As a certified sex therapist and neuroscientist, I get asked tons of questions about sex and menopause. For some, even having a conversation about menopause is associated with dread and distress. This makes sense given that one of the most toxic narratives we have as a culture is equating youth with beauty, with value, and with sexiness, especially when it comes to women. But good sex matters for older adults too.
Before you sink into despair, let’s take a look at the good news about menopause. Every single day, women successfully navigate the transition, embrace the changes, manage the symptoms, and see it as an opportunity for a breakthrough to the next leg of their erotic adventures: the fabulous 50a, sizzling 60s, sexy 70s, and beyond. As detailed in my book Why Good Sex Matters, our capacity for sexual potential is a lifelong journey.
Here’s what you need to know about menopause and sex.
Your sex drive changes—and that’s okay.
Menopause—and the transition period perimenopause, which precedes it—is accompanied by a lot of physical changes triggered by hormonal changes, which occur when the ovaries experience follicular exhaustion. In layman’s terms that simply means that the ovaries begin to poop out as they run out of follicles or eggs. Periods start to become irregular as ovulation becomes less frequent, and then the fun begins.
The most common symptom is hot flashes, which occur in up to 80% of women. These last 2 to 4 minutes and can be accompanied by palpitations, anxiety, shivering, and chills. Other symptoms include irregular menstrual bleeding, insomnia, mood changes such as anxiety and depression, breast tenderness, headaches, and vaginal dryness, which is caused by a drop in your body’s natural levels of estrogen and can make sex painful.
It doesn’t sound very sexy.
It’s true the symptoms of perimenopause can create discomfort that puts a damper on your libido. And when you don’t feel well, you’re not likely to feel frisky. That’s a big reason for the drop-off of sexual desire many women report during this transition period.
This is a great time to remember that there’s a big difference between active sexual desire, when we feel “horny,” and the “responsive” desire that can get jump-started by physical stimulation orby being turned on by a partner. In other words, if your active desire gets lost in the wake of perimenopausal symptoms, don’t panic. Learning how to stoke responsive desire can help you find your way back to pleasure.
Menopause is not the end of orgasms.
For some, menopause symbolizes the end of their sex lives as they know it. It feels like a looming, dooming, inevitable slide into sexual retirement as their libido crashes and burns. But that doesn’t have to be your menopausal destiny. For others, the transition to menopause is an opportunity for a sexual renaissance with their libido actually ramping up in spite of hot flashes and other symptoms.
One of my research participants, a 74-year-old grandmother who donated two orgasms to science (no easy feat considering that the cold, noisy, and cramped environment of the functional MRI brain scanner in which we record orgasms, is just about the least sexy place on earth) said that her sex life only truly began after menopause. That’s when she revamped her life and made sexual pleasure a big priority.
Attitude is everything.
How you think about menopause matters, in other words. For many years, the typical approach to menopause in our country was to medicalize it. Doctors would prescribe hormone replacement therapy as a rite of passage, attempting to reverse the changes that would occur as hormone levels dropped. (When a link between HRT and an increased risk of breast cancer was discovered, the number of women undergoing the treatment dropped dramatically.)
Menopause isn’t a disease—it’s a natural transition. And it will help your sex life to think of it that way.
We harbor a lot of beliefs about aging and sexuality that may negatively contribute to our experience of menopause. In Western cultures that value youth, we tend to think of “old” as ugly and unappealing, particularly when it comes to women. This kind of ageism is a bigger quashing of our libidos than any kind of hormonal change.
In addition, cultural factors can loom large. Some cultures focus on the loss of procreation as a big deal. Other societies, particularly those that value older adults, see menopause as an opportunity for women to develop themselves and share their wisdom. If we experience ourselves as embodied sexual beings and enjoy the experience of sex for our own pleasure, joy, connection, and fulfillment, we can own our sexual narrative.
Loving your body—as is—is important.
When I asked my research participants (ranging in age from 23 to 74) how they got so comfortable with their sexuality that they could donate an orgasm to science, they all mentioned one thing: They learned to love their body, exactly as it is.
It’s something I’ve seen time and time again in my practice as a sex therapist and in my research: By confronting your internalized ageism and old beliefs about your body and your sexuality, you can become a more empowered sexual being. The simple truth is, being comfortable in your own skin can be a big turn-on—for you and for the partner you share your beautiful body with.
Menopause is a good time to address relationship issues.
Menopause is going to take a bigger toll if you are experiencing relationship strife. A big factor in increased menopause symptoms is marital discord. Some of the symptoms of a relationship in trouble include ongoing conflict without resolution (usually associated with tons of blaming, judging, and other destructive relationship habits).
The good news is that good communication tools can help improve the quality of your relationship.
Investigate options with your doctor.
Menopause is a great time to get more assertive about prioritizing your own self-care. Take charge of your own well-being by speaking with your doctor about how to manage any of the symptoms you experience.
There are many different approaches to treating hot flashes, vaginal dryness, and changes in libido—some involve full-tilt pharmaceutical treatments such as prescription hormone therapies, and others are more focused on managing symptoms through the use of various nutraceuticals (nonhormonal therapies) or lifestyle changes in diet and exercise. Adding in stress-management strategies is a good complement to any approach.
Nan Wise, Ph.D., is AASECT-certified sex therapist, neuroscientist, certified relationship expert, and author of Why Good Sex Matters: Understanding the Neuroscience of Pleasure for a Smarter, Happier, and More Purpose-Filled Life. Follow her @AskDoctorNan.
Originally Appeared on Glamour