Sex after Menopause - by Dr. Marilyn Glenville

The menopause is the time when a woman’s periods stop which usually happens between the ages of 47 and 53. As you reach the years leading up to the menopause, you may find your attitudes to sex and relationships changing. This may be for a variety of reasons: Your children may be growing up and leaving home, so the enormous demands they have placed on your time and energy are less You will have more spare time and might find your career taking off or even think about changing your job You may be widowed or divorced and be entering new relationships just at the time when your menopause occurs, and this can lead to anxieties about feeling attractive and worries about sex These life changes can have effects on your mental well-being and it is important to seek help if you feel things are getting too much. Depression and anxiety are common at this time of a woman’s life and are not caused by hormone changes alone, so talk to your GP or a good friend if you feel low.

Will I still want to have sex after the menopause?

A menopausal woman’s desire to have sex and her ability to participate in it are both affected by hormone changes. Although oestrogen plays some part, the hormone most involved with sexual desire is testosterone. This is, like oestrogen, produced by the ovaries, fatty tissue and the adrenal glands that sit on top of your kidneys. Testosterone, unlike oestrogen, continues to be produced after the menopause. Sexual desire (libido) may be diminished during the perimenopause but often returns when the symptoms subside. Many women (and men) believe that women’s libido disappears at the menopause - this is far from true. Up to a third of women experience a reduction in sex drive after the menopause but many more find their sex lives are greatly improved by no longer worrying about pregnancy. With the children gone you have much more time for spending with your partner and rediscovering each other.

CASE STUDY - Margaret, aged 50

Going through the menopause was terrible. I was suffering from stress urinary incontinence and consequently my sex drive was non-existant. This in turn led to me becoming depressed. Then one day I decided to take control as it really was beginning to affect my relationship with my husband. The fact that I couldn’t talk to him about it didn’t help matters either. I made an appointment with my local GP and that’s when I and we began the rest of our lives. He was fantastic and talked through everything with me explaining in detail exactly what was happening to my body and mind and suggested some practical solutions as to how I should deal with it. He recommended a book that showed me how to do pelvic floor exercises and this helped my SUI enormously which made me feel so much better about myself. He also explained that anxiety and depression were normal and that I was not alone. He then suggested that I bring my husband in for another visit. We both listened to each other and began to understand how the other was feeling. I realised that my husband was ‘missing’ me, and not just in a sexual context. He felt excluded from my life and felt isolated and frustrated that he could do nothing to make me happy. I realised that I also was missing him but was taking my unhappiness and anger out on him. All he wanted was my happiness and our happiness. I wouldn’t say things are completely back to normal but we have a very intimate and loving relationship again and we are going on a two week romantic European break in the New Year!

Physical problems

Lack of oestrogen can cause thinning of the vaginal wall and reduced lubrication. This can cause intercourse to be uncomfortable or even painful. Watersoluble lubricating gels can help with this problem. Also helpful are Kegel, or pelvic floor, exercises that can firm up the vaginal wall, control urine flow and enhance orgasm. These exercises involve tightening and relaxing the muscles used to control urine flow. They are also recommended for post-natal exercises.

When do I stop worrying about contraception?

You will be reaching the time when you no longer have to worry about contraception. However you need to wait a full 12 months after your last period before discarding contraception altogether if you are over 50, and two years if you are under 50. With the decreased fertility that comes with the perimenopause you may like to talk to a family planning expert about suitable forms of contraception for you. ‘Change of life’ babies are usually born to women who thought they could not become pregnant again! Remember that HRT does not act as a contraceptive and that it is difficult to know whether you have reached the menopause if you are taking HRT, as it gives you a monthly bleed.

Does HRT help?

‘HRT’ means giving natural or synthetic female sex hormones that replace the hormones which the woman is not producing enough of. HRT comes in the form of tablets, patches or gels and always contains oestrogen (either in a natural or synthetic form), and often a progestogen as well. (A progestogen is similar in effect to the female hormone progesterone.) HRT is extremely good for relieving menopausal symptoms like hot flushes, night sweats and vaginal dryness. Unfortunately, since about 2003 it has become increasingly clear that it is not as free from ill-effects as we had been led to believe. However, if used sensibly, it can be a great help to many women – particularly where sex is concerned. Taking HRT can in almost all cases restore your sex drive and get rid of the physical discomfort. This can take several weeks to happen. Some women, especially those who have had their ovaries removed surgically, will need treatment with testosterone as well as oestrogen.

What else can I do to help myself?

It is important to realise that what you are experiencing is a natural life event. Share your thoughts and anxieties with your partner, a good friend or a health professional. Improve your self-confidence by taking the time to pamper yourself. Don’t underestimate the rejuvenating effects of a good haircut, change of hair colour or a relaxing facial. Make sure your diet is healthy and take regular exercise - you will reap the benefits.

How could the menopause affect my sex life adversely?

It’s fair to say that many women have a great sex life after they pass the menopause. However, others don’t. These are some problems that can occur. Night sweats and hot flushes. These can be counterproductive to relaxation and romance. At night, such symptoms produce an intolerable feeling of heat, often accompanied by profuse sweating, and even a feeling of acute claustrophobia. If the sufferer has to throw off the bed sheets and open the windows when night sweats are at their worst, she’s not going to feel like absorbing even more body heat from her sexual partner!
Relative oestrogen deficiency can bring about vaginal dryness and thinning of the vaginal lining. The lack of lubrication and support for the vaginal walls can reduce arousal during sex and increase friction, which in turn may produce soreness, burning or irritation.
Irregular periods (oligomenorrhoea) can make the timing of spontaneous love-making difficult. (However, the menopause shouldn’t really cause badly irregular periods; if yours are ‘all over the place’ consult your doctor.)
Stress urinary incontinence (SUI) can occasionally arise during love-making – or during a climax.
Some women are conscious of dry skin, changes in the shape of their breasts and of a gradual redistribution of weight away from their breasts towards their waistline.
Loss of libido can occur; a minority of women complain that after the menopause they simply lose their desire for sex. Husbands may feel rejected because of this, and so relationship difficulties can arise.
Psychological symptoms such as mood swings, insomnia and depression can make it difficult to enjoy sex.

Making the most of the menopause

It is now known that women have much the same ability as men to enjoy sex. Indeed, many females are a good deal more highly-sexed than their partners! Women also have the advantage of retaining their capacity to have several orgasms one after another until very late in life. Young men are capable of frequent love-making, but as they get older they aren’t able to do it so often. Ironically, some women discover a renewed or even redoubled libido after the menopause, and sometimes report that their husbands can no longer keep up with their sexual demands. In these cases, buying a sex aid - such as a vibrator - can be a good idea. For many postmenopausal women, the fact that their husbands take longer to reach a climax becomes a bonus; it makes love-making far more enjoyable than when they were younger and everything seemed to be over in a matter of breathless seconds. This more prolonged love-making can provide time for both partners to explore new sensations and enjoy a variety of feelings.

Touching and intimacy

After the menopause, touching and intimacy can sometimes become more important than the physical pleasure of penetrative sex. This need to touch and be touched, physically and emotionally, is well worth nurturing. Such contact offers reassurance and comfort and the opportunity to show tenderness, companionship and love.