Maintaining Your Sex Life During Perimenopause

Social media, films and TV shows, coffee catch-ups and group chats are all infected by the same myth: Menopause equals the end of a woman's sex life.

Thankfully, this belief is woefully inaccurate. Many women dread menopause, and it is life-changing, but it does not have the power to extinguish sexual pleasure in its entirety.

Every year in the United States, approximately 1.3 million women become menopausal, according to StatPearls, a healthcare education resource. Far too many of these women resign themselves to a steadily deteriorating sex life, but no more. Sex is for people of all ages, no matter how hard stigmatizing myths try to erase that fact.

What is perimenopause?

"Perimenopause is the time when ovarian hormone production starts to fluctuate due to aging," explained Tara Scott, M.D., a physician in Ohio. "By definition, it is once your menstrual cycle lengthens by seven days, so if you are normally 28 days, when you have a 35-day cycle, [you're perimenopausal]."

All stages of menopause are colloquially referred to as "menopause," but the term actually refers to one day: when someone hits one full year without a period. After this, you are postmenopausal.

The symptoms we hear all the horror stories about take place during perimenopause.

"Perimenopause is the years before the arrival of menopause," added vagina coach Kim Vopni, who is based in Vancouver, British Columbia. "Perimenopause is typically the six to 10 years prior to menopause."

Although perimenopause typically begins between the ages of 51 and 52, about 5 percent of women experience early menopause between 40 and 45, according to StatPearls. Approximately 1 percent of women experience premature menopause before the age of 40.

Symptoms and diagnosis

According to research conducted by Forth, a women's health site, 74 percent of women have symptoms relating to perimenopause. Perimenopausal symptoms may be similar to those of many other conditions, so a blood test analyzes hormones and diagnoses menopause.

Aside from the obvious changes to your menstrual cycle, perimenopause triggers mental health symptoms, including mood changes and problems with memory and concentration, along with a variety of physical symptoms.

Physical symptoms are more wide-ranging and may include difficulty sleeping, heart palpitations, headaches and migraines, muscle aches, changes in body shape and weight gain, skin changes, recurrent urinary tract infections (UTIs) and hot flashes, which are sudden feelings of hot or cold in your face, neck and chest.

"Many women have a decrease in libido as hormones drop," Scott said. "However, there can also be increases in testosterone—during skipped cycles—that could increase libido. Low estrogen affects libido and can also contribute to pain during intercourse."

As women enter middle age, estrogen levels fluctuate before dropping. This change in hormonal balance triggers changes in our genitals, triggering a number of potential sexual effects, as Vopni outlined.

"With the loss of estrogen, the vagina and tissues in and around the bladder can become thin and dry, which can lead to painful sex, incontinence and an increased risk of UTIs," she said. "It is very common to see an exacerbation of bladder urgency, frequency and also organ prolapse during this time, which can all interfere with sex."

Unfortunately, these pesky hormonal changes modify how much we crave sex, too.

"The fluctuating hormones can also contribute to low libido, while the heavy bleeding often associated with perimenopause can influence energy levels and also interfere with one's sex life," Vopni said.

Symptoms can last for months or years and change over time. They can also come in cycles, so you may experience hot flashes and night sweats for a few years before they stop, and mental health symptoms could begin later.

How is perimenopause treated and managed?

"Many women don't even know what perimenopause is and, as a result, may be offered solutions like blood pressure medication, thyroid hormone or antidepressants," Vopni said. "Treating the symptoms rather than the root cause can leave many feeling like they are going crazy or that they will never feel 'normal' again. Diet and lifestyle are essential to consider, but medication is often initially offered."

While there are benefits to medical interventions, a holistic approach is helpful for managing symptoms.

Scott recommended focusing on increasing sleep to at least seven or eight hours per night, staying active with cardio and weight exercises, managing stress levels, and minimizing the ingestion of processed foods, sugar and alcohol.

She also advised removing certain plastic products from your environment. For example, some plastics contain endocrine disruptors, which interfere with our body's natural hormones. Phthalates are used to make plastic products more durable and can mimic or block female hormones.

"Local vaginal estrogen is arguably essential for most women as they approach menopause," Vopni said. "Estrogen helps keep the tissues supple to ensure sex is not painful and can also help improve or prevent urinary incontinence. Estrogen will also help improve the pH level in the vagina and decrease the risk of UTIs."

Confronting the sexual impact

When our bodies change for any reason, hiding from reality is often tempting. We suppress our worries and our symptoms, basking in the comfort of ignorance.

But this approach only deepens the problem, preventing effective management or minimization of symptoms. Perimenopause is an evitable stage of life for anyone assigned female at birth. Accept it, do not fight it. It is a natural process.

Just remember, the process is not a straightforward path with clearly defined steps, and things will change quickly and without notice.

"It's like a moving target," Scott said. "In some months, you will have too much estrogen; other months, too little. These fluctuations can affect libido, sensation and pain."

Educate yourself on the process and stop allowing the stigma attached to perimenopause to silence you. A sexual partner cannot satisfy you if they do not understand the impact perimenopause is having on you.

"It is important for the person experiencing perimenopause to understand what is happening so they can make informed choices about their health," Vopni said. "It is very common for women to be caught off-guard by their symptoms, embarrassed or even ashamed, which can mean they suffer in silence and pull away from their partner. Letting the other person know what you are experiencing and what you need is a good place to start."

Physical interventions

People of all ages should use lubrication, but it is never more important than when we enter middle age. Vaginal tissues change and they may need extra help facilitating clitoral and penetrative play. Invest in the good stuff and introduce it as a main character in the bedroom.

Taking charge of your pelvic floor also mitigates the effects of perimenopause, Vopni advised.

"Pelvic floor physical therapy is an essential but underused resource that helps optimize pelvic floor muscle function, which can in turn improve one's sex life," she said. "Kegels and pelvic floor exercise help maintain good blood flow, circulation and muscle tone, which are all essential to pleasurable sex, with or without a partner."

Each person's journey to fulfilling their sexuality during and after perimenopause is unique to them. Experimentation and exploration are the keys to maintaining sexual satisfaction, so go forth and throw everything into the recipe before refining the ingredients into a solution that works for you.