How One Woman Revived Her Sex Life After Menopause

By the time Amber M. turned 43, she felt like she had lived enough life to fill two lifetimes. The recently divorced mother-of-three felt like she was ready to start dating again, but had some significant challenges.

In addition to severe bladder incontinence, she also experienced pain and bleeding from endometriosis and was beginning to have the hormone fluctuations associated with perimenopause or menopause.

“I was trying to get back into dating and wanting to have an active sex life but my body had changed a lot since the last time I’d been dating,” she says. “There’s no easy way to say this: I had to wear adult diapers every day and not only is that embarrassing but that’s about the least sexy kind of underwear there is.”

Her fears began to fade when she met Jim S. on a dating site and felt an instant attraction. “There was just something about him that put me immediately at ease, I felt like I could tell him anything and he wouldn’t judge me,” she says. This openness led straight to the bedroom and the couple started having sex within a month of meeting. “It was the best sex of my life, absolutely mind-blowing,” she says.

PeopleImages/Getty ImagesSurgery led to medically-induced menopause

In December 2018, Amber decided to have surgery to fix her bladder issues. This was just a couple of months after she and Jim started dating. Even though Jim wasn’t bothered by her incontinence underwear and accidents, it deeply bothered her. Her doctor suggested surgery, along with a removal of tissue contributing to endometriosis.

“Sex is incredibly important to me and so one of the first questions I asked was how this would affect my sex life,” she says. “He told me that after the initial recovery I shouldn’t feel any difference at all.”

The surgery was supposed to be a simple outpatient procedure. But, when she awoke nine hours later, her surgeon had bad news: Her endometriosis was so severe that they had to give her a complete hysterectomy, removal of her ovaries, and perform a perineoplasty—a procedure that is used to reconstruct the opening of the vagina. The surgery put her into immediate menopause.

Menopause, defined as the time when a woman has not had a menstrual cycle for 12 months, occurs around age 51, on average, says Allison Hill, MD, an OB/GYN and chief of staff at Good Samaritan Hospital in Los Angeles. While many women go through menopause naturally, certain medications, illnesses, or surgery, like Amber experienced, can cause an early menopause, she says.

The news hit Amber hard. “I was in shock, there was a real grieving period,” she says. “I didn’t expect to deal with menopause at 43, I didn’t feel like myself anymore.”

Menopause can affect your sex life

Amber’s reaction is understandable and not uncommon, says Christine Northrup, MD, assistant clinical professor of OB/GYN at Maine Medical Center in Portland, Maine, and author of multiple books on life after menopause, including The Secret Pleasures of Menopause. “However, we need to stop looking at menopause as this terrible thing that happens to women and must be endured or beaten somehow,” she says. “Women need to be educated on what to expect during menopause and hear that it’s not an illness, it’s a natural and beautiful part of the aging process and can offer a lot of opportunities for insight and growth.”

As Amber struggled to adjust mentally, she also had to deal with the physical aspects of surgery and menopause. These included a long, painful recovery and coping with intense symptoms, like hot flashes, from her medically-induced menopause. Her newly discovered amazing sex life was also now in shambles. Her doctor’s promise that nothing would be different couldn’t have been more wrong.

“First, the recovery was so much longer than I’d been told, we basically couldn’t have sex for almost four months after the surgery,” she says. “Then when we could have sex it was incredibly painful, I had a lot of scarring around the opening of my vagina. Not that it mattered much because my sex drive was gone, I went from wanting sex at least once a day to only feeling in the mood once a week or less.”

Low sex drive can be an issue

A decrease in or total lack of desire is a common complaint during and after menopause, says Stephanie Buehler, a certified sex therapist in Orange County, California, and author of What Every Mental Health Professional Needs to Know about Sex. (It’s one of the most embarrassing questions women have about menopause.) “Problems with desire can be psychological, relational, or physical and all of those can be related to changes during menopause,” Buehler says. “But it doesn’t mean you just have to deal with it, there are lots of ways, both medically and behaviorally, to increase your desire.”

Part of the drop in Amber’s libido was due to her reduced ability to climax. After the combination of hormone changes and surgery, she went from having multiple orgasms per session to maybe having one. And if she did orgasm, there was typically a lot of cramping and pain. “My orgasms became much less frequent and less satisfying,” she says.

If you experience a drop in orgasms or libido, it’s important to not assume aging or menopause are the reason why. Talk to your doctor to rule out medication side effects and medical problems, like low thyroid hormones, as the source of the problem. For example, many prescription drugs and supplements have a lower libido as a side effect, including SSRI antidepressants like Prozac, Paxil, and Zoloft, explains Dr. Northrup.

After ruling out any medical conditions, your doctor may want to check your hormone levels as well. Levels of estrogen, progesterone, and androgens (like testosterone) all drop after menopause which can influence your libido. But even if your hormones levels themselves aren’t low, it may be that an imbalance—post-menopausal women often end up estrogen-dominant—is causing the problem, Dr. Northrup says. Traditional hormone replacement therapy (HRT) used to be a standard treatment but is no longer recommended due to an increased risk of stroke, certain cancers, and other problems. However, you still have options through hormone creams and supplements—although these might not be appropriate depending on your personal health history. “It’s very individual, hormones are a miracle for some women and just aren’t appropriate for others, while some may need just one hormone increased while others will need all three,” she says. “Balancing hormones is as much an art as a science,” she says.

“As you age and your estrogen levels go down, the vaginal walls can atrophy, leading to vaginal dryness and painful sex,” Dr. Hill says. “A popular option to treat this is to use a vaginal estrogen cream; it’s considered safer as the estradiol doesn’t go into the bloodstream,” Dr. Hill says. Indeed, post-menopausal women who used vaginal estrogen reported a significantly higher sexual quality of life, according to a study published in Menopause.

Taking supplemental estrogen on its own, even as a vaginal cream, may exacerbate a hormonal imbalance so Dr. Northrup often recommends adding a small amount of progesterone—either through a vaginal gel or a cream you rub into your skin.

Estrogen and progesterone get all the attention but when it comes to libido don’t discount your androgens—even though women have lower levels than men, they are still an important part of your hormonal health, Dr. Northrup says. “Low sex drive is commonly associated with low testosterone levels, so a little bit of testosterone (or its precursor, DHEA) supplementation may help,” she says. However, she notes that this is not the time to DIY it and you should consult with your doctor before, during, and after using hormone products—even if they are over-the-counter.

In 2019, the FDA approved a drug for premenopausal women with reduced sexual desire called bremelanotide (Vyleesi), and another drug, flibanserin (Addyi) was approved in 2015. However, the medications have side effects and contraindications, and neither is approved for use in women who have gone through menopause.

Lifestyle factors, including relationship issues, lack of sleep, low vitamin D levels, or mental health problems are some of the most common causes of low sex drive in post-menopausal women, which is why good self-care is one of the best things you can do for your libido, Dr. Northrup says.

One thing you may be missing is novelty, Dr. Buehler says. By this point in your life you likely have decades of sexual experience and it’s easy to fall into the habit of having sex in the same way. “Making things feel new again can bring some of the excitement back,” she says. This could mean anything from trying adult sex toys or role-playing a fantasy to simply changing the room or time of day you have sex in. Not sure what you need? Talk to a sex therapist, she says.

For Amber, this meant exploring a bondage kink with Jim. It was something he’d been into for awhile but was brand-new to her. She discovered it added an element of risk and excitement that made her crave sex in a way she never had before.

natalie_board/Getty ImagesUsing lubricants can help

Although Amber says her symptoms felt sudden, she probably started to experience menopausal symptoms before the surgery, Dr. Hill says. “What many women don’t realize is that perimenopause and hormonal irregularity starts in women in their late 30’s and early 40’s,” she says. “This is important to address and tackle because in addition to changing your sex life, the changing hormones can cause a wide variety of health issues including weight gain, loss of muscle mass, sleep disturbances, a greater risk for illnesses including heart disease, osteoporosis, and [type 2] diabetes.”

Amber did heal from the physical effects of the surgery, but she also experienced physical changes most likely to due to menopause. “I used to be able to rely just on my own lubrication, but now my vagina is so dry we have to use a ton of lube. I used to love breast play but now my breasts are so tender that most of the time I just tell him to steer clear. Even my vagina itself doesn’t feel the same so when he penetrates me it feels strange, in a way I’m not used to,” she explains.

“Vaginal dryness, breast tenderness, and nipple soreness are all very typical changes we see after menopause,” Dr. Hill explains.

In addition, talk to your doctor about any sexual pain, particularly if you’ve had surgery. Pelvic floor therapists can identify specific causes of pelvic pain and offer treatments like pelvic floor physical therapy, which can include biofeedback, manual therapy, pelvic floor exercises, and vaginal dilators that may help.

One of the most effective ways to reduce vaginal dryness and sexual pain is to use a vaginal estrogen cream or gel but for many women, simply increasing lubrication with a high-quality lube is enough, Dr. Northrup says. She recommends regular KY Jelly but as long as you’re using a reputable brand, you can experiment with different varieties. Amber swears by the Pjur Med line, particularly the Repair Glide water-based lubricant. “It’s expensive but it’s worth it for me for the increased comfort,” she says.

Mental health can change too

Menopause has also had a noticeable effect on Amber’s mental health as well. “I have a lot of mental fog, exhaustion, and mood swings and that can make getting in the mood really difficult. I used to see sex as stress relief and my emotions didn’t really play a part but now if I’m in a bad mood I just can’t get aroused,” Amber says. “It makes me feel like a crazy person some days.”

While these mental symptoms are incredibly frustrating, they are also very normal. Intense mood swings are one of the most important symptoms to keep an eye on, suggests Dr. Northrup. This is because moods are so closely in sync with hormones that they can be an early sign of menstrual cycle-related changes. These include puberty, pregnancy, PMS, and menopause, Dr. Northrup says.

But try to resist the temptation to call your feelings irrational or crazy, she cautions. “Women are often called ‘crazy’ for being emotional but those feelings of sadness, anger, and irritation are often legitimate and based on real underlying issues in your life,” Dr. Northrup says. “Instead of worrying that you’re overreacting, pay attention to what you’re really worried about. Think of menopause like when the moon pulls the tide out and you can finally see everything that’s been sitting on the bottom of the ocean.”

Being gentle with yourself and honest about your feelings can also help your sex life, adds Dr. Northrup. This allows you and your partner to work through issues together.

“Seeing a sex therapist, both alone and as a couple, can help you identify issues and come up with solutions and new things to try,” Dr. Buehler says, adding you may also benefit from more traditional counseling, depending on your situation.

Amber’s self-esteem also took a hit after the surgery and during menopause because she put on some pounds. “I’m very self-conscious about how my figure has changed,” she says. “But I’m lucky, Jim loves my bigger stomach and just says there’s more sexy to love. He helps me see myself in a better light.”

Menopausal women often see physical changes as a sign their bodies are betraying them, but Dr. Northrup instead recommends seeing it as an opportunity to really examine your lifestyle. “This may be your body’s way of saying it’s time to start really taking care of yourself and make your health a top priority.”

After menopause, a woman’s risk of certain conditions, like heart disease and osteoporosis, go up, so it’s a good time to talk to your doctor about lifestyle changes that help.

Amber says she and Jim have started cooking healthy meals and exercising together. Plus, she’s seeing the benefits in and out of the bedroom.

adamkaz/Getty ImagesCommunication is the key to good sex

Through all of these changes, Amber says Jim has been a loving and patient partner. He’s always listening to what she says and going as slowly as she needs to rebuild their sex life. “For a while I thought we were doomed to have bad, infrequent sex but it is getting better,” she says. “Once I accepted that these changes were actually my new normal we started finding ways to work with my body.”

“Before, it didn’t take much to turn me on but now I need plenty of foreplay—not just to get me in the mood but also to make it not painful,” Amber says. “Foreplay used to be the icing on the cake, now it’s essential.”

Amber also says part of rebuilding their sex life is engaging in lots of communication. “From the beginning, we’ve always had great communication about sex and that’s been the key in this transition,” Amber says. “Being able to be honest about what hurts and what feels good, in that moment, and knowing he’ll respect that, is huge.” Talk about sex and your feelings about it before, during, and after sex, Dr. Buehler recommends.

Amber and Jim have also learned to be patient and realistic. “We’ve learned to just go really slowly, easing into penetration only after I’m really turned on,” Amber says. “It’s taught us to be more creative with our techniques and positions.”

At the end of the day, the couple has come to realize they shouldn’t compare themselves to others. “We’ve had to learn not to compare ourselves to others, especially in the kink community, but also not to compare ourselves to what we were in the past,” Amber says. “It’s about learning to love the moment you’re in with your partner you’re with.”

Also, Amber and Jim remember there are other ways to show love than sex. Dr. Buehler recommends things like massages, holding hands, kissing, tickling, laughing and spending quality time together.

Remember, you don’t have to settle for a less satisfying sex life, according to Dr. Northrup. “Too many women think this is inevitable but it isn’t,” she says.