Menopause - American Sexual Health Association

Menopause

Menopause is a normal, natural event—not a disease.

Technically, you don’t actually “hit” menopause until it’s been one year since your final menstrual period. In the United States, that happens about age 51, on average. As women move beyond their childbearing years they may experience many physical and emotional changes.

Despite negative stereotypes, as well as some actual difficulties women can face during this time, many women report that once they’ve reached menopause they feel more confidant, stronger, and energized than they did before. At this period in their lives, many women have fewer child-rearing responsibilities and can use this time to take care of themselves. Women no longer have to worry about getting pregnant when having sex, potentially allowing for less stress and more enjoyment during sex.

Menopause isn’t a one-size-fits-all event, though. It affects each woman differently. Some women reach natural menopause with little to no trouble; others may experience symptoms that can hamper their lives. And when menopause starts suddenly as a result of surgery, chemotherapy, or radiation, the adjustment can be tough. Fortunately, menopause is better understood and more openly discussed than ever before. And better treatment options are available when needed.

Why Menopause Happens

A woman is born with a finite number of eggs, which are stored in the ovaries. The ovaries also produce the hormones estrogen and progesterone, which regulate menstruation and ovulation. Menopause occurs when the ovaries no longer produce an egg every month and menstruation stops.

Menopause is normalMenopause, when it occurs after the age of 40, is considered “natural” and is a normal part of aging. But some women can experience menopause early, either as a result of a surgical intervention, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that occurs before the age of 40, regardless of the cause, is called premature menopause.

Natural menopause happens gradually. The ovaries don’t abruptly stop; they slow down. The transition to menopause is called perimenopause. During perimenopause, it’s still possible to get pregnant—a woman’s childbearing years are winding down, and although her periods may become more unpredictable, her ovaries are still functioning and she still may ovulate, though not necessarily on a monthly basis.

What to Expect

Here are some potential benefits of menopause:

  • Less stress about getting pregnant
  • More time for intimacy with a partner
  • Chance to reflect on priorities in life
  • Increased sexual pleasure and closeness with partner

While many women take advantage of this time of transition to make positive changes in their lives, some symptoms can be inconvenient or difficult to deal with. The signs and symptoms of menopause, which can vary in intensity from woman to woman, often appear long before the one-year anniversary of your final period. Symptoms may include:

  • Irregular periods
  • Decreased fertility
  • Vaginal dryness
  • Hot flashes
  • Sleep disturbances
  • Mood swings
  • Increased abdominal fat
  • Thinning hair
  • Loss of breast fullness
When to See a Healthcare Provider

It’s important to see your healthcare provider during the years leading up to menopause (perimenopause) and the years after menopause for preventive health care as well as care of medical conditions that may occur with aging. If you’ve skipped a period but aren’t sure you’ve started menopause, you may want to see your healthcare provider to determine whether you’re pregnant. He or she may take a medical history, do a pelvic examination and, if appropriate, order a pregnancy test.

Always seek medical advice if you have bleeding from your vagina after menopause.

Alternative Medicine

Many approaches have been promoted as aids in managing the symptoms of menopause, but there is very little scientific evidence to back up the claims. Be sure to consult your healthcare provider before taking any herbal treatments or dietary supplements for signs and symptoms of menopause. Herbal products can interfere or interact with other medications you may be taking.

Sexual Health after Menopause

What are some concerns about sexual health after menopause? For one, less estrogen can lead to vaginal dryness, which may make intercourse uncomfortable or painful. Try using a water-soluble lubricant during sex, or applying a vaginal moisturizer every few days. Vaginal moisturizers are applied regularly, not just before sex, and get absorbed into the skin.

Libido may also change, for better or worse, but many factors besides menopause—including stress, medications, depression, poor sleep, and relationship problems—affect sex drive. Talk to your healthcare provider if sex problems occur—don’t settle for a so-so sex life. And remember, sexually transmitted infections (STIs) don’t end with menopause; safer sex still counts.

FAQs about Menopause

Does menopause lower sex drive in all women?
No. In fact, some postmenopausal women report an increase in sex drive. This may be due to decreased anxiety associated with a fear of pregnancy. In addition, many postmenopausal women often have fewer child-rearing responsibilities, allowing them to relax and enjoy intimacy with their partners. However, if you’re having concerns, take a look at this video for some reassurance and information about sexual difficulties women may face.

How does menopause affect sex drive?
The loss of estrogen following menopause can lead to changes in a woman’s sexual drive and functioning. Perimenopausal and postmenopausal women may notice that they are not as easily aroused, and may be less sensitive to touching and stroking—which can result in decreased interest in sex. Women who have a very low sex drive may be diagnosed hypoactive sexual desire disorder, or HSDD. Until recently, there weren’t medical treatments available for women’s low sexual desire. However, an FDA advisory committee recently approved the drug Addyi to treat HSDD. Addyi is the first medication on the market to treat HSDD in women.

In addition, lower levels of estrogen can cause a decrease in blood supply to the vagina. This decreased blood flow can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse. If you are not getting relief from lubricants and vaginal moisturizes, you might ask your healthcare provider about low dose vaginal estrogen. This is a form of estrogen therapy that is available by prescription in the form of vaginal creams, a vaginal ring, and a vaginal table


How can I treat vaginal dryness?
Vaginal dryness can be treated with water-soluble lubricants such as Astroglide® or K-Y Jelly®. Do not use non-water soluble lubricants such as Vaseline® because they can weaken latex (the material used to make condoms, which should continue to be used to avoid pregnancy until your healthcare provider verifies you are not producing eggs and to prevent contracting STIs).

Vaginal moisturizers are another option for treating vaginal dryness. Vaginal moisturizers are applied regularly, not just before sex, and get absorbed into the skin. They can last for up to three to four days before needing to be re-applied.
In cases where lubricants and vaginal moisturizers are not helpful, low dose vaginal estrogen is another option. This is a form of estrogen therapy that is available by prescription in the form of vaginal creams, a vaginal ring, and a vaginal tablet. This type of therapy restores the health of and sexual functioning of vaginal tissue.


Can I get help?
Although sexual problems can be difficult to discuss, talk to your healthcare provider; there are options to consider, such as hormone replacement therapy, topical moisturizers or creams, potential new drugs coming on the market, or counseling. Your provider may refer you and your partner to a health professional who specializes in sexual dysfunction. Sexual concerns may have a mental health component, and so the therapist may advise sexual counseling on an individual basis, with your partner or in a support group. This type of counseling can be very successful, even when it is done on a short-term basis.

Do I still have to worry about STIs?
Absolutely! Just as you must use protection if you do not want to become pregnant, you must also take measures to protect yourself against sexually transmitted infections (STIs). It’s important to remember that your risk of contracting STIs is a possibility at any point in your life during which you are sexually active, and this risk does not go down with age.

How can I protect myself against STIs?
Here are some basic steps that you can take to help protect yourself from STIs:

  • Use a latex condom consistently and correctly every time you have sex. (If you use a lubricant when using condoms, make sure it is water-based (not oil-based, like Vaseline®.)
  • Make sure to wash sex toys before sharing with a partner, or use a condom and switch condoms before sharing.
  • Limit your number of sexual partners. The more partners you have, the more likely you are to get an STD/STI.
  • Practice mutual monogamy. This means having sex with only one person who only has sex with you.
  • Choose your sex partners with care. Make sure both of you have been tested for STDs/STIs (before having sex).
  • Don’t abuse alcohol or drugs before you have sex. You may be less likely to practice safe sex if you are drunk or high.
  • Learn about STDs/STIs. The more you know about STDs/STIs, the better you can protect yourself.

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