Some women claim that sex is better than ever after menopause, when there's no reason to worry about periods and unplanned pregnancies. Generally, the more sexually active you are, the fewer problems you are likely to encounter. Declining hormone levels, however, can lead to changes that may make sex uncomfortable. The first of these is vaginal dryness.
While menopause may not reduce a woman’s desire for sexual intimacy, it can cause discomfort due to vaginal dryness, in medical terms this is called atrophic vaginitis. It’s a problem many women experience during or after menopause. Yet most never discuss it, even in the privacy of their clinician's office. Often women feel that genital discomfort must be endured as part of the aging process. This is not the case!
Because vaginal dryness has received so little public attention, women often mistakenly blame it on factors such as stress or poor hygiene. In truth, however, vaginal dryness usually results from the declining estrogen levels associated with menopause. Before menopause, estrogen plays an important role in keeping genital tissues elastic and moist. When a woman is sexually aroused, for example, estrogen enables vaginal tissues to become lubricated. When estrogen levels drop, vaginal tissues produce less lubrication. Without adequate lubrication, sex can become uncomfortable, even painful. As a woman gets older, her vaginal walls also become thinner and more vulnerable.
Reduced hormone levels cause subtle changes in the genital tissues. The pelvic muscles may need strengthening. Lower estrogen levels decrease the blood supply to the vagina and the nerves and glands surrounding it. This makes delicate tissues thinner, drier, and less able to produce secretions to comfortably lubricate before and during intercourse. The vagina becomes dryer, less elastic, and more prone to irritation. Most women find it helpful to use an additional lubricant for sexual activity. Water-soluble lubricants are preferable, as they help reduce the chance of infection. Try to avoid petroleum jelly; many women are allergic, and it damages condoms.
Certain medications and alcohol may diminish sexual drive, too. But there are also important emotional issues to face. Sexuality is often a delicate balance of emotional and physical issues: How we feel may affect what we are able to do. For example, men may fear impotence will become a more frequent problem as they age. As a woman ages, she may become more anxious about her appearance. This emphasis on youthful physical beauty can interfere with a woman's ability to enjoy sex.
Older couples may have the same problems that affect people of any age. But they may also have the added concerns of age, retirement and other lifestyle changes, and illness. These problems can cause sexual difficulties. Talk openly with your physician or clinician or see a therapist. These health professionals can often help.
Learn more about Sexual Health here.
Perimenopause and pregnancy
The number of follicles (eggs) in the ovaries steadily diminishes over a woman’s reproductive lifetime. By the age of 40 years, the rate of decline becomes faster. But despite the reduction in the amount of follicles available for ripening, ovulation continues in up to 98% of women over the age of 40 who have regular menstrual cycles. This emphasizes the need for contraception – because YES, you can get pregnant!
Contraception during midlife
During these perimenopausal years, menstrual cycles tend to become irregular. There is a decline in natural fertility, but contraception is still necessary to avoid unplanned pregnancy. In the United States, the highest incidence of unplanned pregnancy is among adolescents and women over age 35 years.
Women approaching menopause often have contraceptive requirements that differ from those of younger women – but is equally important. Pregnancy in the late reproductive years is associated with more complications for both mother and baby.
Every woman has to determine what contraceptive method works best for her depending on her stage of life. Your physician or clinician can help, too. Click here to review birth control information.
When is it OK to stop using birth control?
Contraception should be continued for women who are 50 years or older for one year after menstruation has stopped. For women younger than 50 years, contraception should be continued for two years after the last period.
If you are still using birth control pills (oral contraceptives) as you approach age 50, it may be a good idea to change to another method for several months. This is to get a more accurate picture of your menstrual activity and menopausal status. To determine what method may be the best for you and your lifestyle, read more about the different birth control options. You should also talk to your physician or clinician for more information.