GETTY
You can still have sex during and after the menopause
However, strictly speaking, you can’t be menopausal while you are still having periods, no matter how erratic they are.
In this situation you are described as perimenopausal. The main sign of the menopause is that periods stop.
There are two rather different sides to the topic of sex and the menopause. Firstly for perimenopausal women, is the issue of whether or not contraception is still needed and, if so, what is the best method to use.
Then there is the issue of sex after the menopause. On the plus side, you don’t need to worry about contraception or an unwanted pregnancy any more but on the negative side libido has a habit of going through the floor.
If you do want to have sex, the arousal response seems to have disappeared and your vagina stays dry, making intercourse uncomfortable, even if you are with the man of your dreams.
For perimenopausal women In theory it’s possible to become pregnant even if you are only ovulating sporadically and for this reason it’s recommended that if you don’t want a baby you should use contraception for a year after your last natural period.
GETTY
Women will likely see their libido fall off a cliff post-menopause
It’s a myth to think that just because you are in your mid-40s you can’t get pregnant and it’s OK to have unprotected sex.
Libido has a habit of going through the floor
In 2013 more than 7,600 abortions were performed for women aged between 40 and 44, 686 for women aged 45 to 49, and 24 for those over 50.
Once you are in your late 40s the eggs that are being produced are of much lower quality than before and even if one is successfully fertilised the chances of the embryo developing into a normal, healthy baby are slim.
That means that if you do get pregnant in your late 40s the chances are higher that you will have a miscarriage, so it really is better to take precautions to stop a pregnancy occurring in the first place.
So what are the contraception options for women in their 40s? There are two main types – those that contain hormones, such as the pill, the patch and the ring, and those that don’t, such as the copper coil, diaphragms and caps.
In general, hormonal methods are best for preventing you from getting pregnant. They also can be very good at controlling the chaos that can occur around the time of the menopause.
However they are the worst for side effects and don’t offer any protection against sexually transmitted infections. The number of cases of sexually transmitted infections (STIs) is growing at an alarming rate in women over 40, mainly because they are not taking any precautions against them.
For post-menopausal women After the menopause there is no need to worry about becoming pregnant and for many women this brings a feeling of liberation and greater enjoyment to sex.
GETTY
A bonus of having has the menopause is that you cannot get pregnant
However there are two problems that can and often do arise: vaginal dryness and lack of libido. Both are due to the very low levels of oestrogen that inevitably become an issue when the ovaries stop working.
Oestrogen has a moisture-retaining effect on the skin and this means that after the menopause the skin does become noticeably drier and thinner, not only in the more obvious places like the face but also in the genital area.
It’s a condition known medically as atrophic vaginitis. Many women just notice that sex is dry and uncomfortable, no matter how much foreplay you have, and the lubricating glands that help make sex enjoyable just don’t work any more.
Other symptoms include feeling a bit itchy and sore and this is often mistaken for thrush. If you are finding sex uncomfortable, see your GP.
A good doctor will be able to make the diagnosis straightaway from the characteristic appearance of the genital tissues but if you have been having itching or a discharge as well as the other symptoms, swabs should be taken to rule out an infection.
Occasionally other problems can be to blame and any woman who has vaginal bleeding after the menopause should have a pelvic scan to rule out causes other than simple inflammation.
A number of products available can give relief from vaginal dryness and make intercourse much more enjoyable. Bio-adhesive products, such as Replens, Senselle and Balance Activ Menopause Moisture Gel, aim to replace moisture in cells and are generally more effective than water-based gels such as K-Y Jelly.
The most effective way of dealing with atrophic vaginitis is to boost oestrogen levels again. One way to do this is with hormone replacement therapy (HRT). This has the added advantage of often helping out with a flagging libido as well.
GETTY
Dr Rosemary has a book on the menopause that will help answer any question you might have
However the risks associated with taking HRT (especially stroke and breast cancer) mean that in general it’s not recommended for treating just atrophic vaginitis.
The other way of boosting oestrogen levels is to apply the hormone just where it’s needed. This can be done through pessaries, creams or a ring. Several different brands are available and in general pessaries inserted into the vagina are much less messy than creams.
All types work and the application of oestrogen in this way can make the whole area more comfortable, and make sex enjoyable again, though you may still need to use a little extra lubricant.
Topical oestrogens can also help prevent a problem with recurrent urinary infections.
Menopause: The Answers by Dr Rosemary Leonard is published by Orion Spring. Readers of the Daily Express can order it for the special price of £12.99 (RRP £14.99) by calling 01903 828503 and quoting ref no: PB141. UK postage & packing free, overseas add £1.60.
Daily Express :: Life and Style Feed
