Welcome to Doing It, a column where sex educator Dr. Varuna Srinivasan explores the deep connections between sex and emotions. This month, they speak to individuals about how their sex lives changed after menopause.
Fifty-two-year-old Sarah is currently going through menopause and using this time to reinvent herself. She finally came out as bisexual and is in the process of getting a masters degree. But she’s also dealing with some less-positive side effects: On top of all the physical symptoms commonly associated with menopause, Sarah experienced a low sex drive, to the point where she didn’t even want her partner to touch her.
For people with ovaries, menopause — defined as 12 months without a period — typically happens between age 40 and 58, with the average age of onset at 51. There are over 33 different symptoms associated with menopause. A fluctuation of hormonal levels can lead to vaginal dryness, hot flashes, sagging breasts, weight gain, all of which can have an effect on one’s sex life.
LaReesa Ferdinand, MD, a board certified ob-gyn who specializes in women’s hormones and menopause, says 40 to 50% of women who are experiencing menopause report a loss of desire or low libido. But she says that the decrease in libido cannot be solely attributed to the hormonal changes patients experience during perimenopause and menopause.
“There are a lot of psychosocial reasons why someone at that age might have a decrease in libido,” Dr. Ferdinand explains. “For example, women [in this age group] experience the highest rates of divorce. They can end up being caretakers for elderly parents or empty nesters going through financial changes.” Chronic stress can mess with your hormone levels and, in turn, lead to low libido.
Though the mainstream narrative has long portrayed menopausal women as universally sexless beings past their prime, a lower libido is not something everyone experiences. In the case of Eaton, a 69 year old writer and painter from Canada, their sex drive did not fluctuate at all. When they entered menopause around age 52, they experienced hot flashes and a decrease in vaginal lubrication but, according to Eaton, “sex became magnificent.”
“I'd always loved sex, but it became astonishing,” Eaton says. “Every week, it seemed, the sensations altered in some new, more wonderful way. Pre-menopause, sex had been pretty much the same for all those decades, but not any longer. Sexual pleasure increased 10 or 20 fold!’
Tina, a 33-year-old techie from San Francisco, Tina is currently experiencing artificial menopause, a byproduct of a complete double cystectomy as part of treatment for her stage 3/4 endometriosis. The changes she’s experienced around her sex life aren’t bad, but different.
“I was always the higher sex drive partner and now I feel like my partner and I match more similarly — which has honestly been a plus,” she says. While she now needs more lube than before, Tina reports she’s seen “no change in ability to have or frequency of orgasms.”
While some people find the physical and sexual changes unbearable on their own, in a lot of cases, menopause can lead to temporary mood shifts caused by fluctuating hormones and in some cases, worsening of pre-existing mental health issues like depression.
“When you’re going through menopause, many times, you aren’t ready to face some of these changes and it can feel like your body is breaking up with you,” Dr. Ferdinand says. And as women, we are often conditioned to push through the discomfort and dark times.
“My perimenopausal depression started when I was 42,” says Alle, a novelist living in Seattle. “It made me feel useless around the house, which resulted in a great deal of stress on my husband. By 46, I was yelling constantly at him — in front of our children — and several times, I came way too close to hitting them.”
Having sought professional mental health treatment and “every other remedy I could find,” Alle’s doctor finally recommended she opt in for surgical menopause, AKA a hysterectomy AKA removal of the uterus, to cut short her symptoms — an “insta-pause” as Alle calls it. She says she found instant relief after the surgery, becoming, in her words, more “functional.” She started to rebuild a romantic life with her husband.
All this is to say, there is no one “normal” way to experience sex after menopause. Your libido may completely plummet, increase 10 fold, or stay about the same. But there are plenty of ways to define what pleasure and sex looks like, regardless of what your body is going through.
Communicate your needs to your partner and sit with whatever discomfort may come up, physical or otherwise. Try expanding your understanding of the word “sex.” Maybe it doesn’t include vaginal penetration — or any type of penetration — anymore. It can simply involve intimate acts, like hugging, kissing, cuddles, and sensual back rubs.
Whether you are single or partnered, masturbation can be an incredibly rewarding process with the addition of aids, if needed. Vaginal dryness can be such a buzzkill, but using too much lube never hurt anyone. Dr. Ferdinand recommends a lube that’s rich in vitamin E, hyaluronic acid, or even coconut oil. If you’re into sex toys, like Eaton, invest in clitoral stimulators, vibrators, and other external toys if penetration is completely out of the question.
At the end of the day, the most empowering thing you can do is to own your journey. Be self-aware. You know your body best. Take notice of the physical changes and mental shifts. Note how they make you feel and if you’re genuinely having a tough time dealing with them. Bring a non-judgemental approach towards this period and remind yourself that this phase is completely normal.
While it can be difficult to ask for help, it can be beneficial to be proactive in the early stages of perimenopause and assemble a care team who you know you can rely on for assistance. Who are the people in your life that you can text and call on for help anytime you need? Pick the friends and family who know you the best to check in on you and help you when you can’t seem to advocate for yourself. Let them know you’ll be there for them in return.
And most importantly: Believe yourself. While menopause will inevitably cause some degree of discomfort and pain, you do not have to stay silent through the consequences of a changing body. If your symptoms are getting the better of you, don’t let anyone tell you to just get over it.
Advocating for yourself — and creating a happy, healthy sex life — during menopause might look like many different things. It can involve buying more lube to make sex more comfortable. It could be increasing the frequency of your appointments with a psychiatrist and getting a prescription for an antidepressant. You might opt for an affirming surgery, or one that relieves your symptoms. You know your body best, so listen to it and prioritize your needs.
Read more from Doing It:
What Really Happens at a Sex Party
My First Threesome Was Nothing Like What You See on TV
What It's Like to Try an Open Marriage After 10 Years of Monogamy
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