You may know all too well about hot flashes, night sweats, and other menopause-related changes. But if intercourse becomes painful after menopause, you may have a lot of questions. Many women don't realize that painful intercourse can result from vaginal changes that happen during menopause. In fact, a recent survey of postmenopausal women, 97% considered hot flashes a symptom of menopause. Yet only 57% were aware that painful intercourse is also a symptom. Painful intercourse after menopause is more common than you may think. Over half of menopausal women experience vaginal symptoms. And while other symptoms, like night sweats and hot flashes, will lessen over time, painful intercourse is unlikely to get better on its own. In fact, it can get worse.
Why does it happen?
Less Estrogen: After menopause, your body makes less of the female hormone estrogen. Estrogen helps keep vaginal tissue, or vaginal "walls," moist. As your estrogen levels drop, your vaginal walls can lose moisture, become thin, and shrink. This causes dryness and inflammation that can make intercourse hurt. These vaginal changes are a common condition called vaginal atrophy.
Less natural moisture: Estrogen helps create vaginal fluid. This fluid decreases vaginal irritation during sexual intercourse. Less estrogen means less natural moisture, which means more dryness, inflammation, and pain during intercourse.
Loss of elasticity: As your vaginal walls shrink and thin, they also lose their ability to stretch during intercourse. Without that ability, sex can be painful.
If you have pain during intercourse and have not had a period in more than a year, it's time to talk with your doctor. Vaginal dryness and painful intercourse are common symptoms of menopause—but they are not likely to go away on their own and can worsen without treatment.
So what can I do?
Here are some common ways to deal with vaginal dryness and painful intercourse from menopause:
Over-the-counter lubricants: Lubricants include vaginal gels and liquids. They can be purchased without a prescription, and are used prior to sex to offer temporary relief of vaginal dryness. They are designed to lessen symptoms rather than treat the root cause of the pain.
Prescription estrogen treatments: These are medical options, which include hormone therapy, and require a prescription from your healthcare professional. Prescription treatments can help replenish estrogen to the vagina, helping rebuild the tissue that creates vaginal lubrication. Like all medicines, hormone therapy has risks and benefits and is not right for everyone. They come in several different forms:
Prescription estrogen creams are inserted directly into the vagina, usually with an applicator, to target the cause of dryness and painful intercourse. Your doctor can recommend the lowest dose possible, based on your individual needs.
Prescription estrogen vaginal tablets are placed in your vagina with a disposable applicator. Your doctor will let you know how often to insert the tablet; you might, for instance, use it daily for the first two weeks and then twice a week thereafter
Prescription estrogen vaginal rings are inserted into the upper part of the vagina by you or your doctor. The soft, flexible ring releases a consistent dose of estrogen while in place.
Prescription oral and transdermal estrogen treatments are an option when vaginal dryness is accompanied by other symptoms of menopause, like hot flashes and night sweats.
The risks and benefits may not be the same for all hormone products for menopause, so be sure to talk to your doctor about your health history and treatment goals. You may also want to talk to your partner about what you're experiencing. Being honest could help you get the support you may need.