What does it mean to reach that often described “mysterious” time frame of menopause? As a woman and a gynecologist, I’ve come to embrace this stage in life. I like to explain menopause not as a disease but rather as a transformative time in a woman’s life — one that can be quite amazing. It’s just like the saying: “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.”
Clinically defined, menopause is the end of regular monthly menses in women. When you’ve had no menses or bleeding for 12 months consecutively (and possibly some of the side effects), it’s considered menopause.
The complexity of this transition heralds the beauty of women and their journey through life.
Many women might remain asymptomatic, but a vast majority will go through some type of symptom. And at times, the symptoms — night sweats, hot flashes, vaginal dryness, anxiety, etc. — can be so severe that they have a negative impact on women’s lives. These symptoms are related to the decrease in the production of estrogen and progesterone.
One of the most overlooked symptoms in menopause is decreased sex and intimacy. The lack of desire, vaginal dryness, and pain with sex can be a result of changing hormones levels, or even the stress of menopause itself.
Between all these symptoms, many women don’t get the help they need to keep sexual intimacy and intercourse a priority. But they should be.
1. Rediscover what libido means to you
In my office, women talk of changes in their sexual lives. Our conversation often surrounds what to do and what is available for treatment. Often it requires opening up the can of worms to discuss what libido is and what drives it.
Libido is a complex aspect of sexuality. Many people are uncomfortable discussing it. And many times, it isn’t until menopause happens that we try to find the time to peel back the layers and figure out what libido really means for us individually.
Finding new ways to transform arousal and moments of excitement — such as pelvic physical therapy or laser vaginal rejuvenation — also restore intimacy in relationships. The incorporation of lifestyle changes, technology, and medications can together help maintain the results of arousal with vaginal lubrication and vaginal tissue changes.
Sex therapists are also extremely effective in helping foster a new sense of intimacy with partners. Their tips may include:
More importantly, a well-rounded approach to treating decreased libido should integrate medical and psychosexual treatments, including pelvic exercises, couples counseling, and holistic changes.
2. Bring in the cavalry for symptoms support
Part of this journey includes changing the narrative of how we traditionally thought of menopause. You may need more than one professional’s help, more than one treatment, and more understanding. Menopause isn’t just physical changes.
Psychological symptoms, such as anxiety, stress, and depression, can also happen. These changes can affect sexual intercourse and sexual desire.
There’s a plethora of therapies, medications, and resources for women in menopause that can address the sense of losing femininity and sexual attractiveness. Engaging in mind-body activities can help relieve those symptoms that interfere with sexual intimacy, desire, and even sleep quality. These include:
- tai chi
There’s no one answer to approaching menopause. It requires many approaches, and often it’ll take some time to find the right therapy and lifestyle change.
Stress relief techniques should be explored extensively as well. They can also improve sexual intimacy, stimulation, and feeling more comfortable with sexual activity after menopause.
3. There’s no shame in rebalancing yourself with medications
For some, the desire for sex may still be strong, but other physical symptoms can get in the way. For example, the effects of decreased estrogen can cause vaginal atrophy, which narrows and shortens the vagina. The uterus can also prolapse and lead to discomfort, painful sex, and urinary leakage.
These symptoms can be managed using medications, including hormonal replacement therapy (HRT). HRT can come in various forms, like pills, foams, patches, and vaginal creams. The goal of this therapy is to help vasomotor symptoms and vulvovaginal atrophy.
HRT is an effective treatment for vaginal changes and libido, but discuss your needs in detail with a medical professional before starting a regimen. They can ensure that no medical risks are overlooked.
Another option is testosterone. While the U.S. Food and Drug Administration (FDA) hasn’t approved this option yet, some clinicians do administer it. A few studies have shown that it’s led to a noticeable improvement in sexual dysfunction. Testosterone therapy options include pills, patches, creams, and oral therapies. All of these should be monitored carefully. There’s specific dosing for each type of transdermal testosterone product.
If you’d like to go natural, there are herbal supplements that may help increase libido. Some supplements that have been recommended to increase libido in women include:
- black cohosh
- red clover
While they can be easily bought online, it’s important to keep in mind that the FDA doesn’t regulate herbs and supplements. Always make sure you buy your supplements from a reputable source.
Become your champion for the new you
Many people don’t account, anticipate, or plan for the changes that come with menopause. But the journey that begins in menopause doesn’t have to be miserable or lonely. And often, society interprets menopause as negative, coloring women’s experience and journey with biases — even before it begins.
As a healthcare providers, especially gynecologists, we’re trained to think of these symptoms, how they affect women individually, and what the best therapies are to help minimize them. It all starts with implementing better understanding of good health practices and promoting healthy lifestyles. The integrity of our sexual health and well-being should certainly be no exception.
Finding the means to address low libido are available. Tackling it with new knowledge can minimize any negative impacts on your quality of life, emotional satisfaction, and intimacy. It’s entirely possible to continue having healthy sexual relationships.
Remember: Menopause is the journey of recreating balance and discovering new beginnings in the relationship with yourself.
Dr. Shepherd is an OB-GYN, women’s health expert, and founder of Her Viewpoint, an online women’s health forum that focuses on addressing taboo topics in a comfortable setting. As an OB-GYN, she practices at the Baylor University Medical Center and specializes in minimally invasive gynecology. has written for various publications, including Cosmopolitan, Teen Vogue, Women’s Health Magazine, and Parents. She’s also a regular expert on “Good Morning America,” “The Today Show,” “Dr. Oz,” “Steve Harvey,” CBS Arrived, and FOX Arrived. As a healthcare expert, she strives to educate women on their bodies, and as a national speaker, uses her expertise to help women understand their health conditions and how to address them appropriately. Follow her on and .