Sexual and Psychological Issues with Menopause

The onset of menopause, typically in a woman’s early 50s, is a time of major physiological transition, due mainly to plummeting estrogen levels. The hormone estrogen, primarily produced in the ovaries, controls the female reproductive cycle and sexual response and affects all of female biology. Estrogen is anti-inflammatory and protects the bones, brain, gut, heart, joints, nervous system, and skin, so when a woman enters menopause, her whole system undergoes major changes. These changes lead to unwanted sexual changes, such as vaginal dryness, reduced lubrication, painful intercourse, orgasmic difficulties, and low libido. Estrogen is to women as testosterone is to men: with low levels of estrogen, women can lose interest in sex and have difficulty performing. If they become anxious or depressed, this, too, can impact their sexuality.  

The extent and severity of menopausal changes can vary significantly from woman to woman. Some may experience no mood changes, while others may experience low mood and even depression. Unhappiness and dissatisfaction can arise from physical changes and loss of fertility that accompany aging. Weight gain, graying hair, and wrinkles can negatively affect a woman's self-esteem..

Menopause is no longer synonymous with old age, but rather a time of transition and potential growth. With women now living at least one-third of their lives past menopause, many are prompted to make positive changes - increasing exercise, improving diet, giving up unhealthy habits, and making  psychological adjustments. Many women find themselves feeling empowered and better than ever, a state that anthropologist Margaret Mead referred to as “menopausal zest.” 

However, many women do experience deep depression that may require psychiatric medication; some require hospitalization for the first time in their lives. Rates of depression increase two-fold (Freeman, 2006). The reduction in estrogen decreases the feel-good neurochemicals dopamine and serotonin. For most women, there is a period when hot flashes interfere with the workday and also with sleep, which contributes to depression. Again, duration and severity vary widely. Many women experience a reduction in sexual feeling and interest related to hormonal changes, vaginal discomfort, disturbed sleep, and low energy. For some, this persists, but not for all. At the same time, their partner may be experiencing problems related to sexual functioning or midlife issues. These experiences are normal and shared by many women going through menopause. You are not alone in this new normal.

What can a woman do to minimize the psychological and sexual changes that accompany menopause? First and foremost, maintain a healthy lifestyle. Reducing alcohol intake, quitting smoking, regular exercise, and consuming a balanced diet can all offer benefits - these changes alone can often stop hot flashes and insomnia. Secondly, engage in stress-relieving practices, such as meditation, yoga, exercise, spending time in nature, enjoying music, and engaging in pleasurable hobbies. Seek support and guidance from specialists who can provide solutions. And finally, do not neglect your sex life and go into sexual retirement. Keeping it active can improve your psychological health, relationship, vaginal health, sexual competence, and vitality.