It’s an undeniable fact: Menopause can mess with your sex life. If you’re going through “the change” and find yourself facing challenges in the intimacy department, you’re not alone. Many women report painful sex, difficulty connecting with their partners, and an overall lack of enjoyment during and after menopause. With those factors and more – think hot flashes, night sweats, fatigue, and brain fog – putting a damper on your libido, how do you begin to tackle the problem?
There’s no magic bullet for getting your sex life back on track, and it may take a little figuring out, but don’t let that deter you. Sex is an important component of a relationship regardless of age: Not only does it help you bond with your partner, studies have shown that it relieves stress, improves heart health, sharpens your memory, and boosts happiness.
To better understand the issues women face and how to address them, we got in touch with Dr. Suzanne Gilberg-Lenz, OB/GYN, sexual wellness expert, and medical adviser for Kindra, which provides medically reviewed, educational material on menopause as well as a line of estrogen-free products.
What causes low libido during and after menopause?
Dr. Suzanne points out that every woman experiences menopause differently. Some may experience a lower sex drive, and some might not. In either case, she says, libido can be influenced by societal pressure. “It’s really important to acknowledge that people’s libido is on a spectrum,” she says. “I think women who are getting toward menopause, in menopause, or past menopause [today] were raised with a very different set of social mores.” As a result, many women may feel shame having sex at an older age, whether it’s because they think older adults shouldn’t have sex or because they’re embarrassed about their bodies.
In addition, Dr. Suzanne notes that women often face changes in their personal lives during menopause. The New York Times reports that many women between 50 and 74 years old feel far too busy for a sex life. Some care for older parents, and some have partners with serious health issues that make sex difficult.
The other side of the coin is physical change. “Estrogen loss is not a disease. It is a normal physiological event,” she says. “That’s going to change the tissue and the responsiveness [to stimulation]. Sex may become less satisfying, or more painful.” Other hormones in the body will fluctuate as well, including progesterone and testosterone. All these fluctuations can lead to hot flashes, night sweats, fatigue, insomnia, headaches, vaginal dryness, and other symptoms.
On top of that, you may be facing other medical issues at this stage of your life. Health problems can crop up unexpectedly in middle age, including high blood pressure, high cholesterol, diabetes, and arthritis. It’s no wonder, then, that all these factors can contribute to low libido.
Can taking supplements help your sex drive?
Though there isn’t a one-size-fits-all solution to low libido, Dr. Suzanne believes that supplements can indirectly improve your sexual intimacy by easing menopause symptoms. The North American Menopause Society notes that hormone therapy is the most effective treatment for menopausal symptoms like hot flashes. However, women who still have a uterus generally need to take progestogen (a progesterone product) along with estrogen to prevent uterine cancer.
It’s important to note that hormone replacement therapy (HRT) comes with risks, including increased risk of blood clots in the legs and lungs. HRT may also increase the risk of breast cancer, especially if a patient uses it for five or more years. As a result, doctors generally won’t recommend it to women with histories of breast cancer, blood clots, and other risk factors like heart disease and stroke.
Fortunately, there are plenty of hormone-free supplements that can ease menopause symptoms and potentially boost your libido. “I’m a breast cancer survivor, so I can’t use estrogen [pills] for hot flashes,” says Dr. Suzanne. “I absolutely use the [Kindra] Core Supplement (Buy from Kindra, $47) and the Sleep Enhancing Supplement (Buy from Kindra, $37). These aren’t going to increase libido specifically. However, if you feel better in your body, if you’re not hot flashing all day and night, and you’re getting some sleep, you will feel more able to connect sexually.”
Looking for other estrogen-free supplements? Nature’s Nutrition Female Libido Support (Buy from Amazon, $24.82) contains maca root and ginseng, which can reduce stress and improve mental clarity, respectively. You might also try something more simple that you can add to a smoothie: the Terrasoul Superfoods Maca Powder (Buy from Amazon, $12.49). The powder comes from maca, a radish-like root veggie that may ease stress.
Why Estrogen Loss Causes Painful Sex
Research shows that the loss of estrogen causes vaginal dryness, a common culprit behind discomfort during sex. “Estrogen has a direct effect on blood flow to the area,” says Dr. Suzanne. “And that blood flow is really important for not only bringing nutrition and taking waste away, but for creating the lubrication – fluid that’s coming through the blood vessels and leaking, essentially.”
In addition, the loss of estrogen in menopausal women causes vaginal cells to store less glycogen. (Glycogen is a molecule made up of multiple glucose molecules, and cells use it for energy.) Glycogen loss changes the vagina’s acidity. “The vagina [gets] less acidic, the microbiome shifts and causes irritation, [and] you get different kinds of bacteria in there than what you had before,” says Dr. Suzanne.
Vaginal Lotions and Moisturizers That Reduce Painful Sex
If you think that a vaginal lotion or cream containing estrogen would improve your symptoms, talk to your OB/GYN. A doctor may prescribe an estradiol vaginal cream (which contains estrogen) that you can apply on a daily basis. And if you aren’t a candidate for systemic hormone therapy – hormone therapy in pill form – because of your health status, Dr. Suzanne says that an estradiol vaginal cream may still be safe to use.
“I don’t think enough people realize that you can use hormone replacement therapy in the vaginal and vulvar tissues, and [it’s] not going to affect the rest of your body at all,” she says. “I’m a breast cancer survivor. I can use [vaginal hormone cream]. That’s not a problem for me … I think a lot of my colleagues are misinformed about this too.” Talk to your doctor about your specific limitations to see if topical hormone therapy is right for you.
Otherwise, a topical product without estrogen may work for you. While a non-estrogen vaginal lotion won’t help in the same way as an estrogen lotion, it can restore moisture to the area. “If you put some of these novel therapies in that tissue, you’re not going to increase the blood flow. But you are going to increase the plumpness [of the vaginal tissue],” says Dr. Suzanne.
With vaginal lotions and moisturizers, it’s important to use them regularly to reduce symptoms over time. These are not lubricants for sex – think of them more like skincare. For a clinically tested, fragrance free option, try the Kindra Daily Vaginal Lotion (Buy from Kindra, $49). Or check out the BeeFriendly Queen Bee Organic Vaginal Moisturizer (Buy from Amazon, $27.99). You may even prefer a cream-free, vaginal insert like the Revaree Vaginal Moisturizer from Bonafide (Buy from Bonafide, $55 for 10 inserts). All three options contain zero estrogen.
How to Address Intimacy Issues With Your Doctor
While you can certainly use supplements and products to ease menopause symptoms and indirectly improve your libido, it’s important to work with your doctor as well. Getting expert advice for your symptoms and other health conditions that indirectly lower libido will help you form a comprehensive plan to address your issues.
However, Dr. Suzanne acknowledges that some women have difficulty expressing themselves to their doctor, or sometimes feel that their concerns are dismissed. “If your doctor’s telling you, ‘No, there’s nothing you can do,’ or, ‘my way or the highway,’ then I think that’s just a huge red flag,” she says. “I’ve learned so much over the years from my patients. It’s opened my whole world, my mind, and made me a much better doctor, because I’m a super curious person.”
Don’t be afraid to bring research to your next doctor’s appointment and ask your doctor to work with you on the issues you’re experiencing. And be firm about getting the help you need, even if that means switching doctors. Dr. Suzanne also recommends utilizing online resources, such as the International Society for the Study of Women’s Sexual Health (ISSWSH), the International Society for Sexual Medicine (ISSM), and her own sexual health startup, Le Minou.
With the right resources, products, and healthcare, you can dramatically improve your sex life and enjoy intimacy at any age.
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This article originally appeared in our print magazine, Woman’s World.
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