4 Things You Need to Know About Sex During Menopause, According to Experts

Let’s talk about that dreaded thing that literally every woman experiences at some point in her life: menopause. The good news is that we’ve come a long way towards normalizing the experience, whether that’s with products that ease symptoms or simply by getting our lexicon in order. But what about sex during menopause? Somehow that still feels taboo. Lucky for you (and me, a woman who very much still wants to have a sex drive in her 60s), there are experts here to help. Read on for a whole new perspective on what sex during menopause really looks like. (Spoiler: It can be pretty damn good.)

• Dr. Nan Wise, PhD is a certified sex therapist, relationship specialist, neuroscience researcher, and author of Why Good Sex Matters: Understanding the Neuroscience of Pleasure for a Smarter, Happier, and More Purpose-Filled Life. She has garnered international recognition for her research that addresses gaps in the literature regarding the neural basis of human sexuality.
• Dr. Maureen Slattery is a board-certified OBGYN with 20 years of clinical experience. She has advanced training in sex counseling and education, and is an AASECT-certified sex counselor. In addition to sexual health, her clinical practice also focuses on menopausal care. Maureen has been featured in online columns for the American Association for Retired Persons (AARP) on sexual health and aging for those over 50 (In the Mood), and  for the Rochester Regional Health’s Health Hive on using HRT during menopause. 

Twenty years ago, there was a lot of confusion and mixed messaging with regard to the safety of hormone replacement therapies designed to ease the transition to menopause. The verdict is in, though, and you can totally seek relief.

“Two decades of women were afraid to treat their symptoms and were pretty uncomfortable at best and miserable at worst due to one poorly designed WHI study that literally scared women to death about vasomotor symptoms,” explains Dr. Slattery, adding that “menopause is essentially endocrine failure and it causes real disruptive symptoms, but I have found that the Gen X cohort is not buying into the misinformation that came out in the early 2000's.” 

In other words, women now can use hormone replacement therapy to ease symptoms like hot flashes, genitourinary syndrome of menopause (aka vaginal dryness and/or a frequent urge to urinate), diminished sensation and arousal, and joint pain; treating these symptoms during the rough transition to post-menopause allows women to improve their sex life by increasing their comfort during sex, and just in daily life, too. 

Dr. Wise says that recent research indicates that medical doses of marijuana might do wonders for easing pesky menopause symptoms and bringing back your libido. (In fact, Dr. Wise is currently petitioning the New Jersey Medical Marijuana Commission to include female orgasmic disorder as a condition for prescription.)

You might be thinking, well, of course I will get some relief if I’m just stoned out of my mind. However, the science actually indicates that even small doses can be quite effective—so you don’t, in fact, need to get high as a kite to experience the benefits of cannabis. I’ll allow the expert to explain:

“Cannabis interacts with a wide ranging system that we have, the endocannabinoid system, which is so involved in all kinds of functions including sleep, mood, memory, appetite, pain and reproduction. We have endocannabinoid receptors all over the body and they're even in the reproductive organs,” explains Dr. Wise.

For this reason, Dr. Wise says she’s not at all surprised that preliminary research indicates that marijuana can help with everything from hot flashes to sex drive during menopause, which is why she’s also advocating for more really good studies to be done on the subject.

OK, you’re experiencing endocrine failure and your ovaries have breathed their last. It does sound rather bleak, and society has crafted a narrative around these natural biological changes that basically says menopause sounds the death knell for your sex life. That’s simply not true, though. Will your sexual desire change during menopause? Perhaps. But desire isn’t everything. “We don't have to just take the changes in our sex lives at this transition. Sex doesn't have to hurt! We don't have to let our libido diminish. I spend a lot of time coaching women in menopause and perimenopause about pleasure and intimacy, and to value it over desire,” says Dr. Slattery. Or as Dr. Wise so succinctly put it in our interview “f*** desire.”

Sexuality, like pretty much everything else, is what Dr. Wise describes as biopsychosocial. That means your beliefs, your experiences, the culture you live in—all these things and more will ultimately determine your experience of sex far more than just the biological changes that come with menopause. 

Fortunately, word has gotten out that women are still sexual beings during and after menopause, and there is research that shows senior citizens are actually having the time of their lives in the sack. Indeed, a Swedish study of septuagenarians revealed a shift in sexual attitudes: from 5% of 70-year-old women in the 1970s citing sex as a positive aspect of life, to 78% in 2000. 

I shared with Dr. Wise the fact that as a 35-year-old mother of two, I have definitely started to notice that I’m only really horny when I’m ovulating. (TMI?) For this reason, I was very curious to hear more about how a woman’s libido could stay active during and after menopause. As previously noted, sexuality is biopsychosocial; we already addressed the psychosocial factors, but it turns out there’s a biological one, too. “There are compensatory systems that get activated and adjustments your body makes during menopause,” explains Dr. Wise. In fact, one such adjustment is that the brain actually starts making more estrogen receptors to compensate for the decline of your ovaries. The takeaway? When you get to the other side of the rather strange and unpleasant transition, your body will find its equilibrium and you’ll be raring to go again—and this time without any worry of unwanted pregnancy, painful menstrual cramps or all that monthly bleeding that, let’s be honest, nobody really relishes.