Menopause and Sex
While menopausal women are no longer at risk for unintended pregnancy from unprotected intercourse, a dangerous myth is that menopausal women are no longer at risk for sexually transmitted diseases (STD's). This isn't true. Menopausal women may be less likely to get pelvic inflammatory disease (PID) than younger women, but they are still at risk for virally transmitted STD's such as HIV/AIDS, herpes, HPV, gonorrhea, chlamydia, syphilis, genital warts and hepatitis B. Recent news articles have reported on the rising rates of all STD’s in retirement communities. Condoms are still recommended for any sexual intercourse outside of a mutually monogamous relationship.
Another prevailing myth about menopause is that it is associated with "empty nest syndrome" and causes depression. Research has shown that the incidence of depression in women actually peaks in the 30's; on the contrary, many women in their 50's experience what Margaret Mead termed "post menopausal zest". Menopause is a risk factor for depression in certain women however: women who have had a previous history of depression (including postpartum depression), women with any other psychiatric illness, women with a family history of menopausal depression, and women with a history of premenstrual dysphoric disorder (PMDD, a severe form of PMS). Depression can also be a symptom of numerous other medical disorders, from hypothyroidism to heart disease to infectious conditions; any menopausal women with depression should consult their physician, rather than assume it's "normal" to become depressed when one enters menopause. What if your doctor's diagnosis is depression? Remember- it is treatable. Depression is not only a major cause of decreased libido and sexual satisfaction, but decreased libido and decreased sexual satisfaction can be early symptoms of depression.
Unfortunately, some of the common medicines used to treat depression may also negatively impact your sex drive- or your partner's. Other common medications such as medicines for high blood pressure may have the same effect. Talk with your physician about this or have your partner do the same; there may be simple changes that can be made which can have very positive outcomes. It's also important-although it may be embarrassing--to talk with your physician about any physical difficulties you may be having related to menopause that may impair your sexual activity. Many of these difficulties can be improved or resolved with medical therapy, such as hormone therapy ( HT), vaginal lubricants, Osphena, aids for incontinence, or making changes to existing medication regimens.
It is clear that estrogen has a positive benefit on treating menopausal symptoms in the short term (less than 5 years), which in turn may improve sexual desire and satisfaction. Some studies have also shown that a combination of estrogen and testosterone, the male hormone that women normally manufacture, may improve sexual desire. All medical treatments have advantages and disadvantages, however. Results from the Women's Health Initiative indicated that women whose average age was 63.5 who took a combined estrogen-progesterone combination therapy had an increased risk of invasive breast cancer, heart attacks, strokes, and blood clots. Estrogen-testosterone replacement may also reduce the cholesterol benefits that estrogen alone provides and have other side effects. More studies are needed to evaluate fully the benefits/risks of combined estrogen-testosterone therapy, as are studies to elucidate the benefits of estrogen or its alternative therapies on menopausal sexuality in general. Only your physician can give you individual recommendations as to what's best for you given the information we now have and your own personal risk profile.
One approach to learning more about menopause and sexuality is to ask menopausal women themselves. The largest study of this kind queried 27,347 women aged 50—79 years published in the journal Menopause (2011) to determine the patterns and predictors of sexual activity in women in the hormone therapy trials of the Women's Health Initiative (WHI). There were some very interesting findings from this cohort, notable that many older women preferred more sexual activity rather than less; many women are sexually active into their 70s and 80s; the majority of women surveyed were satisfied with their sexual activity; that among those who were dissatisfied, 57% would prefer more sexual activity and only 8% would prefer less; and that the main reason older women are not sexually active is lack of a partner.
There is so much that women can, and should, do to protect their health-physical, emotional, psychological, and sexual--during and after menopause. Exercise, nutrition, good relationships and a positive attitude will all help women live vital and healthy lives. Sex is just one part of the equation. Women entering menopause and even those already in menopause should speak with their doctors-and their partners--about what's best for them.
Revised: 2/7/2015 - Donnica Moore, M.D.
Created: 9/25/2000  - Donnica Moore, M.D.
Reviewed: 8/27/2003  - Donnica Moore, M.D.