How to Have THE Menopause Talk
Jan. 26, 2022
Hot flashes, irritability, and sex pain aren’t exactly dinner conversation. But cluing your partner into your situation can help them understand—and you feel supported.
“You don’t understand how big a deal, how strong a connection, and how major a point of pride our sex life has been for our marriage,” says Maria, 50, a yoga instructor who lives in a suburb of Denver. “There was never, ever a time I was ‘too tired’ for sex. There was never a day I wasn’t feeling like, to quote Marvin Gaye, ‘let’s get it on.’ Then along came peri-menopause, and intercourse hurt. I found myself creating all kinds of excuses to avoid sex.”
Welcome to the land of shifting hormones: peri-menopause (the years leading up menopause) and menopause itself (the cessation of menstruation).
And the changes aren’t just about what happens in bed: Peri-menopause and menopause can also lead to bouts of irritability, insomnia, drenching hot flashes, and more.
“It’s hard to look cute and feel good about yourself when you’re having such a major hot flash that even your eyebrows are sweating,” says Priscilla, 59, an editor who was dating her now wife (who’s 14 years her junior) when these symptoms struck. “That symptom identified me as an older gal. I was a peri-menopausal woman. The cultural stigma, even if just mild and internalized, exists.”
It’s not always comfortable, or convenient, but having The Talk about what you are experiencing is important. It’s something both Maria and Priscilla did, and we can help you do it, too.First, understand what’s happening to your body. It’s easier to explain your issues to your partner when you fully grasp them yourself. There’s a huge lack of education about menopause out there, so your partner, and yourself, may understandable be somewhat in the dark. One small survey of American obgyn residents finds that fewer than one in five receives formal training in menopause medicine. As such, here’s some intel. Due to shifting hormones, a woman’s sex drive may decline, and she may experience vaginal dryness and discomfort with intercourse. “This is known as GSM or genito-urinary symptoms of menopause. Sex can become painful due to thinner, dryer tissue. The vaginal opening narrows, too, which can cause discomfort with penetrative sex, and that goes for same-sex couples as well,” says Sheryl Kingsberg, PhD, a psychologist, professor at Case Western Reserve University School of Medicine, and chief of the OBGYN Division of Behavioral Medicine at University Hospitals Cleveland Medical Center.
This stage of life can also mute sexual desire, though Dr. Kingsberg is quick to say that “midlife sexuality is not an oxymoron.” Hypoactive sexual disorder, which means low libido, occurs often in younger women, but the incidence does tick up among women 45 to 64. In addition to the changes in hormones and neurochemical levels as women reach the end of fertility, notes Dr. Kingsberg, “cultural messages can communicate that women shouldn’t be sexual at this age.”
5 Key Talking Tips
It’s a lot—discussing big changes that are challenging to process and accept, especially given our society’s reticence to explore the topics of peri-menopause and menopause. Here, some advice to help you share and get in sync:
1. If the issue is painful intercourse, put it out there. Dr. Kingsberg recommends using language like, “We as a couple need to communicate better because our bodies are changing.” She explains, “One of the benefits of aging for males and females is that they can’t rely on same old, same old. They have to talk about their relationship and how to address the shifts. Explain GSM to your partner and that penetration is painful. Brainstorm other ways to be intimate so there isn’t avoidance of sexual activity due to discomfort.” In same-sex couples, this conversation is also vital. No one wants to feel as if they might be hurting their partner while being intimate. Asking about how something feels and hearing feedback on what’s good and what’s ouch become crucial.
2. Bring the pleasure back. “There are safe and effective treatments, hormonal or otherwise,” says Dr. Kingsberg, if sex is uncomfortable. “Talk to your healthcare provider about what options are available for you.” And talk to your partner about the steps you are taking. “After years of our hot sex life, I felt sad for a while about the changes going on and ashamed that my body didn’t respond like it used to,” says Maria. “But after a mourning period, I sat my guy down and said, ‘Here’s the deal, we need to make some accommodations in the bedroom. He got it. Then I went out, got lube, and made an appointment with my healthcare provider to discuss other options. Our sex life may be different now, but it’s still so good.”
3. Deal with a difference in desire. This is an important topic to air because it can have such a profound impact. “A partner may think, ‘If you don’t want sex, you don’t want me,’” explains Dr. Kingsberg. “For women experiencing lower desire, sit your partner down outside the bedroom and say, ‘This may be a tough conversation, but it will help us, and we’ll learn about each other.’ You might explain that it’s like being at your favorite restaurant but having no hunger. So you need to find ways to build up an appetite and also negotiate the desire discrepancy. Maybe you want sex once or twice a month, and your partner thinks three times a week sounds good. How can you find a mutually enjoyable frequency?”
4. Explain the symptoms that can interfere with intimacy, both physical and emotional. “A couple may not be able to cuddle at a given moment if one partner is having a hot flash,” observes Dr. Kingsberg. In this situation, if the hot-flashee says nothing and darts off to splash on cold water, a partner can feel confused and rejected. Try being open about what is going on (as simple as “Hold on, I’m having a hot flash” works), the impact it’s having, and what workarounds you have developed to manage your symptoms. That kind of sharing goes a long way towards being a united front.
5. Own any irritability. It happens during peri-menopause and menopause. And it’s worth saying, “Sorry, I realize I was just being difficult; I think it’s due to peri-menopause.” Says Priscilla, “I had debilitating insomnia, the kind where after 20 minutes of sleep, I’d be wide awake for hours. Sometimes, after a challenging moment, I would look back and say, ‘Oh, that was the lack of sleep.’” Letting her partner know what was going on was a deeply positive experience: “Having someone encouraging you to seek help from a profession when needed and then celebrate the results with you is quite simply fantastic.”
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