If Menopausal Women Learn More About Menopause, Sex Improves
Education and counseling yield less pain, and more arousal, desire, and orgasms
Posted May 15, 2026 | Reviewed by Tyler Woods
Every woman who lives beyond age 45 experiences menopause, which is normal and natural. Menopause brings many changes. Women’s menstrual periods become irregular then end, and many experience mood swings, hot flashes, decreased sexual desire and pleasure, vaginal dryness, and vaginal tissue thinning (atrophy).
Many women heading into menopause are poorly informed about it. Their ignorance causes stress and often aggravates symptoms, particularly mood changes, and sexual issues.
Recently, researchers in Portugal performed a meta-analysis on the effects of education and counseling programs on menopausal women’s sexuality . Meta-analysis is a statistical technique that combines the results of small studies as if they were all part of one big study. Study size matters. The larger the studied population, the more credible the findings. The meta-analysis showed that education and counseling significantly relieved menopausal sexual complaints.
The investigators reviewed eight studies that enrolled 619 women, aged 39 to 75. The studies included a variety of menopause-education programs involving four to 10 sessions that lasted 45 to 60 minutes per session. Topics covered included: menopausal physiological changes, its possible sexual effects, and the many myths that surround it, for example, the idea that menopause can be psychologically devastating, causing extreme irritability, disorienting mood swings, and total libido collapse. Such severe symptoms are possible—but rare.
In addition to education, three of the studies included mindfulness meditation . Five included cognitive behavioral therapy . Both reduce stress and promote the kind of deep relaxation necessary for satisfying sex.
Compared with routine medical care, the women in the education and counseling programs reported significant sexual benefits (p < 0.0001). Their sex-related pain decreased. They were more likely to have orgasms. And their desire, arousal, lubrication, and sexual satisfaction all increased.
What Women—and Men—Need to Know
Menopause marks the end of women’s fertility. Synthesis of the female sex hormone , estrogen, gradually declines, and egg release (ovulation) and menstrual periods become irregular and eventually cease.
Once periods stop, birth control becomes unnecessary. But even infrequent periods mean women are still ovulating, and might get pregnant . Women having periods should continue to use contraception until several months after they have ceased. When in doubt, consult a physician.
Most menopausal discomforts occur from age 45 to 55, but may begin as early as women’s late thirties and may last into their sixties.
In 1900, women’s life expectancy at birth was 48 years. Only a minority experienced post-menopausal living. Today, women’s life expectancy is around 80. Most women live for decades beyond menopause.
As post-menopausal living became the norm, physicians mistakenly called it an illness requiring treatment. But starting in the 1970s, women’s health activists campaigned to celebrate menopause as a normal passage that opens doors to new productivity , wisdom , and fulfillment.
Estrogen typically begins to decline around age 40. As this happens, women's menstrual periods become irregular—skipped periods or unusually heavy, frequent, or extended flow with possible bleeding between periods (spotting). These changes are harbingers of menopausal complaints: mood swings, libido decline, hot flashes, and vaginal dryness and atrophy that may make vaginal intercourse painful.
Menopausal Changes Vary Greatly
Beware of generalizations. Women experience menopause individually. Around 20 percent hardly notice their passage through it. About half experience mild discomforts. And around 30 percent suffer considerable distress, including:
• Emotional upsets . Some women become irritable, anxious , and/or depressed . It’s difficult to predict who experiences what, but women with histories of premenstrual upsets (PMS) and/or post-partum depression are at greatest risk. To minimize emotional upsets, exercise more and try relaxation therapies: mindfulness , yoga, meditation, and cognitive-behavioral therapy.
• Reduced sexual desire . Menopausal discomforts may reduce libido, mostly from age 45 to 55. As women adjust to post-menopausal living, many experience libido rebound. Meanwhile, independent of libido changes, older women’s frequency of partner sex often declines due to widowhood or chronic illness . For libido loss, try hot baths and full-body massages before sex. Or consult a sex therapist.
• Difficulty concentrating . Many women complain of “ brain fog ,” problems with memory , focus, and attention . Exercise often helps.
• Hot flashes . Declining estrogen levels disrupt the brain’s temperature-control center, often causing sudden feelings of heat. Hot flashes may strike at any time day or night, lasting seconds to minutes. They typically affect the face, neck, and chest, and cause sweating. At night, women may kick off blankets and sleep poorly.
To treat menopausal discomforts, some doctors prescribe estrogen ( hormone replacement therapy , HRT). It helps, but has lost popularity because it may increase risk of breast cancer. Fortunately, effective non-drug treatments are available:
-Eat more soy foods. Tofu, and soy meat substitutes contain plant estrogens (phytoestrogens) that have effects similar to pharmaceutical estrogen, but at lower cost and with fewer side effects.
-Eat more fruits and vegetables. All plant foods, not just soy, contain phytoestrogens. Studies show that as women consume more plant foods, they suffer fewer and less severe hot flashes.
-A Native American herb, black cohosh ( Cimicifuga racemosa ), is rich in phytoestrogens. A commercial product, Remifemin, is available at most health food stores.
-Vitamin E may also help soothe hot flashes. Try (800 IU/day).
Vaginal dryness . With age, less blood flows to the genitals. In women, this decreases vaginal lubrication, and may cause discomfort or pain on intercourse. To treat it:
-Consume more phytoestrogens.
-Try a sexual lubricant. For some, saliva is sufficient. But many menopausal women prefer commercial lubes. They’re available at pharmacies near the condoms.
-Doctors can prescribe topical estrogen creams or vaginally inserted plastic rings that deliver estrogen. These approaches don’t cause the cancer risk of HRT.
• Vaginal atrophy . The mucous membrane that lines the vagina thins, which may aggravate the discomfort of dryness and cause pain. Treatments for vaginal dryness may help.
• Sleep problems . Some menopausal women experience trouble falling or staying asleep. Exercise may help.
Women experience menopause individually, but as this meta-analysis shows, the more women learn about this normal, natural process, the less likely they are to suffer during their menopausal transitions.
Silva, IMS et al. “Educational Programs and Sexual Counseling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis,” Journal of Sexual Medicine (2022) 19:54.
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Michael Castleman, M.A. , is a San Francisco-based journalist. He has written about sexuality for 36 years.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.