/S0140-6736(98)05352-5

2. Guay, A., Munarriz, R., Jacobson, J., Talakoub, L., Traish, A., Quirk, F., ... & Spark, R. (2004). Serum androgen levels in healthy premenopausal women with and without sexual dysfunction: Part A. Serum androgen levels in women aged 20–49 years with no complaints of sexual dysfunction. International journal of impotence research, 16(2), 112-120.

3. Zacur, H. A. (2006). Hormonal changes throughout life in women. Headache: The Journal of Head and Face Pain, 46, S50-S55. https://doi.org/10.1111/j.1526-4610.2006.00554.x

4. American College of Obstetricians and Gynecologists. (2020). Perimenopausal Bleeding and Bleeding After Menopause. FAQs. 

5. Regan, P. C. (1996). Rhythms of desire: The association between menstrual cycle phases and female sexual desire. Canadian Journal of Human Sexuality, 5(3). https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause

6. American College of Obstetricians and Gynocologists. (2018). The Menopause Years. FAQ. https://www.acog.org/womens-health/faqs/the-menopause-years

7. North American Menopause Society. (2012). The 2012 hormone therapy position statement of the North American Menopause Society. Menopause (New York, NY), 19(3), 257. 10.1097/gme.0b013e31824b970a

8. Mannella, P., Palla, G., Bellini, M., & Simoncini, T. (2013). The female pelvic floor through midlife and aging. Maturitas, 76(3), 230-234. https://doi.org/10.1016/j.maturitas.2013.08.008

9. Handa, V. L., Cundiff, G., Chang, H. H., & Helzlsouer, K. J. (2008). Female sexual function and pelvic floor disorders. Obstetrics and gynecology, 111(5), 1045. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746737/

10. Sherburn, M., Guthrie, J. R., Dudley, E. C., O’Connell, H. E., & Dennerstein, L. (2001). Is incontinence associated with menopause?. Obstetrics & gynecology, 98(4), 628-633. https://doi.org/10.1016/S0029-7844(01)01508-3

11. Price, N., Dawood, R., & Jackson, S. R. (2010). Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas, 67(4), 309-315. https://doi.org/10.1016/j.maturitas.2010.08.004

12. Nazarpour, S., Simbar, M., Majd, H. A., & Tehrani, F. R. (2018). Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women: a randomised clinical trial. Sexual health, 15(5), 396-402. https://doi.org/10.1071/SH17203

13. Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, 31(6), 485-493. https://doi.org/10.1097/GCO.0000000000000584

14. Davis, S. R., & Tran, J. (2001). Testosterone influences libido and well being in women. Trends in Endocrinology & Metabolism, 12(1), 33-37. https://doi.org/10.1016/S1043-2760(00)00333-7

15. Thornton, K., Chervenak, J., & Neal-Perry, G. (2015). Menopause and sexuality. Endocrinology and Metabolism Clinics, 44(3), 649-661. https://doi.org/10.1016/j.ecl.2015.05.009

16. Deeks, A. A., & McCabe, M. P. (2001). Menopausal stage and age and perceptions of body image. Psychology and Health, 16(3), 367-379. https://doi.org/10.1080/08870440108405513

17. Alleva, J. M., Sheeran, P., Webb, T. L., Martijn, C., & Miles, E. (2015). A meta-analytic review of stand-alone interventions to improve body image. PLoS One, 10(9), e0139177. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0139177