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Categories > Menopause > Menopausal hormone therapy

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Forget the notion that intimacy takes a nosedive after menopause. For many women, this period marks the beginning of a warmer, more spontaneous love life.

Midlife role models have without a doubt taken a revolutionary turn. Flash back to Auntie Em. Fast forward to the stars of “Desperate Housewives.” Got the picture?

Luckily, you don’t have to be famous to enjoy the confidence and independence that come with age and experience. Antiquated ideas about life after menopause have been upended, including the notion that waning hormone levels mark the end of a woman’s sexuality. In fact, many women report that menopause brings new freedom and spontaneity to their love lives. As children leave home, husband and wife are afforded greater privacy and more leisure time.

Overcoming obstacles

As estrogen production slows down, menopausal women may experience some physical changes that make it difficult to enjoy sex. Vaginal tissues may become thin and dry. The vaginal opening may become narrower, and it may take longer for the vagina to become sufficiently lubricated. In addition, hot flashes, night sweats and insomnia can put a damper on desire.

Women with these symptoms may benefit from estrogen creams. Applied directly to the genital area, the creams help keep the vaginal lining thick and ease lubrication problems; however, they won’t relieve other menopausal symptoms or protect against heart disease and osteoporosis. (Note: Estrogen creams should not be used immediately before intercourse because they can enter the man’s penis.)

An estrogen-filled vaginal ring called Estring is yet another hormonal option. Estring is inserted into the upper portion of the vagina by a healthcare provider, where it releases a low dose of estrogen for up to 90 days.

Women who prefer not to use hormone therapy at all may use water-based lubricants, such as KY Jelly or Replens, to help make intercourse more comfortable.

Adapting to changes

Remaining sexually active may be the most important way to combat physical changes that occur during menopause. That’s because blood flow to the area increases during sexual activity, helping to keep the vaginal lining nourished and improving elasticity. If adequate lubrication is a concern, it may help if you and your spouse slow the pace of your lovemaking to give your body ample time to respond.

When desire wanes

Interestingly, it’s not estrogen but testosterone, the male hormone produced by the ovaries and adrenal glands in tiny amounts, that fuels a woman’s need for intimacy. However, after menopause, testosterone production may decrease, lessening sexual desire. Women disturbed by a decreased sex drive may benefit from low doses of testosterone and should raise the issue with their gynecologists.