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How to increase your sex drive after menopause

Sex after menopause
Menopause can lead to a host of physical and emotional changes, causing a knock-on effect on intimacy

Menopause can have a profound impact on women’s sex lives. A host of physical and emotional changes can cause libidos to drop, making sex unappealing or painful. A survey by the British Menopause Society found that 40-55 per cent of women reported a loss of sex drive, while it’s estimated that 8-45 per cent of women in midlife and beyond experience pain during sex.

“The majority of women I see have simply stopped having sex,” says Dr Louise Newson, a GP and menopause. “They’re relieved to find they’re not the only one, but also that there’s plenty we can do to improve the situation.”

Here’s our guide to sex during the menopause.

Perimenopause: what is it and how does it affect your sex life?

Perimenopause is the extended transitional phase leading up to menopause, or the end of menstruation. For most women, it begins in their 40s, although it can start earlier and may last up to 10 years, until a year after their last period.

Perimenopause varies greatly from one woman to the next. As ovarian function starts to decline, women often display an array of symptoms, usually starting with erratic or heavy periods. As they get closer to menopause, they may experience hot flushes, night sweats, poor sleep, muscle and joint pain and brain fog.

“During this time, so many things happen to women that can affect their sex lives,” says Dr Shirin Lakhani, an intimate health expert specialising in menopause. “Losing oestrogen leads to vaginal dryness and thinning of the tissue, so intercourse can be painful. There’s often also tiredness, anxiety, weight gain, not feeling like yourself, all of which can have an impact too.”

What’s happening to hormones during menopause?

When women enter perimenopause, their oestrogen levels fluctuate, which is the reason periods often become erratic. Meanwhile, progesterone levels are the first to decline.

“The ovaries stop responding so well to the follicle-stimulating hormone, which is why women don’t consistently ovulate – and when they don’t ovulate, they don’t produce progesterone,” explains Dr Alice Duffy, a former GP who runs Health in Menopause, a private clinic in Nottingham. “Oestrogen is a get-up-and-go hormone, nature’s way of saying, ‘Get out there and find someone to fertilise this egg’, while progesterone is a calming, nurturing hormone designed to support new life if fertilisation has occurred.”

This decline in progesterone is why women often feel off-kilter during these years, she says – “anxious and less sure of themselves”. Added to that is a sense of confusion caused by random surges of oestrogen that give women energy while they last but leave them exhausted when they end.

Then, as women grow closer to actual menopause, oestrogen levels begin to decline more rapidly until post-menopause, when they are very low.

Why sex can be painful during and after menopause

As the ovaries produce less oestrogen, causing levels to drop dramatically, it can have a major impact on sexual function. It can lower desire and make it more difficult to become aroused, as well as to achieve orgasm – even the clitoris can become less sensitive.

“The majority of menopausal women will develop symptoms related to vaginal dryness,” says Newson. “A lot of women have told me they find it extremely painful. The tissues of the vagina become much thinner and less elastic, which can also cause discomfort.” The vagina can also shorten, so deep penetration can become particularly uncomfortable.

This pain is one symptom of genitourinary syndrome of menopause, or GSM. Also known as vaginal atrophy, other symptoms include a burning sensation, itching, frequent urination and recurring urinary tract infections.

Once menopause ends, most of the symptoms, such as hot flushes and night sweats, will end too, but the lack of oestrogen means GSM symptoms continue and sex can remain painful for as long as women continue to have it.

How to increase your sex drive during menopause

Along with the physical factors affecting desire, many women also face emotional barriers. “Menopause usually coincides with a time in women’s lives when they already have so much on their plates: they’re juggling jobs and family responsibilities and often feel resentful towards their partners, which is one of the biggest killers of libido,” says Duffy. “A real barrier can come up between couples because women don’t talk about what they’re experiencing, which can be misinterpreted as a loss of love and rejection.”

As a result, experts say open communication between partners is essential to build the foundation to reignite desire. If broaching the conversation between them feels too daunting, couples counselling can help.

Trying to get enough sleep, eating well, exercising and cutting back on alcohol are crucial. Women can also consider hormone replacement therapy (HRT), which restores oestrogen and progesterone. “HRT can help women sleep better, have more energy and feel less stressed, as well as addressing their vaginal symptoms, which makes them more likely to want sex, helps with arousal and also makes sex feel better when it happens,” says Duffy.

Some women choose to take systemic HRT, which enters the bloodstream via pills, patches and gels. Others opt for vaginal oestrogen, a topical treatment – gels, creams or pessaries – applied in the genital area with very little absorption into the bloodstream, making it the lowest-risk form of HRT and a good option for women who are unable to take it in a systemic form due to personal or family medical history.

“One in five women who use HRT will use both to get their symptoms under control,” says Duffy. “But for those who only want to use local vaginal oestrogen, it’s really effective at getting rid of the vaginal symptoms.” Finding and talking to a doctor you trust is the starting point to discovering the right treatment path.

Duffy adds: “If women come back to us and say they no longer have issues with vaginal dryness but they still have no interest in sex, we’ll look at whether they want to try testosterone too.”

How to make sex more comfortable during and after menopause

“We’re living longer now, and many people want to continue having sex long after menopause,” says Lakhani, a speaker at the Pause Live! 2023 conference, an event dedicated to the menopause. “I saw a patient in her 80s recently who wanted to carry on having sex with her husband. If you still want to do it, there shouldn’t be a limit.”

For women who can’t or don’t want to take HRT, there are plenty of options to help make sex more pleasurable – which can also be used by those who do opt for HRT.

Duffy recommends using a gentle, unperfumed moisturiser on the skin of the vulva and the delicate tissues inside the vagina. She says Yes and Sylk, both of which are available on the NHS, are particularly good since they are designed to match the vaginal environment and don’t contain any of the chemicals typically found in vaginal moisturisers, For sex, lubricants are crucial, but again Duffy suggests choosing carefully: “A lot work by taking moisture from the vaginal wall into the vaginal canal, which will actually leave it drier.” Brands such as Sutil don’t do this and also have a balanced pH that won’t dry or irritate skin.

Duffy suggests that her patients browse the Jo Divine website, which was founded by former nurse Samantha Evans and features only sex toys and lubricants that are skin-friendly and irritant-free, as well as a wealth of information about sex during and after menopause.

“I recommend that women experiment with toys on their own at first to get that pleasure element back for themselves,” she says. “Orgasms are fantastic for overall health: very good for sleep, stress, lowering blood pressure and improving the blood supply to the pelvis to keep those tissues healthy. Start to engage with your sexual function on your own and then it’s much easier to share that with your partner.”

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