Hormonal changes during menopause can cause physical and emotional effects that may affect female arousal and a person’s sex life.

When a person reaches their 40s, their estrogen and progesterone levels start to dip. Eventually, menstruation will stop. When a person has not had a period for 12 months, it marks the beginning of menopause. In the United States, this occurs at an average age of 52.

Some people experience menopause early. This may be due to genetic factors, a medical condition, or some types of medical treatment. If a person undergoes surgery to remove the ovaries or the uterus, the effects will begin almost at once.

Regardless of when menopause starts, the reason it starts, and a person’s gender identity, it can affect the desire for and experience of sex.

However, some treatment options can help manage these effects and improve a person’s quality of life. Read on to learn more.

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During perimenopause, the hormones that are responsible for fertility and pregnancy, including estrogen, decrease. This causes changes in the blood vessels and tissues of the vagina and vulva. Some lifestyle modifications may be necessary to manage these changes.

One effect of these changes is vulvovaginal atrophy. The vulva and vaginal tissues lose elasticity and moisture, and they become thinner, become drier, and lose their folds. Thinner tissues are more easily broken, bruised, and irritated.

The tissues also receive less lubrication. This intensifies friction during intercourse and increases the risk of damage.

Physical effects that can affect sex during menopause include:

  • a decrease in vaginal tone or loss of elasticity 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

Lower estrogen levels can also increase the risk of atrophic vaginitis, which involves inflammation of the vaginal tissues. This, too, can cause pain, swelling, itching, and burning.

The experience of menopause and the severity of its effects can vary widely from person to person. It is important to see a doctor if these effects begin to interfere with daily life or reduce quality of life.

Fluctuating hormones can also have an emotional impact, affecting sleep and mood. Tiredness, anxiety, irritability, difficulty with concentration, and depression are particularly common.

Combined with the physical effects of menopause, these can also affect a person’s experience or enjoyment of sex. A reduced sex drive or inability to enjoy sex can also affect self-esteem and intimacy.

Sadness, depression, and stress can also play a role. Some people experience grief during menopause, as they feel they are reaching the end of their youth. Some may grieve their fertility. The person can also lose interest in activities that used to bring them pleasure, including sex.

The most common emotional effects that interfere with sex include:

  • anxiety, nervousness, or uncertainty
  • irritability
  • a lack of concentration and motivation
  • fatigue
  • depression or sadness
  • a sense of loss or regret
  • a loss of sexual desire or interest
  • a loss of self-confidence
  • a loss of intimacy

Not everyone experiences negative emotional effects during menopause, however.

Some people have a sense of liberation that they no longer need to worry about pregnancy or menstruation. Many see it as the start of an exciting new stage in life, which they can approach with greater wisdom, confidence, and an ability to speak for themselves.

Depending on circumstances, some also experience a liberation from childcare responsibilities and enjoy having the chance to focus on themselves and their own needs.

It is important to remember that age can also affect libido. Many people find that their partner is also experiencing similar changes at this point in life. Having an open conversation may help find new ways to explore intimacy together. There may even be a sense of relief that the pressure is off to have sex frequently.

However, if emotional changes start to affect a person’s quality of life, they can talk to a doctor.

Read about some research that explores why women may have less sex as they age here.

A person born with ovaries will experience menopause, but the experience may vary, depending on their gender identity.

If the person undergoes surgery to remove the ovaries before midlife, the effects of menopause will start to appear soon after the procedure. Effects may be more abrupt and feel more severe than with natural menopause, as they will not develop gradually. Male hormone supplements may either reduce or complicate these effects.

Females in same-sex couples who experience menopause naturally at midlife may find that their partner can offer positive support regarding changing sexual emotions and activity. According to some research, however, same-sex couples may also find that stigma and societal pressures add to their stresses and make it harder to access support.

People who were assigned male at birth but have transitioned to female may use hormone therapy for life. As long as they continue treatment, menopause-type effects should be limited. Their libido is unlikely to change due to hormonal fluctuations, but age-related changes may still affect it.

The physical and emotional impact of menopause can lead to a reduction in sexual activity. However, staying sexually active can help prevent these complications. This is because consistent activity can help the vagina remain healthy, especially after menopause.

Regular sexual stimulation helps promote blood flow to the vagina and retain the vagina’s elasticity, depth, and overall shape.

Over-the-counter products can often help. If these are not effective, however, a doctor may prescribe medication.

Some simple tips to reduce sexual complications include:

  • engaging in regular sexual activity
  • applying a vaginal lubricant before intercourse
  • using a vaginal moisturizer regularly and before intercourse
  • avoiding detergents, soaps, oils, and washes that can cause dryness
  • using lukewarm rather than hot water for cleansing
  • increasing foreplay or activities that promote sexual arousal
  • engaging in couple bonding or strengthening activities
  • managing stress with exercise and relaxation activities
  • talking to a therapist or counselor
  • finding ways to rekindle passion or repair partner relations
  • trying new or different sexual activities
  • treating any vaginal irritation, infections, and inflammation
  • staying hydrated
  • avoiding materials that irritate the skin

Learn about more ways to boost libido here.

Many people do not seek treatment for the effects of menopause. In time, the effects lessen and eventually go away.

However, treatment is available for those who experience intense and persistent effects. For example, doctors may prescribe medications or creams that contain estrogen, progesterone, or both.

Depending on the individual, options may include:

  • Topical estrogen or progesterone medications: A doctor can prescribe rings, tablets, creams, or suppositories to place directly on vaginal tissues. These can help reduce dryness.
  • Menopausal hormone replacement: This can help reduce vaginal dryness, discomfort, and associated pain during sex, as well as hot flashes, mood changes, and mild depression.
  • Medications designed for other conditions: Some medications for managing depression, anxiety, epilepsy, and high blood pressure may also help reduce hot flashes and mood changes.

However, it is important to note that hormonal treatment options might not suit everyone, as they may trigger adverse effects. A doctor may not advise them for those with high blood pressure, a risk of blood clots, and various other conditions.

Some people use herbs and supplements to reduce the effects of menopause, but research has not yet confirmed their safety or effectiveness.

These include:

  • black cohosh
  • evening primrose
  • red clover
  • dong quai
  • ginseng
  • plant estrogens present in legumes, such as soybeans and chickpeas, and some whole grains, seeds, and fruits

The Food and Drug Administration (FDA) do not monitor herbal medications and supplements for purity or quality. People should always choose products from a reputable source.

Many herbs can also interact with medications. People should speak to a doctor before using herbs or supplements.

Other options for reducing the effects of menopause include bio-identical hormone therapies, which pharmaceutical companies have developed to try to counter the risks associated with traditional hormone therapies.

These medications use hormones from plants. The body may tolerate them better than other hormone therapies, but they are not identical to human hormones.

Many have approval as safe and effective options.

The North American Menopause Society advise people to avoid custom-compounded bio-identical hormone medications. These are mixtures of hormones prepared by pharmacists and tailored to individual needs.

Drug mixtures prepared by pharmacists, doctors, nongovernmental laboratories, or individuals are not subject to regulation, so there is no guarantee that they are safe or effective.