Straight Talk About Peri-Menopausal and Post-Menopausal Sex! - Ellen Dolgen
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Straight Talk About Peri-Menopausal and Post-Menopausal Sex!

One of the things that prompted me to write a book on menopause was how many hours I spent searching for information during my own menopausal journey. I was like a sponge trying to soak up every bit of knowledge I could find, and I really wanted someone to take the mystery out of it for me, but all the medical jargon just confused me even more.

So here is the Menopause Myth Buster – straight talk about perimenopause/menopause and sex!  Let’s start with a common question:

“How come many women going through menopause don’t want sex?”
Unlike being drenched from a hot flash, this particular symptom of menopause can feel a little more private, a little more personal, and that makes it harder for some women to talk about. It’s the mystery of what’s happening to my sex life.  I title my own experience,” Sex in the Desert”!   My once tropical island of a libido turned into the equivalent of the Mojave Desert. I’d rather scrub the floors, clean the closets, and do just about anything else to avoid going to bed. And let’s face it, my libido wasn’t the only thing that felt dry. I began to wonder if I was the only menopausal woman going through this. I decided to ask around. Not surprisingly, at first, most of the women I talked to didn’t want to admit their sex life was taking a nosedive. As women, we’re often focused on being “fine” all the time, and not wanting sex means suddenly there’s something wrong. In the beginning, I was even embarrassed to talk about it with my doctor!

Here’s the truth. You are not turning into a sexless shell of your former self! You don’t need to consider spending the rest of your life in a nunnery! Almost every woman I spoke with went through the desert period at some point during perimenopause or menopause. Even if it’s not “fine”, it’s not unnatural.

So why is your libido dropping? It could be your hormones. If you recognize what’s happening to your body and know why -you can work toward getting back to your island paradise.

Every 28 days or so, the premenopausal vagina starts doing some redecorating. It fluffs up the pillows in the womb, releases the most attractive egg it has, and starts surging hormones through the body. Cue the biological bow-chicka-bow-wow music. Women going through perimenopause and menopause don’t get that same monthly reminder from Mother Nature to “get some.” The bow-chicka-bow-wow music stops and you didn’t even get the last dance. On top of that, most experience a drop in the level of their estrogen hormone across the board, which can cause their vagina’s natural state to become Mojave Desert -esk.

The great news is that there is help for this. Having your doctor check your hormone levels is one of the best things you can do if you feel like you’re wandering through the desert. Even if you have had a test done recently, these levels can shift at any time during perimenopause or menopause. Low testosterone is often responsible for a crashing libido. Low estrogen can contribute to dryness which can result in painful sex.  When sex hurts, you don’t want to have it.

If you are experiencing vaginal itching and burning, pain during sex, urgent or painful urination, frequent urinary tract infections, and/or bleeding during sex, make an appointment with your Menopause Specialist!   Your specialist will give you a pelvic exam to confirm this diagnosis.  Do not despair, your symptoms ARE treatable!

There are local estrogen therapy (LET) options available to treat these issues. LET is applied directly to the vagina. There are LET creams, tablets, or slow-release estradiol rings.

If you are already on systemic hormone therapy (oral tablet, patch, gel, spray, or injection)  and start experiencing these symptoms, circle back with your menopause specialist as you might need an adjustment in your dosage. It is not uncommon for women on systemic HT to find that they still need to add a local estrogen therapy to the mix.

If your symptoms are not very severe you may find that simply adding moisturizers (used regularly often 2 or 3 X week) and lubes (used during sex) can be your solution.

The FDA approved Intrarosa in 2016.   Intrarosa is the first FDA-approved product containing the active ingredient prasterone (DHEA). This is vaginally administered.

An option for post-menopausal women is Osphenia. This is an estrogen agonist/antagonist and the only orally available product approved for the treatment of vaginal dryness and moderate to severe dyspareunia (genital pain associated with sexual intercourse).

In addition, in 2015 the FDA approved Addyi (known generically as Flibanserin) to boost a women’s sex drive.  Clinically doctors refer to this as hypoactive sexual desire disorder (HSDD). Addyi works to balance brain chemicals (neurotransmitters) that may be responsible for low libido in pre-menopausal women.  According to Pharmaceutical Technology, the FDA has said it is “evaluating the need for regulatory action” after a spike in the number of adverse events reported to the regulator in 2020.

In 2019, the FDA approved bremelanotide (Vylessi).  It is an approved bremelanotide for pre-menopausal women with low libido. This is an injectable medication used to treat hypoactive sexual desire disorder (HSDD). A woman injects the medication into her thigh or abdomen at least 45 minutes before anticipated sex.

It is not uncommon to need a combination of a couple of the above therapies to get you wet and wild again.

My mission is to educate and empower women to get the help they need and deserve.

Remember:  Suffering in silence is OUT!  Reaching out is IN.

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* does not recommend, endorse, or make any representation about any tests, studies, practices, procedures, treatments, services, opinions, healthcare providers, physicians, or medical institutions that may be mentioned or referenced.


4 thoughts on “Straight Talk About Peri-Menopausal and Post-Menopausal Sex!”

  1. Hi Ellen,
    How does one get on your list of menopause providers? I am a Physician Assistant in Thousand Oaks, CA. I work in a practice specializing in hormone replacement therapy for men and women: Bioidentical Wellness. We treat menopause, peri-menopause, andropause, PCOS and other hormone related disorders as well as adrenal issues. I would love to be a part of your recommended providers.
    Thank you.

  2. What seems to be missing here is any sense of motivation. As a husband, I understand how hard it can be for wives to get “in the mood,” even without the physiological effects of menopause making, or even thinking about, sex difficult, if not painful. I think most wives reading this might be thinking, “Why bother?” Like my wife, they may simply decide that not having sex is the easiest solution. I could more readily accept that were it not for the fact that what I miss is not the sex so much as the intimacy that went with it.

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