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Depending on your symptoms, you may benefit from medical care. But HRT isn’t likely to be the sole fix. In a new small study of women between the ages of 45 and 55, researchers found that women who used HRT didn’t have more desire or an easier time becoming aroused. Women who saw themselves as having a sexual problem did tend to have more severe menopause symptoms–but they weren’t more or less likely to be using HRT.
The first thing you need to know: losing desire in your post-menopause years is only a problem if you think it is. Many women simply move on. In a survey by the North American Menopause Society (NAMS), only half of women in their fifties reported masturbating or having sex in the previous year, and the numbers dropped in each of the next decades.
Women tend to be most upset about this from the ages of 45 to 64, NAMS also reports, and then stop worrying. A smaller group keeps up their sex lives—in the same survey, about a fifth of women in their 80s said they masturbated.
If your relationship is suffering because your partner wants more sex or more enthusiastic sex, you do have a relationship issue. You may want to do something to keep a partner happy–or not. That’s not the same thing as having a medical problem.
So what can you do to rev up your post-menopause sex life? Consider medical help to evaluate and address any of these factors:
Your medication could be getting in the way. Medicines that dampen libido include all of the common anti-depressants, heart meds, the blood pressure medication Clonidine (it also comes as the patch called Catapres) and the heartburn over-the-counter (OTC) drug Tagamet (cimetidine). Ask for another option. Anti-histamines can make it harder to lubricate.
Intercourse may be painful. About half of all post-menopausal women find that their vaginas become dryer, which can make intercourse painful for up to nearly 80 percent of this group. You’ll need more lube and foreplay than you did in your twenties. Try the OTC product Replens.
If need be, taking estrogen directly to your vagina isn’t the same cancer risk of oral HRT: very little enters your blood stream.
You can use an estrogen cream, dispense tablets inside the vagina or wear a ring that dispenses the hormone over three months.
Non-estrogen options for dryness are also available. Osphena (ospemifene) is a pill you swallow. Intrarosa (prasterone) is a pill you inject into the vagina
Be sure you are evaluated for fibroids, ovarian cysts, and pelvic inflammatory disease.
Some women experience “pelvic prolapse”—when your bladder or another pelvic organ drops and pushes against your vagina. You might try different positions, for example sitting on your partner’s penis.
Don’t keep it secret if you have pain in the external part of your genitals, the vulva rather than the vagina. This is a rarely diagnosed but not uncommon condition called vulvodynia–and can happen even if you’re taking HRT, so again HRT may not be the fix. You may also have another pain issue–irritable bowel or bladder infection symptoms without an infection. You can have both dryness and vulvodynia.
The fixes aren’t obvious. As with other pain problems, cognitive behavioral therapy (CBT) to help you learn different mental and emotional responses to your sensations that can be helpful. Feeling trapped by pain makes it worse.
Relationship tension. Losing interest in sex doesn’t mean you’re with the wrong partner. But if you want to keep up a regular sex life together, you may need to resolve issues that are keeping you from feeling relaxed and open to pleasure.
One study of women who had pain during intercourse reported that a third never told their partners about the issue. They often said that they didn’t share their partner’s sexual preferences or appetite, but they were no less likely to be happy with the relationship overall than women who didn’t experience pain.
Secrets create other problems, of course: Your partner may come to a wrong conclusion about your lack of interest in sex that could hurt the relationship more. There are lots of ways to feel close that don’t involve intercourse. Neck rub, anyone?
A version of this story appears on Your Care Everywhere.