Menopause can be a touchy subject for some women—notwithstanding the mood swings—because it basically ends a period of life when she can reproduce, or experience the “miracle of life.” But there’s more to life than reproducing, and it doesn’t have to mean the end of vitality and sex for all parties involved.

Stages of Menopause

Climacteric is a term that refers to the physiological changes that occur in a transition period from fertility to infertility; in women, it’s commonly known as menopause. And despite popular belief these changes occur in both men and women, though the shift is more subtle in men. Menopause is the more widely known condition but there are two other common stages that are not really known: perimenopause and postmenopause. There is also a male version of menopause, called andropause, which affects men between the ages of 40 and 55. A drop in sex hormone levels (testosterone in men and estrogen and progesterone in women) characterizes both andropause and menopause. The drop in sex hormones in men is more gradual than in women. Andropause can last at least a decade in some cases.

Perimenopause refers to the period of time prior to menopause where a woman is developing symptoms of menopause. Those symptoms include missed periods or heavier than normal flow, hot flashes and the occasional mood swing. Perimenopause may start as early as 35 and could last for a few months to a few years prior to menopause.

Menopause, on the other hand, usually starts between the ages of 45 and 55; and besides a cessation of menstruation, some of the other side effects that can accompany menopause are irregularities in sleep, hot flashes, mood disturbances, headaches, weight gain, sudden, frequent urges to urinate (known as urinary incontinence) and a change in sexual interest and response. After a year has passed since her last period, a woman as officially reached menopause. Menopause can last up to five years.

Postmenopause is defined as the period of time after menopause when estrogen and progesterone levels have drastically decreased and a woman is no longer able to have children, mainly because eggs are no longer released from the ovaries each month.

Sometimes, the onset of menopause may not be from simply aging. If a woman undergoes a full hysterectomy (has both her uterus and ovaries removed), she will not experience perimenopause and will feel the symptoms of menopause, including hot flashes and menstrual stoppage. Additionally, cancer treatments, such as chemotherapy and radiation therapy, can cause menopause. Then there are women who may belong in the 1 percent group where menopause occurs before they turn 40. There are no known factors for the onset of premature menopause, save genetics or an autoimmune disease—like AIDS—that can cause this to happen.

How Menopause Affects Women

During the ages that a woman is subject to menopause, the experience can put a beating to a woman’s sex drive. Her decreased libido may largely have to do with her view of herself as a non-sexual being as she is unable to bear children. Women may also experience decreased libidos due to the physiological changes happening within her. The sharp decrease in estrogen levels leaves a woman’s vagina unable to lubricate as it once did. At times, she may develop vaginal atrophy and vaginismus as a result of her vagina drying out.

Vaginal atrophy occurs when the vaginal muscles become tense and stiff due to lack of lubrication. At this point, sex is painful and most likely impossible. Vaginismus is more of an involuntary movement and spasm of the vaginal muscles that makes it extremely difficult and at times impossible for penetration. Up to 40 percent of postmenopausal women have symptoms of vaginal atrophy due to estrogen deficiency. Vaginal atrophy may also occur in menopausal and perimenopausal women who take anti-estrogen medications or who have medical or surgical conditions that result in decreased levels of estrogen.

That said, can older adults enjoy sexual activity? The answer to this question is a resounding yes. After the onset of menopause or andropause, there are still sex hormones present in the body. Many of these sex hormones, called androgens, are housed in the adrenal glands (located on top of the kidneys) to serve as “back up” sex hormones. However, though we may still be able to enjoy sex, there may be some added issues that were not present when we were younger. In women, it would take longer than normal to become vaginally lubricated and it’ll take longer for men to get erect.

Treatment

To relieve the symptoms of menopause, doctors may sometimes prescribe hormone therapy (HT), otherwise known as hormone replacement therapy (HRT). However, estrogen supplement prescriptions have declined in recent years because studies have shown long-term usage actually increases the risk of heart disease, stroke and breast cancer. They are, nevertheless, recommended for short-term use to stave off osteoporosis, as decreased estrogen levels leave the bones less dense and brittle.

Low-dose antidepressants, such as Prozac, Zoloft and Paxil, may be recommended for some women to alleviate their hot flashes. There are other drugs available that mimic the effects of estrogen in body, without the actual hormone, to help endure menopause symptoms and keep osteoporosis at bay. There are also vaginal estrogen suppositories—that also come in cream, tablet and ring forms—to help lubricate the vagina for a more pleasurable, postmenopausal sexual experience.

Living with It

If hormone treatments and medicine are not favorable options “natural” remedies, such as exercising regularly, not smoking, avoiding foods that are spicy, staying away from alcoholic beverages, or simply staying cool, can decrease incidences of hot flashes. Performing Kegel exercises (squeezing the floor of the pelvic muscles) may help with urinary incontinence.

In recent years, some women have sworn by soybean supplements to help with menopausal symptoms. Other age-old remedies include dong quai, licorice, chasteberry, evening primrose oil, wild yam, black cohosh (herb found in Europe) and vitamin E. For most of these homeopathic remedies, there is no scientific data to confirm the positive (or negative) effects on menopausal women. It’s highly recommended to speak to a physician before trying any of the mentioned remedies.

Overall, in spite of what it may feel like, menopause is not a medical condition or a disease but a natural biological process brought on by age and should be treated as such. Regular activity, such as sex, does not have to be interrupted by age. Nothing should stop a person from enjoying a healthy sex life—not even age.