Tips For Sex After Menopause

by Deborah Maragopoulos FNP | Feb 20, 2023 | Menopause, Women's Health | 0 comments

What are the best tips for sex after menopause?

Honestly, I get this question all the time as a Family Nurse Practitioner: now that I’m menopausal how can I have a better, healthier sex life?

I always start by assessing vaginal health.

Because if your vagina is atrophic from lack of estrogen, sex will be uncomfortable. Your menopausal vagina may require estrogen replacement therapy – directly placed into the vagina. I prefer estriol over estradiol vaginal cream to get the vagina as healthy as possible.

Estrogen helps to keep the vagina lush, thickening the tissue and helping vaginal cells to lubricate adequately for intercourse. My menopausal patients who have incontinence issues, or birth trauma or surgical trauma, and have poor vaginal tone especially benefit from vaginal estradiol.

Poor vaginal tone with age comes from loss of collagen. Besides estrogen, the use of vaginal vibrators can actually be very helpful at improving the vagnial tone as well as practicing kegels exercises. You can find kegels muscles by trying to stop your urine flow while in the process of urinating.

Lubrication is key to good sexual health too.

Even once your vagina is healthy again and its tone is better, you may still need a little extra lubrication. That’s because arousal can be slower in menopause. So make sure you have a lubricant on hand.

My favorite is coconut oil. It has antimicrobial activity, tastes good, and is healthy for the vaginal tissues.

The longer you go without sexual activity, the more difficult it is to initiate but it’s not impossible. You just have to get your vagina healthy again. If you don’t have a partner, that’s where your vaginal vibrator can help maintain vaginal tone.

Remember, as your hormones start falling, orgasm may take longer because you don’t have the same blood flow to the genitals that you did when you were younger. Everything takes a little bit longer. So you need to be patient with yourself and get to know your changing body. A vibrator may come in handy to figure out what you need to orgasm.

Sometimes low libido is an issue.

Estrogen is the main driver of libido in women. But if your vagina is well estrogenized and your FSH is being adequately suppressed with systemic estradiol then you may need a little bit of testosterone to help your libido. Too much testosterone can be an issue but a small amount can actually be very effective at increasing libido once your estrogen and progesterone levels are balanced.

And communication with your partner is key. Menopause is a great time for you to have very frank conversations with your partner. Hopefully your partner has a sense of humor because things are different now. It’s important that you both understand that the female body changes after menopause.

Sex after menopause can be very exciting, beautiful, and fun. Especially with good communication with your partner. I find male partners have a lot of questions about sex in menopause. So let’s talk. Please join me in our Hormone Support Group. You get access to it through my free Hormone Reboot Training.

Frequently Asked Questions:

Can your hypothalamus cause weight gain?

Yes. The hypothalamus is the master regulator of metabolism, controlling how your body stores and burns energy through its signaling to the thyroid, adrenals, and pancreas. When the hypothalamus becomes dysregulated by chronic stress, poor sleep, inflammation, or blood sugar instability, it defends a higher weight "set point" — causing the body to hold onto fat regardless of diet or exercise. This makes hypothalamic dysfunction an upstream root cause of stubborn weight gain.

What is a weight set point and why won't mine move?

A weight set point is the body weight your hypothalamus works to defend, calibrated over time by stress, sleep, hormones, and inflammation. When you diet, the hypothalamus perceives scarcity and responds by slowing metabolism, increasing hunger hormones, and suppressing satiety signals to return you to that set point. This is why most people regain lost weight within two to five years of conventional dieting — the set point itself was never recalibrated, only temporarily overridden.

Why do I gain weight under stress even when I'm not eating more?

Chronic stress raises cortisol, which disrupts blood sugar regulation, promotes abdominal fat storage, and signals the hypothalamus that the body is under threat. In survival mode, the hypothalamus defends fat stores and slows metabolism — so weight can increase even without any change in calorie intake. The stress chemistry, not the food, is driving the weight gain, which is why stress reduction is essential to any lasting metabolic reset.

Why do I regain weight after stopping GLP-1 medications?

GLP-1 medications work peripherally on appetite and gastric signaling, but they do not address the underlying hypothalamic dysregulation that sets your defended weight. Because the hypothalamic set point is never recalibrated, the body resumes defending its original weight once the medication stops — leading to significant regain. Long-term success requires restoring hypothalamic regulation so the set point itself lowers, rather than relying on appetite suppression alone.

How long does it take to reset your metabolism?

Genuine metabolic recalibration takes a minimum of 90 days, because the hypothalamus needs consistent signals of safety and sufficiency before it will lower its defended set point. This differs from a diet, which produces temporary suppression the body quickly corrects. A 90-day reset typically moves through three phases: stabilizing stress chemistry (days 1–30), rebuilding metabolic efficiency (days 31–60), and lowering the weight set point (days 61–90).

Why does my thyroid feel slow even though my labs are "normal"?

Under chronic stress, the body converts thyroid hormone into reverse T3, which blocks active thyroid receptors and slows metabolism at the cellular level — even when standard lab values appear normal. This means you can experience genuine symptoms of slow metabolism, such as fatigue, cold intolerance, and brain fog, while your thyroid panel looks unremarkable. Addressing the upstream hypothalamic and stress signaling often improves thyroid conversion and symptoms.

Is stubborn weight gain a willpower problem?

No. Stubborn weight gain is a signaling problem, not a willpower problem. The hypothalamus governs weight through survival mechanisms that operate below conscious control — defending its set point by slowing metabolism and increasing hunger when it perceives threat. No amount of discipline can override this system; lasting change comes from restoring hypothalamic regulation through reduced stress, balanced blood sugar, restorative sleep, and targeted nutritional support.

About the Author - Deborah Maragopoulos FNP

Known as the Hormone Queen®️, I’ve made it my mission to help everyone - no matter their age - balance their hormones, and live the energy and joy their DNA and true destiny desires. See more about me my story here...

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Last Updated: February 20, 2023