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Is It Hot in Here Or Is It Just Menopause?

By: Carol Queen, PhD

Got ovaries? If you're noticing your mood, libido, and powers of concentration getting a little unstable, don't just blame it on the state of things—at least not entirely. You might be heading into perimenopause. (Or perhaps it's your partner, if that's who has/had ovaries in your household.) Perimenopause is the point at which hormone-related physical changes begin leading up to “the change of life,” sometimes also called the menopausal transition. Let’s explore this midlife morph. From the beginnings of perimenopause 'til you get to the other side, menopause can definitely alter what we  experience sexually, so let’s talk about rolling with it. Also, remember that sometimes "the change" changes your sex life for the better! 

Menopause refers specifically to the time in life when menstrual periods have been over for one year. So anyone with a uterus and who has experienced periods will go through it, if they live long enough to stop menstruating. Thinking of the menopause journey as a midlife event that happens around 50 (or the early 50s) is basically right (for most). But the hormonal changes that finally end menstrual periods can take several years, and that’s the still little-acknowledged part called perimenopause. That can start before age 40 for some! Periods continue during this time (though they may become more infrequent), but hot flashes aka vasomotor symptoms, libido changes, sleep effects, and other shifts will likely begin that signal menopause is on the horizon.  

And of course we want to acknowledge surgical or medical menopause! This can happen when someone gets a total hysterectomy (uterus + ovaries), or an oophorectomy (removal of the ovaries). It may be for health reasons, or part of a gender-affirming process. Because the ovaries are the primary source of estrogen and progesterone—and these are the hormones that regulate the menstrual cycle, among other things--surgical menopause is sudden. It stops periods and ushers in the perimenopausal bodily changes that ordinarily take several years. 

Menopause is hard for some to navigate—but for many, this time of life may come as a relief. Those who have struggled with birth control side effects or worries about unwanted pregnancy can breathe easier when menopause ends that possibility. Generally, it’s recommended that contraception continue for a year after the last period, so don’t ditch the condoms when you get a hot flash for the first time. In fact, maybe don’t ditch them at all, since STI risk will still be important to think about!

Our post-fertility years also open up new opportunities for centering and experiencing sex in different ways. Menopause and its lead-up and aftermath can shift how you experience your body, desire, and arousal. And for many, this is a gift! Needing to slow down, be more clear about needs and wants, and respect your body’s messages can literally lead to better sex. 

Some experience changes that affect sex quite a bit. For some menopausal folks, the urge for partner sex will decline. Whether or not that happens, libido can fluctuate, genital sensation may change, orgasm may take longer. This is a time of life when some choose to turn their vibrators to the highest power setting! It might also be more advisable than ever to be frank about what you need to get in the mood, and want in bed. Is it more sensuous arousal play, slower sex in general, a vibrator on the clitoris? Sounds like a terrific way to spend the afternoon to us! And if lubricant hasn’t already been part of your life, we bet you will discover its charms once you hit menopause, or if you have a hot-flashin’ partner in bed with you.  

Some will find these mid-life changes are a lot. For others, the many potential effects of menopause will be mild. To best handle the physical changes, stay hydrated and do all you can to get good sleep. Up your exercise game—especially moving in ways that are good for your core. Walk, take the stairs, dance—all of these help, since a sedentary life is likely to make libido and other changes hit harder. And talk to your doc about all this! If they dismiss your experience and concerns, start looking for another doctor who’s sex-positive and menopause-savvy. Not all doctors learn much about this, which is a freakin' scandal given that half or so of the population will eventually need a doctor who understands what their menopausal patients are going through.

Speaking of docs and their prescription pads: Some menopausal folks choose hormone replacement therapy (HRT), which can minimize the effects of many physical changes associated with menopause's drop in hormone levels. Speak to your doctor about whether this is the right choice for you. Some will avoid them for health reasons, others prefer to age “au naturel,” and still others swear by them. Hormones are available in pill form, but you can also use intravaginal HRT methods, including rings and creams. 

After the last period hormones will begin to stabilize and the changing effects of perimenopause may be behind you. After you’ve had a few years of power surges (er, hot flashes), this post-menopausal time may see you really feeling great, if your health is otherwise good. With less estrogen, though, genital changes can continue, including less vaginal lubrication; inner mucosal skin may be more sensitive and in need of moisture to prevent friction and damage. Grab the lube, take it slow, learn to enjoy sex with a body that might feel new to you in some ways. Enjoy the ride—and consider exploring yourself with or without a partner, since staying erotically active helps with all these sex-related menopausal changes. Read all of the wonderful Joan Price’s inspirational books.

Finally, make sure you can communicate about your needs and experience to any partners you may have, whether they've been on the ride through perimenopause with you or have stepped into your life more recently. Solo or with partners, menopause reminds us what a journey life is. 



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