Got Sexual Dysfunction Around Menopause? You Are Not Alone

Michael Hunter MD
Dec 8, 2019 · 4 min read

Sexual dysfunction increases by nearly thirty percent during perimenopausee.

Photo by Kristina Flour on Unsplash

Perimenopause, or menopause transition, begins several years before menopause. It’s the time when the ovaries gradually begin to make less estrogen. It usually starts in a woman’s forties, but can start in her thirties or even earlier. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs.

For many women, sex becomes less satisfying with age, with a pronounced decline during peri-menopause. There are many factors that can negatively impact sexual function, including mental and emotional status, aging, chronic medical problems, and menopause status. Diminishing estrogen levels during the menopause transition can result in a myriad of biological changes , leading to vaginal atrophy, or the thinning, drying, and inflammation of the vaginal walls.

A new study indicates that sexual dysfunction increases by nearly thirty percent during perimenopause, and vaginal dryness most often has the greatest effect on desire, arousal, lubrication, and overall satisfaction. Study results were published this week in Menopause, the journal of The North American Menopause Society (NAMS).

While historical studies have examined the effects of vaginal atrophy or decline, the current investigation is unusual in that it assessed vaginal status during the transitional time before menopause when the ovaries are gradually reducing their estrogen production. Researchers found the following:

Certain symptoms of vaginal atrophy, such as vaginal dryness, are much more prevalent during the menopause transition. Largely as a result of vaginal dryness, researchers noted that sexual satisfaction scores decreased while sexual dysfunction increased by about thirty percent during the perimenopausal years.

Photo by Gabriel Matula on Unsplash

Make Sex Better After Menopause

So what might a woman do, if she wants to make sex better? Here are some suggestions:

  1. Rediscover What Libido Means to You

As you may well-understand, libido is a complex aspect of sexuality. You may even be uncomfortable discussing it. In an effort to restore intimacy in a relationship, many woman turn to medical means to transform arousal and arousal—think pelvic physical therapy or laser rejuvenation. Others make lifestyle changes, take medicines, or incorporate technology to help with vaginal tissue changes, including dryness.

Sex therapists may offer hope in facilitating a new sense of intimacy for you and a partner. This may mean changing sexual routines, bring sex toys into the mix, or focusing on foreplay. And let’s not forget medical and psychosexual treatments, including pelvic exercises, couples counseling, and holistic changes.

2. Get Support for Symptoms

A single approach is not always sufficient. You may need more than one professional’s help, more than one management approach, and more understanding. As important as the physiologic changes may be, menopause is not simply a constellation of physical changes. Many experience stress, anxiety, depression and other emotions. These in turn can affect sexual desire and performance.

Among the many approaches are mind-body activities. For some, these may help relieve those symptoms that interfere with sexual intimacy, desire, and even sleep quality. These include:

  • mindfulness
  • tai chi
  • acupuncture
  • yoga

No single approach is completely effective, so any women test various approaches. And don’t forget stress relief.

Photo by Sharon McCutcheon on Unsplash

3. Medicines

Physical changes typically occur with the onset of perimenopause. For example, drops in the hormone estrogen can cause the aforementioned atrophy of the vagina, which then can lead to narrowing and shortening of the vagina itself. Others may experience uterine prolapse, a condition in which uterus descends toward or into the vagina. It happens when the pelvic floor muscles and ligaments become weak and are no longer able to support the uterus. This is not always so benign, as women can have pain with sex (dyspareunia) or leakage of their urine.

Some turn to medications for symptom management. Examples include hormonal replacement therapy, or HRT. This approach may be in the form of pills, patches, foams, or vaginal creams. With HRT, you may have less vaginal atrophy, and fewer menopausal symptoms such as hot flashes. Still, HRT should be offered only in the context of a thorough review of the risks of this approach.

Some women turn to testosterone, even though it is not approved by the US Food and Drug Administration. As with estrogen or estrogen/progesterone replacement therapy, testosterone comes in many forms, including pills, creams, and patches.

While many woman turn to herbal supplements (such as soy or black cohosh) to help with sexual desire or libido, in the United States, the Food and Drug Administration does not regulate herbs and supplements.

Fortunately, many women can discover the means to address low libido, if they seek them out. With information you may reduce the adverse impact on your quality of life and intimacy from the symptoms associated with perimenopause.

Tackling it with new knowledge can minimize any negative impacts on your quality of life, emotional satisfaction, and intimacy. It is entirely possible for many to continue to have healthy sexual relationships.


  1. Menopause, the journal of The North American Menopause Society (NAMS), November 2019.
  3. [a wonderful resource for both professionals and non-professionals alike).

Michael Hunter MD

Written by

I have degrees from Harvard, Yale, and Penn. I am a radiation oncologist in the Seattle area. You may find me regularly posting at

Welcome to a place where words matter. On Medium, smart voices and original ideas take center stage - with no ads in sight. Watch
Follow all the topics you care about, and we’ll deliver the best stories for you to your homepage and inbox. Explore
Get unlimited access to the best stories on Medium — and support writers while you’re at it. Just $5/month. Upgrade