Perimenopause happens in the years before periods stop and is characterized by hot flashes and other symptoms. Menopause begins when the menstrual cycle has stopped for at least a year.
While every woman's experience is different, an estimated 17-45 percent of menopausal women say sex can be painful.
Luckily, there are options to help treat the most common complications. In this article, we look at menopause effects and some helpful treatments.
The physical changes during menopause can vary from woman to woman and may cause emotional side effects as well.
During perimenopause, the hormones that bring about fertility and pregnancy decrease, including the hormone estrogen. This produces changes in the blood vessels and tissues of the vagina and vulva, making the organs more vulnerable to damage.
Most sexual complications of menopause stem from vulvovaginal atrophy, a condition marked by a loss of elasticity, moisture, and thickness of the vulva and vaginal tissues.
During perimenopause, tissues of the vagina and vulva receive less estrogen. As a result, these tend to thin, lose their folds, and dry out. Thinner tissues are more easily broken, bruised, and irritated.
The tissues also receive less lubrication, which intensifies the friction they are exposed to during intercourse, so increasing the risk of damage.
Other physical symptoms of menopause include:
- decrease in vaginal tone or loss of stretch in the vaginal wall
- pain, bleeding or burning during sex
- a feeling of tightness during intercourse
- decreased libido or sexual drive
- difficulty becoming or staying aroused
- repeated urinary tract infections
Some women also experience atrophic vaginitis, which causes inflammation of the vaginal tissues. Again, atrophic vaginitis stems from reduced estrogen levels and can cause pain, swelling, itching and burning.
Not all women see the same physical changes during menopause, and the severity of symptoms can vary. Women should see their doctor if symptoms begin to interfere with daily life or reduce the quality of life.
Decreased sex drive or inability to enjoy sex can also lead to loss of self-esteem and intimacy.
What menopause represents can also cause emotional problems. These side effects can be just as debilitating as physical effects, especially when it comes to sex.
During times of stress or sadness, people often lose interest in activities that would otherwise bring them pleasure. In this respect, pain and discomfort can make it difficult to enjoy sex.
Many of the physical changes that occur with aging can also intensify the emotional symptoms of menopause.
If sexual arousal or sensitivity is also affected, some women will shy away from sexual activity altogether, which can worsen symptoms.
The most common emotional side effects that interfere with sex include:
- anxiety, nervousness, or uncertainty
- lack of concentration and motivation
- depression or sadness
- sense of loss or regret
- loss of sexual desire or interest
- loss of self-confidence
- loss of intimacy
- feelings of worthless or helplessness
One survey found that 70 percent of menopausal women who experienced pain during sex said the problem also caused tensions with their partner.
Not all women experience negative emotional symptoms linked to menopause. Some women gain additional wisdom, confidence, and ability to speak for themselves. Those who do experience negative symptoms should talk to a doctor if they interfere with healthy sexual activity or everyday life.
Reducing sexual complications
The sexual complications of menopause may be reduced by maintaining an active sex life.
Staying sexually active is one of the easiest ways to lessen the sexual complications of menopause.
The physical and emotional side effects of menopause cause many women to reduce or refrain from sexual activity. However, the vagina needs consistent use to remain healthy, especially after menopause.
Regular sexual stimulation helps promote blood flow to the vagina. It also helps maintain the vagina's elasticity, depth, and overall shape.
Behavioral changes and over-the-counter products are often the first recommended treatments. In worse cases, a doctor may prescribe hormone therapies to help reduce vaginal dryness or hormonal creams to apply to the tissues.
Simple tips and treatments for the sexual side effects of menopause include:
- engaging in regular sexual activity
- vaginal lubricants applied before intercourse
- vaginal moisturizers applied regularly and before intercourse
- avoiding detergents, soaps, oils, or washes that can cause vaginal dryness
- using lukewarm versus hot water for cleansing
- increasing foreplay or activities that promote sexual arousal
- engaging in couple bonding or strengthening activities
- regulating or reducing stress through exercise and therapies
- talking to a therapist or counselor
- finding ways to rekindle passion or repair partner relations
- trying new or varied sexual activities
- treating vaginal irritation, infections, and inflammation
- keeping hydrated
- avoiding materials that irritate the skin
Treating sexual complications
Around 55 percent of women do not seek medical treatment for menopause symptoms, although most side effects lessen over time and eventually go away.
For some women, however, menopause symptoms are intense and persistent, so medical treatment is advised. Doctors may prescribe medications or creams that are composed of estrogen, progesterone, or both.
Individual treatment plans depend on a variety of factors, including additional health complications. Women who no longer have a uterus will not require extra progesterone, for example.
Medical treatment options for managing the side effects of menopause include:
- Topical estrogen or progesterone medications: Prescribed rings, tablets, creams, or suppositories put directly on vaginal tissues to help reduce dryness.
- Low-dose oral contraceptives: Mainly prescribed to reduce vaginal dryness, moodiness, and hot flashes. May also come in transdermal patches.
- Menopausal hormone replacement (MHRT): Prescribed to help reduce vaginal dryness, discomfort, and associated pain during sex. MHRT may also help reduce hot flashes, mood swings, and mild depressive symptoms.
- Medications meant to treat other conditions: Some management medications used to treat depression, anxiety, epilepsy, and high blood pressure may help reduce hot flashes and moodiness.
Additional health complications may rule out the use of hormonal treatment options, such as:
- high blood pressure
- personal or family history of heart disease or stroke
- cigarette or tobacco use
- family or personal history of cancer
- high blood cholesterol
- alcoholism or heavy alcohol consumption
- liver or kidney disease
- history of chronic bleeding
- blood clots or clotting complications
- those over 60 or who have already undergone menopause
Alternative treatments options
Though many herbs and spices are praised as cure-alls for menopause symptoms, little research has affirmed their benefits. Some menopause supplements have even proven harmful with continual use.
Evening primrose may be recommended as a menopause supplement but any supplement use should be discussed with a healthcare professional.
Commonly promoted though scientifically unproven menopause supplements include:
- black cohosh
- evening primrose
- wild yam creams
- red clover
- dong quai
- plant estrogens found in legumes, such as soybeans and chickpeas, and some whole grains, seeds, and fruits
The United States Food and Drug Administration do not monitor herbal medications and supplements for purity or quality. People should choose products from a reputable source.
Many of the above herbs can also interact with medications, so a woman should speak to her doctor before self-prescribing herbs or supplements.
Furthermore, pharmaceutical companies have created bio-identical hormone therapies in response to the cardiovascular and cancer risks associated with traditional hormone therapies.
Unlike traditional hormone replacement therapies that rely on synthetic hormones, these medications use hormones from plants. These may be better tolerated by the body, but they are not identical to human hormones.
There are many approved bio-identical medications that are proven safe and effective.
According to the North American Menopause Society, individuals should avoid custom-compounded bio-identical hormone medications. These medications are mixtures of hormones prepared by pharmacists and tailored to individual needs.
Drug mixtures prepared by pharmacists, doctors, non-governmental laboratories, or at home are not subject to regulation, so there is no guarantee that they are safe or effective.