What is the menopause?
The menopause is the time when a woman's periods stop for good. In the years leading up to the menopause, the supply of eggs in a woman's ovaries begins to run out. Consequently, the level of oestrogen (the female sex hormone) starts to fall. This usually starts over the age of 40 and the effects (menopausal symptoms) become increasingly noticeable as time goes by. The menopause itself takes place when the ovaries have totally exhausted their supply of functional eggs, an event that usually occurs in the early 50s, but can happen much earlier if a menopause is premature.

Can I have sex after the menopause?
These days, there is no earthly reason why women cannot continue to enjoy a happy and satisfying sex life during and after the menopause, if they want one.

Before now, negative attitudes surrounding the menopause and sexuality were widespread and very damaging. Many women had been made to believe that sex stops during 'the change', if not some time before, and many found it difficult to accept that people in later life could have sexual desires and drives. Many even found the idea inappropriate or distasteful. But these unhelpful attitudes are rapidly dissolving.

Sex and love-making are not the be-all and end-all of life, and many loving couples enjoy fulfilling and satisfying relationships with infrequent or no sex. But for those women who have always enjoyed the emotional and physical intimacy that love-making brings, there is absolutely no reason whatsoever, medical or otherwise, why the menopause should deprive them of this pleasure.

It is true that menopausal symptoms can affect your sex life, but every psychological and physical inconvenience encountered can be overcome.

While it is also true that sex drive (libido) tends to naturally fall as we get older, physical contact need not diminish at all. Also, with some treatments, a woman could even find that her sex drive increases.

Your physical sex life is not over simply because the menopause is passed.

Some women even report an enhanced love life after the menopause. If children have grown up and left home, a woman may have more freedom and independence to be intimate with her partner. Release from any fears of pregnancy and from periods can actually lead to a renewed and revitalised love life.

No woman should feel trapped because she is unable to consider sexuality positively or to explore the wide range of expressions of sexuality that are available.

How can the menopause affect my sex life?
Many women sail through their menopause with very few symptoms, or if they are extremely lucky, none at all. However, a large proportion of women experience some of the physical or psychological symptoms. Every woman's experience of the time around the menopause is individual and unique, so no two women will react identically. Some menopausal symptoms can temporarily hamper a woman's ability to enjoy a fulfilling sex life.

Night sweats and hot flushes can be counterproductive to relaxation and romance. At night, these symptoms produce an intolerable feeling of heat, often accompanied by profuse sweating, and even a feeling of acute claustrophobia. If the sufferer has to throw off the bed sheets and open the windows when night sweats are at their worst, body heat from her partner lying near is hardly going to improve matters.

Relative oestrogen deficiency can bring about vaginal dryness and thinning of the vaginal lining. The lack of lubrication and support for the vaginal walls can reduce arousal during sex and increase friction, which in turn may produce soreness, burning or irritation.

Irregular periods can make the timing of spontaneous love-making difficult.

Stress incontinence can sometimes arise during love-making itself.

Some women are conscious of dry skin, changes in the shape of their breasts and of a gradual redistribution of weight away from their breasts towards their waistline.

Loss of libido is very common around and after the menopause; many women complain that after the menopause they simply lose their desire for sex. Even women who used to initiate sex with their partners may determinedly avoid it, although many say that once they do make love, they are surprised that they enjoy it. Husbands may feel rejected at this time and relationship difficulties can arise.

Psychological symptoms such as mood swings, insomnia and depression can compound physical effects. Women who have undergone hysterectomy, but who are not fully counselled before their operations, can have negative attitudes about their sexuality and femininity, as might women who have had a mastectomy. Such psychological trains of thought can have potent adverse effects on a woman's ability to enjoy sex.

The good news is that all these problems can usually be remedied.

Hormone replacement therapy (HRT)
HRT consists of natural or synthetic female sex hormones that replace the hormones a woman loses around the menopause. It comes in the form of tablets, patches or gels and always contains oestrogen (either in a natural or synthetic form). HRT can improve many symptoms of the menopause that can hinder a satisfactory sex life. Vaginal dryness, loss of lubrication, soreness, irritation and vulnerability to bacterial infections and thrush may all be vastly improved by HRT. Hot flushes and night sweats may also be banished.

It is uncertain whether diminished sexual desire, arousal, orgasm and overall sexual satisfaction improve as a direct result of taking HRT. Much media coverage has been devoted to well-known celebrities boasting of their dramatically increased sexual prowess after taking HRT, but much of this is hype and scientifically unsubstantiated. What is more likely is that testosterone has a much more significant effect on libido than oestrogen.

Many studies have suggested that low-dose testosterone is effective and well worth trying for postmenopausal women who have low sexual drive. A large study is currently being conducted in Aberdeen to confirm these findings. Currently, many specialists consider giving women with low sex drive a short trial of oral methyltestosterone together with conjugated equine oestrogens. This treatment is closely supervised and given in low dose for a short duration to minimise the risk of side effects. Testosterone therapy seems of particular value for women who have a surgical menopause (which occurs when both ovaries need to be removed surgically) at a relatively young age.

Making the most of the menopause
It is now known that women have at least the same ability as men to enjoy sex, plus the additional advantage of retaining their capacity to have several orgasms one after another until much later in life. Young men are capable of frequent love-making, but as they get older they become satisfied with less frequent love-making. Ironically, many women discover a renewed or even redoubled libido if they start taking hormone replacement therapy for menopausal symptoms and not uncommonly report that their husbands can no longer keep up with their sexual demands.

For many post-menopausal women, the fact that their husbands take longer to reach a climax becomes a bonus; it makes love-making far more enjoyable than when they were younger and everything seemed to be over in a matter of breathless seconds. This more prolonged love-making can provide time for both partners to explore new sensations and enjoy a variety of feelings.

Touching and intimacy
After the menopause, touching and intimacy often become more important than the physical pleasure of penetrative sex. This need to touch and be touched, physically and emotionally, is well worth nurturing. Such contact offers reassurance and comfort and the opportunity to show tenderness, companionship and love.

Around the menopause, the physical focus of sex tends to be overtaken by the emotional, social and spiritual ingredients of love, as the couple and the relationship become more mature. Remember that there are many expressions of love other than sexual intercourse and all can boost confidence and enhance feelings of self-esteem and worth.

Loss of desire
Reduced libido around the menopause is extremely common and remains a tough therapeutic nut to crack. Much work is being conducted by the pharmaceutical industry to find remedies. One existing medication that may help is hormone replacement therapy. Recent work using natural herbs such as Muirapuama combined with ginkgo biloba has shown considerable success in treating lowered sex drive in women. Unproven products abound that promise to boost a low sex drive; ask for evidence that they work before you buy.

Could I get pregnant?
A woman's fertility falls after the age of 35, but many an older woman has been surprised when she has fallen pregnant with an unplanned baby in her late 40s or even early 50s. Cherie Blair, the Prime Minister's wife, was certainly not alone in assuming that her fertility was negligible only to be surprised and delighted to be proved wrong. Late pregnancy can and does happen, and for this reason it is important to get correct advice about contraception even beyond the menopause. The recommended advice is:

women over the age of 50 should use contraception for 12 months after their last period.

women who are under 50 when they have their menopause should continue to use contraception for two years after their last period.

if a woman started taking HRT before her last period, she should continue using contraception until the age of 53 to be on the safe side. This is because HRT has a different hormonal content to the oral contraceptive pill, so is not effective contraception on its own.

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