Sexual Decline During Menopause

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Are you menopausal and experiencing a decline in your sexual function?

Do not worry, you are not alone.

A study which used data from the  Study of Women’s Health Across the Nation (SWAN) provides more information to us about sexual decline during the menopause. It was published in Menopause, the journal of The North American Menopause Society (NAMS).

Researchers gathered data from about 1,400 women who were in either the natural menopause or hysterectomy groups of the SWAN study.

NAMS explains the findings for us:

  • No decline in sexual function was documented until 20 months before the final menstrual period.
  • From this time until one year after the final period, sexual function scores decreased by 0.35 annually and continued to decline more than one year afterward but at a slower rate.
  • The decline was smaller in black women and larger in Japanese than in white women.
  • Women who had a hysterectomy before the final menstrual period did not show a decline in sexual function before surgery but did experience a decline afterward.
  • In total, sexual decline persisted for five years after the final menstrual cycle.
  • Although menopause is often accompanied by such related symptoms as vaginal dryness, depression, and anxiety, these factors did not explain the effect of menopause or surgery on sexual function.
  • The problem of declining sexual function is a serious one, because more than 75% of the middle-aged women in the study reported that sex was moderately to extremely important.


Dr. JoAnn Pinkerton, the executive director of NAMS further explained, “This study highlights the need for healthcare providers to have open conversations with their patients about their sexual issues, because there are many options for women to help maintain or improve their sexual lives as they transition to and beyond menopause. Low-dose vaginal estrogen, for example, which has minimal risks for most women, is an effective and safe treatment for painful intercourse as is a non-estrogen therapy called ospemifene.”

Information is power!

If you are experiencing sexual issues, please reach out to your menopause specialist.  If you don’t have one, I have some helpful tips here!

Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide To Surviving and Thriving During Perimenopause and Menopause.

My motto is:  Suffering in silence is OUT!  Reaching out is IN!

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • Carolyn Cullen

    What has helped me greatly with this is the amino acid L-Citrulline, which is made from watermelon and is natural, safe and available from vitamin/health stores (I paid $20 for 120 capsules, fyi). Studies have shown it helps men with erectile disfunction and is safer than viagra, etc, and it works similarly in women, reducing dryness and hot flashes, improving blood flow, and so on. It increases nitric oxide production, which supports the lining of your cardiovascular system, similar to one of estrogen’s effects. Detailed resources: and
    So far I have one friend who tried it and agrees (I take 1 500 mg pill morning and 1 evening) and want to tell more women. Please give it a try; it can’t hurt and may help a lot! (I have two technical degrees and am not a pill fanatic and do my research, really 🙂 ).

    • Carolyn, I have not heard of this one. Thanks for sharing this with us. I shall do some research on this.

    • KS

      I wonder if this would be safe for someone who gets migraines? I just read recently that they suspect it is a nitric acid issue that contributes to migraines.

      • That is a great question for a headache specialist. I have read that nitric oxide does impact headaches, too.

      • I reached out to Dr. Hutchinson, M.D., director of the Orange County Migraine & Headache Center in Irvine, California for her advice on this question. She said that the general consensus is to avoid estrogen-containing contraception in a migraine with aura to avoid an increase in stroke risk. However, HT (hormone therapy) is different than oral contraceptives. My opinion is that the risks have to be weighed against the benefits so if a woman who has a migraine with aura is having hot flashes and would like to try hormonal therapy then I would recommend a trial of an Estradiol Patch and an oral progesterone. I like “bio-identical” meaning that the estrogen and progesterone would have the same chemical structure as a woman’s own ovaries and would be more likely to help a migraine than hurt. Once HRT is started I would advise the woman to watch the pattern of her headaches and aura carefully and report any marked increase to her treating provider. I hope this is helpful

  • I agree that information is power, and it is wonderful that you share information so badly needed!

    • This is a tough problem for many women. I think it helps to understand that this issue is real and that their is new research to shed some light on it.

  • Great information Ellen. It is always fascinating the data that the studies show. I like this one that goes for 5 years but of course what happens after that?

  • This is another one of those areas nobody likes to discuss, but is really important to be aware of – that amino acid L-Citrulline that Carolyn mentioned sounds interesting too.

    • Agreed, Leanne. I share this info to help encourage women to speak to their healthcare professionals. No need to suffer in silence. It’s great that Carolyn shared this info on L-Citruline. I am not familiar with it. I am going to do some research on it.

      • Carolyn Cullen

        Hi Ellen,
        Please let us know if you have anything to report. I have told several friends about it and they are also enjoying amazing results (as is my husband 🙂 ). Take care, all!

        • My blog is here to share your own stories to help others with theirs! Of course, before taking anything…even over the counter remedies, it is always best to check with your doctor.

          • Carolyn Cullen

            Yes, I totally agree and my friend and I did. It can lower blood pressure by improving the lining of your circulatory system but that’s usually a good thing, unless it were to compound the effects of a prescription drug too much. Thanks!

          • Glad you checked it out with your healthcare professional. So smart of you, Carolyn.

  • Watermelon is so good for you. More lycopene than tomatoes. Good to know it works in other ways.

    • I love watermelon! I feel as excited about eating it as I do a cookie! And, it is so much better to have the natural sugar rather than the processed sugar.

  • Watermelon? I love watermelon! Lots of good info here and actionable. Thank you, dear Ellen.

    • For women who are dealing with sexual decline, it is always helpful to know that it is real and not in their head so that they reach out and get the help they need. I love watermelon, too!

  • Lois Alter Mark

    I’d love to know what you find out about the watermelon. If only it were that easy!

    • Will keep you posted. In the meantime, I shall think about it differently when I eat it!!

      • Carolyn Cullen

        From what I have read, more of the compound is in the skin/rind than the juicy part and you’d need to eat impossibly huge amounts to help in that way, thus the concentrated supplement approach. But of course it’s great and healthy otherwise, too!

  • Estelle Sobel Erasmus

    More great and helpful info from you as always. And I love watermelon!

    • I love watermelon, too. Although, I am not quite sure if it is helping a dry vagina!

  • Carolyn Cullen

    If anyone tries the L-Citrulline, I’d love your thoughts. I have been taking 1 500 mg capsule morning and one evening for over 6 months and it’s miraculous–no hot flashes, etc and as much moisture as ever. Happy Thanksgiving all.

    • How fabulous! Happy Turkey day to you and yours!