If you’ve been through menopause, then you might say that your sex life has never been better. After all, the pregnancy worries are gone and so are the children. You can be spontaneous! Have sex in any room of the house! You’re no longer running your kids to endless activities, so you have more energy at the end of the day. You’re relaxed and comfortable with who you are and what you want.

Right?

Hold up. For every woman in the throes of postmenopausal sexual bliss, there’s a woman (or two or three) out there who quivers at the mere mention of sex. Or, she may have the desire but not the ability. Sexual dysfunction affects millions of women in the United States.

Face it, a woman’s sex drive is quite complex. Aside from the emotional aspects, there are physical changes during menopause that can, well, complicate things. Take those extra pounds and the altered body shape that come with them (hello, belly fat!). A woman may feel uncomfortable or self-conscious about her body and may barely recognize it as her own.

Poor self-image aside, if you’re carrying extra weight, physical problems like reduced energy or reduced mobility may interfere with your sexual function.

And what of those momentous hormonal changes that go hand-in-hand with menopause? While your body is busy ushering your estrogen out, it’s welcoming in some pretty significant vaginal changes, like dryness and thinning of its lining (otherwise known as vaginal atrophy). Less estrogen equals less vaginal lubrication, leading to a less elastic vagina. What ensues? Pain, burning, tightness or soreness. In fact, according to the North American Menopause Society, vaginal atrophy is the most common cause of painful sex at midlife and beyond.

Other possible sex-busters: hot flashes, mood swings, night sweats, irregular bleeding, sleep problems and insomnia. Those usual suspects of menopause.

So, what’s a menopausal woman to do? First, remember that sexual problems are not problems if they’re not bothersome to you or your partner. Everyone has their own “normal” and their own threshold for letting a problem get in the way of their relationship (or not).

With menopause comes symptoms that may lower libido and make sex painful. Don’t let your relationship suffer if this is your story. Here’s how to communicate effectively with your partner to maintain a satisfying sex life or even improve it.

It’s hard to get into the mood when you’re dealing with the physical and emotional symptoms of menopause – things like hot flashes, fatigue, weight gain or depression. Plus menopause can cause numerous sexual difficulties for women, including vaginal dryness, loss of libido and delayed orgasm. And it’s even harder to communicate these things to the man in your life. (Even a female partner who’s not experiencing the same things you are may need to be clued in.)

“A woman can feel very fragile and insecure at this time, and if the relationship isn’t solid and supportive to begin with, [sexual issues] can become amplified,” says Faina Novosolov, M.D., a psychiatrist in private practice and faculty member at the Women’s Mood and Hormone Clinic at the University of California San Francisco.

The good news: Menopause doesn’t necessarily mean an end to your sex life (or a healthy relationship). 

In fact, many women find that intimacy is enhanced during midlife. No interruptions from kids, no worries about menstruation or unwanted pregnancy– these newfound freedoms can be liberating.

As we grow older, the need and desire to be close to others doesn’t go away. And a satisfying sex life can be a big part of a healthy, happy relationship. But it’s normal for aging to bring physical changes to women (and men). Let’s take a look at some common changes that occur after menopause, as well as treatments that are helping post-menopausal women rediscover their sexuality.

Some normal changes

Normal aging brings about physical changes that can affect a woman’s ability to have and enjoy sex. After menopause, estrogen levels decrease. Less estrogen causes changes in a woman’s vagina: her vaginal tissue can become thinner, dryer and less elastic, which can make intercourse painful.

Physical changes in your body aren’t the only things that can affect your ability to enjoy intimacy. Some illnesses, disabilities, medicines and surgeries—as well as emotions or problems in your relationship—can also play a role. So now it’s time to talk about how important it is to share these issues with your doctor.

What you can do

There are things you can do on your own to help your sex life. Make your partner a high priority. Take time for each other, enjoy each other and understand the changes you both are facing. Be patient, be open to trying new things and try not to hurry things along. Keep in mind you’re both in this together.

How your doctor can help

You may not find it easy to talk to your doctor about this. But remember, your doctor has talked about aging and intimacy with many patients who have these same issues.

One of the most common problems is painful intercourse due to vaginal dryness. Your doctor may recommend water-based lubricants or vaginal moisturizers—both easy to find at a grocery store or drug store. Topical estrogen therapy is another option to help replace some of the hormones your body is lacking.

This can help target the area directly and relieve vaginal dryness symptoms. Unlike menopausal hormone therapy (MHT), formerly known as hormone replacement therapy, which can take the form of a pill and skin patch, topical estrogen therapy doesn’t put as much estrogen into your blood stream.

There is also a non-hormonal medicine to treat moderate-to-severe vaginal dryness brought on by menopause that may be right for you. Your doctor can tell you about the risks and benefits of this option.

It’s not easy to decide to treat symptoms of menopause that affect intimacy. The transition can be complicated and, of course, personal. But talking with your doctor can make a big difference, and that can make it all worth it. We’re all familiar with the phrase “use it or lose it,” and it perfectly applies to our body and muscles. Muscles are made to be used, and if they’re neglected it’s our health and quality of life that suffers.

Cardiovascular exercise is defined as any activity that increases your heart rate. Elevating your heart rate for an extended period of time (at least 30 minutes daily) will improve your heart health. A stronger, healthier heart is able to more efficiently deliver oxygen to the muscles and also burn more fat while you’re exercising and resting.

The benefits of a stronger heart through cardiovascular exercise are numerous. In addition to a stronger heart and lungs, regular exercise has been shown to lead to better sleep, less stress, reduction in mood swings and depression and an overall more active lifestyle.

You have a target heart rate zone that you should strive for during activity. A simple way to calculate it would be to first find your predicted maximum heart rate, which you can find by subtracting your age from 220. Once you’ve figured your maximum heart rate, you can find your target healthy heart rate range by multiplying your maximum heart rate by 65 percent (0.65) to find the low end of that range and multiply your maximum heart rate by 85 percent (0.85) to find the high end of the range.

Example: 

The maximum heart rate for a 45-year-old is 175 and the target heart rate range would be about 113 to 149 beats per minute.

Step 1: 220 – 45 (Age) = 175 beats per minute—maximum heart rate

Step 2: 175 x 0.65 = 113.17 beats per minute—low end of target range

Step 3: 175 x 0.85 = 148.75 beats perm minute—high end of target range

Keep in mind that this is just an estimate. There are several other ways to monitor your heart rate during physical activity to maximize the potential benefits.

The benefits of a stronger heart cannot be understated. As with anything new, please consult your physician for more information about your individual target heart rate and to determine the best course of action for you. If you have fallen out of the exercise routine, there’s no time like the present to get back on track. Any regular physical activity, no matter what it is, will be beneficial in the long run.

Often at the beginning of the year, we begin new resolutions that can include changing the way we eat. When thinking about defining which foods are “healthy” or “unhealthy,” it’s important to understand not just the quality of your food but also the quantity you’re eating.

You can gain weight by eating high-quality, healthy food in incorrect quantities. Each individual needs a different quantity of daily food and beverage intake. Another way of thinking about the quantity you need would be to think about the total number of caloriesyou need.

Caloric need is calculated based on a variety of factors including a person’s age, height, weight and activity level. A more precise way to determine your caloric need is to obtain a body composition measurement using a BOD POD or an indirect calorimeter test. No matter which method you choose, a registered dietitian can help identify and explain your specific calorie needs.

A registered dietitian can also help you identify and set goals related to your diet. For example, if you want to eat healthier and lose weight, the dietitian will most likely prescribe a healthy and controlled calorie deficit so you can begin learning and planning. Then, the dietitian can help teach you how many calories are in the food you consume.

Being mindful of caloric intake can be tedious at times. So it’s always important to go back, reflect and learn from what you’ve consumed. For example, if you eat three slices of pizza, a breadstick and side salad for dinner at a local pizza restaurant, you may be surprised to learn you just consumed 960 of your allotted 1,500 daily calorie need. This type of scenario is bound to happen at some point when you first start to make changes in your diet, but until you go back and reflect on this meal and think about what you could have done differently, you won’t learn from this situation.

Reviewing your caloric needs and learning nutrient recommendations with a registered dietitian can help you succeed at healthy weight management over time.

We’re given only one body in life, and each day we have the opportunity to either build it up or tear it down. We all want a physique we can be proud of, but more importantly, we need a body that works well. Age and illness will play a role in the condition of our body, but we have the ability to prevent, reduce or eliminate many ailments and injuries.

Practice these six body basics for an ideal body:

• Build up muscular strength. The capacity to exert force can help with day-to-day activities and, when needed, help you through a fight-or-flight situation such as carrying someone to get help or stopping a falling item.
• Flexibility is freedom. Having a full range of motion is an asset you may not value until it diminishes. Start stretching daily to reduce risk of injuries and to help your body age gracefully.
• Increase muscular endurance. The ability to perform actions for a prolonged time will prove beneficial for manual labor and physical activities.
• Keep your composure. Body composition is the element of fitness we notice the most about our body. Fat, bone, muscle and water make up the body. Weight is best when it’s lean and strong.
• Practice stability. Balance is a key element of fitness. The ability to control your body takes work, but this skill will keep you safe. Practicing yoga, trying out a BOSU ball, walking along a thin line or working through obstacles can go a long way.
• Swim, walk, run or hike. Cardiovascular endurance ensures that a strong heart, good set of lungs and healthy blood vessels deliver oxygen to your body tissues.

Many people struggle with body image. Remember—as long as you have the elements of fitness listed above, you are in perfect shape!

Before you throw up your hands in despair (or throw out your lacy lingerie), here are some ideas worth considering:

• Physical therapy for pelvic discomfort
• Kegal exercises
• Regular sexual activity, which promotes vaginal health and blood flow. To make it easier, you may want to consider:
• Vaginal dilators
• Over-the-counter vaginal lubricants (for temporary relief of dryness before and during sex)
• Over-the-counter vaginal moisturizers (for longer-term relief from dryness)
• Low-dose vaginal estrogen therapy in cream, ring or vaginal tablet form (reverses underlying atrophy and dryness)
• Higher-dose hormone therapy throughout the body via pills, patches and other preparations (reverses underlying atrophy and dryness, but generally reserved for women with bothersome hot flashes.
• A recent Australian study published in the New England Journal of Medicine found that a testosterone patch may significantly improve a woman’s sexual satisfaction. The patch is currently available in Europe to treat loss of sexual desire in women, but it is associated with a possible increase in the risk of breast cancer. More research is needed before the U.S. Food and Drug Administration (FDA) would approve the therapy.

Other treatments:

Laser therapy. 

A new non-hormonal therapy, the MonaLisa Touch is a fractional carbon dioxide (CO2) laser specially designed to help restore vaginal health in postmenopausal women. It was recently introduced in this country after successfully treating more than 15,000 patients around the world. Performed by an OB/GYN, it works by delivering controlled energy to the vaginal tissue to revitalize the cells to make morecollagen (which is an essential ingredient in vaginal cell health) and is an in-office, virtually pain-free procedure requiring no anesthesia.

Flibanserin.

Touted as the “female Viagra,” the FDA twice rejected this drug, citing safety concerns like low blood pressure, dizziness and fainting. As of this writing, an FDA advisory panel has recommended approval of the drug on the condition that the drug’s manufacturer, Sprout Pharmaceuticals, try to reduce the risks of side effects. Stay tuned for a final decision, possibly in summer 2015.

Ospemifene (Osphena). 

This drug was approved by the FDA in 2013 for postmenopausal women who experience pain or discomfort during sexual intercourse. The once-a-day pill, which works by acting like estrogen in some parts of the body, helps make vaginal tissue thicker and less fragile.

Any woman considering taking any medication should have a thorough discussion with her health care provider to consider the risks and benefits.

With menopause comes symptoms that may lower libido and make sex painful. Don’t let your relationship suffer if this is your story. Here’s how to communicate effectively with your partner to maintain a satisfying sex life or even improve It’s hard to get into the mood when you’re dealing with the physical and emotional symptoms of menopause – things like hot flashes, fatigue, weight gain or depression. Plus menopause can cause numerous sexual difficulties for women, including vaginal dryness, loss of libido and delayed orgasm.

And it’s even harder to communicate these things to the man in your life. (Even a female partner who’s not experiencing the same things you are may need to be clued in.) “A woman can feel very fragile and insecure at this time, and if the relationship isn’t solid and supportive to begin with, [sexual issues] can become amplified,” says Faina Novosolov, M.D., a psychiatrist in private practice and faculty member at the Women’s Mood and Hormone Clinic at the University of California San Francisco

The good news: Menopause doesn’t necessarily mean an end to your sex life (or a healthy relationship). In fact, many women find that intimacy is enhanced during midlife. No interruptions from kids, no worries about menstruation or unwanted pregnancy– these newfound freedoms can be liberating.

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