Anonymous question:
Do many women want or have a fulfilling intimate life post menopause? My wife says it’s all down to her hormones and there is nothing that can be done.
Menopause is not the end of a woman’s erotic life. But the way we talk about it? Absolutely makes it feel that way.
For many women, menopause can feel like a dead end. There’s vaginal dryness, weight gain, hot flashes, disrupted sleep, decreased libido—not to mention a cultural script that basically whispers: “You’ve aged out of eroticism. ”
Doctors often don’t help either. The average physician receives less than 4 hours of menopause education in medical school, and it shows.
Many women are told to “just wait it out” or are wrongly prescribed anti-depressants because of their doctor’s ignorance.
Partners, meanwhile, are left feeling helpless or shut out.
So it’s not surprising that your wife feels like nothing can be done. But I want to offer both of you something better than resignation: information, validation, and possibility.
What the Research Actually Says Contrary to popular belief, sexual satisfaction can increase with age. In You Are Not Broken , Dr. Kelly Casperson cites research showing that more than half of sexually active women over 80 report being sexually satisfied “almost always.” Even more compelling? Only 3% of them report feeling desire “almost always.” That tells us something huge: desire isn’t a prerequisite for pleasure .
So if your wife is waiting for her libido to spontaneously bounce back, that may not be the best benchmark. And if you’re waiting for her to feel like her “old self,” that might never happen either. But something different—something even better—might be possible.
Menopause Can Mark a Sexual Awakening Mireille Silcoff’s recent NYT piece, “Why Gen X Women Are Having the Best Sex,” beautifully captures this shift. Citing research from Lisa Miller, she writes that many women in middle age are now finding their “sexual voice.”
With less pressure to conform to social standards, feeling better in their bodies, and no risk of pregnancy, women are finally asking: What do I want?
I’ve spoken to postmenopausal women who tell me their orgasms are stronger than ever. Others say they feel more confident in bed, more willing to advocate for their needs, and more playful with their partners.
When we drop the goal of “returning to how things were,” a new landscape of eroticism opens up.
Hormones Matter—But They’re Not the Whole Story Let’s talk hormones. Yes, declining estrogen can cause discomfort—vaginal dryness, pain with penetration, decreased arousal. But that doesn’t mean “nothing can be done.”
Here’s what can help: Vaginal estrogen (safe, effective, FDA-approved) to treat genitourinary symptoms like dryness, irritation, UTIs, and pain with sex.Systemic hormone therapy (HT) for vasomotor symptoms like night sweats, hot flashes, and poor sleep.Testosterone replacement helps with desire, arousal and overall energy. While it isn’t FDA-approved for women in the U.S. yet, it is safely prescribed off-label by informed providers.Lubricants and vaginal moisturizers , especially for day-to-day comfort and non-penetrative pleasure.Pelvic floor therapy for pain, arousal, and stronger orgasms.Yet many women are terrified of hormone therapy—because of misinformation.
Back in the early 2000s, a major study (the Women’s Health Initiative) made headlines linking hormone therapy to increased breast cancer and heart disease. What most people don’t know is that those results came from women who hadn’t taken hormones in decades and were suddenly given estrogen in their 70s.
Today, leading experts clarify: for healthy women aged 45 to 60—or within 10 years of menopause—hormone therapy is not only safe, it’s often protective, especially for the heart. Estrogen helps keep arteries healthy and may even have protective effects against certain cancers (including breast cancer). Vaginal estrogen, which is topically applied to your genitals, is safe and FDA-approved.
So if your wife has concerns, encourage her to visit menopause.org and look up a provider who’s certified by the North American Menopause Society. Because many OB-GYNs still aren’t up to date.
The Bigger Barrier? Cultural Messaging Let’s zoom out for a second. We live in a culture that equates sex with youth, spontaneity, and penetration. If it doesn’t look like that, we think something’s wrong. But that mindset is the real dead end—not your wife’s body.
Sex after menopause might look different. But different isn’t worse.
In fact, it might be the first time she gets to define sex on her terms—what feels good, what feels safe, what feels intimate. That’s a powerful shift.
So What Can You Do? Here’s what I don’t recommend: trying to “fix” it.
Instead, invite her into a new kind of conversation—one rooted in curiosity and collaboration.
Ask: “If we could redefine intimacy—no pressure, no performance—what would that look like for you?”
This shifts the dynamic from “I want more” to “I want us to figure this out together.” It gives her space to grieve what’s changed while gently opening the door to new possibilities.
If she’s open, read books like The Menopause Manifesto (Dr. Jen Gunter) together. Or suggest a consultation with a menopause-informed doctor, sexologist or pelvic floor specialist.
Because here’s the truth: sex doesn’t have an expiration date.
It just needs room to evolve. And this evolution begins with accurate information, compassionate support, and permission to explore intimacy in new ways.
And that is absolutely within reach.
Would you like help navigating intimacy changes with your partner? My 1:1 coaching for couples is open for summer. Book a free discovery call here .
