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When we hear the word menopause, we think of symptoms such as hot flashes, mood swings, brain fog, no more periods, and old women. But this is only part of the story. Gen X women, the ones who grew up in the 1980s and partied in the 1990s, are smack dab in the middle of this stage of life. And they are being vocal about it, especially when it comes to their sex lives.

I was recently at a party, and the topic on all the women’s lips was menopause and sex. Numerous friends were expressing serious concerns about self-esteem and worries about their relationships crumbling. And with the average age of divorce in Canada hovering in the late 40’s, my friends have a point. 

Phrases like “sex drive is gone forever,” “I feel so unsexy,” and “now that the fear of becoming pregnant is gone, so is the urge” floated in the air. Years ago, women talking about sex in middle age was a no-no, and menopause was a silent and solitary stage, yet at this table of friends, the discussion flowed freely and with genuine concern. 

As of 2024, there are approximately 5.15 million women in Canada who fall between the ages of 45 and 64 and are at some stage of the menopausal journey.  The Health Insider has outlined the map of menopause and what women can expect. The article details the symptoms and phases of menopause. 

Understanding Menopause and Its Impact on Sexual Health

Hormonal fluctuations during this stage of life affect sexual health. The sudden drop of  estrogen levels and slow decline of testosterone can lead to a decrease in libido and can affect sexual activity. 

Menopause can also cause urogenital issues. Vaginal dryness, elasticity, and burning can make having sex painful. The vaginal wall becomes thinner, and there is less blood flow, which affects arousal and can make orgasms more challenging to achieve or become less intense. Some women can experience vaginal bleeding or loss of bladder control. Hot flashes and night sweats can leave us feeling uncomfortable and irritated. The association between sex, pain, and mediocre sex can be the ultimate mood killer. 

The decrease in estrogen also affects our moods, stress levels, and emotional health. The one constant that kept coming up in the round-table discussion was the feeling of losing who we fundamentally were. We had confidently embraced being  20-year-old hot young things,sexy 30-year-olds and flirty 40-year-olds. 

Yet it was obvious that the confidence isn’t quite there as we negotiate this line drawn in the sand that separates one part of our lives from our uncertain futures as menopausal women. Our bodies are changing again, but this time, it feels like it’s not for the better. Our self-image and sexual confidence from yesterday can be hard to tap into. Desire is diminishing, and many women are embarrassed to talk about it. 

Sexual function is important to all of us, and talking about it among friends was a significant first step for the women in the room that night. Still, for those of us in relationships, we needed to shed the embarrassment and bring this discussion into the bedroom. 

Communication, Intimacy, and Desire

Desire doesn’t disappear; it changes. When we begin a new relationship, desire seems to magically appear and carry us off into the throes of passion. As our relationships grow and life happens, desire changes. Babies, diapers, fatigue, and careers can impact our sexual lives. Dr. Jen Gunter, the author of The Menopause Manifesto, wrote that women approaching this stage of life should “think how they can be proactive in cultivating desire”. 

  • Communication with your partner is important. If you don’t share your concerns about what is going on, you and your partner will be unable to make it better. You may be surprised at how an open dialogue can evoke support and understanding and put you on the same page in moving toward enhancing desire.
  • Foreplay will help with arousal. It can begin hours before and include anything from sexy text messages to romantic lunches to little kisses on the neck. The act of foreplay helps build anticipation.
  • It may seem counterintuitive, but scheduling a time to be intimate can help with desire. Plan a romantic getaway or a night together doing something you both enjoy. Whatever you plan, remember intimacy doesn’t always have to be rooted within the confines of sexual activity. It is about connection and sharing. These moments of intimacy can deepen emotional bonds and help with desire.
  • Sexual exploration can be a fun way to help with desire. What you may have been too timid to try in your youth may now be something exciting and new. Talk about what you like, what you don’t like, and what you want to try. Read an erotic book, purchase some toys, or watch some sexy television. This may be what you need to help rekindle that spark.
  • Self-care, health, and wellness can positively impact our self-esteem and our sexual health. Maintaining a healthy diet, exercise, and self-care contribute to our self-esteem. When we feel good about ourselves, the effect on our sexual health is positive.

Dr. Gunter writes, “the more effort we put into it, the better the outcome”. 

Of course, desire can also be affected by issues outside the realm of menopause, for example, if the relationship is in trouble, illness or medications, stress and demands from work, money, or family.

Managing Sex and Menopause

There are ways to help with sexual function and desire via medications. Some of these options include:

  • Prescription Treatments: Low-dose estrogen creams, tablets, or rings can help replace estrogen in your body. These are applied in your vagina and can be used daily for relief. Estrogen rings differ in that these are placed in the vagina for up to three months. Other medications like ospemifene and dehydroepiandrosterone can also help by acting like estrogen to help relieve the pain associated with vaginal changes.  Flibanserin, bremelanotide, and testosterone increase dopamine and can help with low desire. Speak to your healthcare professional to understand more about prescription medications.
  • Non-Hormonal Treatments: Over-the-counter solutions before and during sex can help. Vaginal moisturizers can be applied internally every few days to keep your nether regions dewy. Lubricants help things glide more smoothly during sex. These can be oil-based or water-based. Cannabis lubes are also available in Canada, and although there is no research on effectiveness, users report positive results. Regular sexual stimulation and foreplay are great for arousal as it helps with vaginal moisture. 
  • Counselling and Therapy: Cognitive behaviour therapy and mindfulness can help during menopause. This treatment helps address sexual function concerns by reframing our perceptions and anxieties around this stage of life, both individually and as a couple. The Health Insider offers a 101-guide on options for dealing with anxiety. You can find a good therapist through online search or ask your friends and family for suggestions. If you have a family doctor, they can help by referring you to healthcare professionals specializing in this area.

Women are talking about menopause more than ever. The taboo shrouded around this life stage is being lifted as more research and conferences focus on it. It is a natural phase of life, and women should feel comfortable asking for support and help to maintain a fulfilling sexual relationship. 

The first step is creating an open dialogue between you and your partner without shame, fear, or embarrassment. Talking about these menopausal changes with your partner can help couples maintain a satisfying sexual relationship that remains just as intimate and exciting as it used to be.

You can connect with a medical menopause professional here to help navigate this stage of your life and explore solutions that you may not yet know about. 

As Dr. Gunter writes, women at the doorstep of this stage of life should “think how they can be proactive in cultivating desire and to work on communication about their relationship and sex before a problem develops.”

~Read more from The Health Insider~

The information provided on TheHealthInsider.ca is for educational purposes only and does not substitute for professional medical advice. TheHealthInsider.ca advises consulting a medical professional or healthcare provider when seeking medical advice, diagnoses, or treatment.

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Audrey Bresar holds a B.A. from the University of Toronto and her editing credentials from Simon Fraser University. From the time she was a young girl, words fascinated her, stories captivated her imagination, and so began her love affair with sharing stories. At The Health Insider, Audrey uses this passion to connect people with their health through the written word. She currently lives in Toronto, Canada, with her blended family and three dogs.

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