Menopause is often associated with a range of symptoms, but one that doesn’t get as much attention is the decrease in libido. In fact, more than a third of women in perimenopause or menopause report experiencing sexual challenges, including reduced interest in sex and difficulty reaching orgasm, according to Johns Hopkins Medicine.
The primary cause? Dropping estrogen levels, which can dampen sexual desire and make arousal more challenging.
During a recent a panel in New York City, a group of leading experts gathered to have an honest conversation about this specific topic. Titled The Marvelous Mrs. Menopause and moderated by Flow Space’s editor-in-chief Galina Espinoza, the conversation was meant to shed light on the challenges midlife women face and to offer practical advice for navigating them.
From understanding the role of hormones to embracing sexual pleasure, the discussion highlighted the power of knowledge, choice and self-care during menopause.
The panel began with Espinoza introducing Dr. Alicia Jackson, CEO and founder of Evernow, a telehealth company focused on perimenopause and menopause care. Beside her sat Gabriella Espinosa, a sexual wellness coach and host of the podcast Pleasure in the Pause, which explores menopause and sexuality. Dr. Somi Javaid, a board-certified OB-GYN and founder of HerMD, and Dr. Rocio Salas Whalen, a triple board-certified endocrinologist specializing in hormonal health and weight management, rounded out the panel.
Sex in Menopause: It’s Going to Change—But You’re in Control
Kicking off the conversation, Espinoza asked the experts to share one thing they wish women knew about how menopause impacts their sex life, beginning with Jackson.
“It’s going to change. End of story,” Jackson stated. “But that doesn’t mean you have to just roll with it.”
Jackson went on to explain that menopause affects the body in profound ways, largely due to the reduction in estrogen, but emphasized that women have options when it comes to maintaining a satisfying sex life.
“Sex isn’t just a ‘nice to have,'” Jackson said. “For many women, it’s a ‘must have’—whether for relationships or their own enjoyment of life. And it truly is about health.”
Additionally, Jackson highlighted that solutions, such as vaginal estrogen, can significantly improve sexual discomfort, noting that “painful sex decreases by 75% within two months of using vaginal estrogen.” But most importantly, she stressed that the decision is up to each woman.
“You’re in charge of that. So whatever you want—testosterone, vaginal estrogen or nothing at all—it’s your call,” she said.
Redefining Pleasure: Taking Back What’s Yours
Espinosa followed up with an empowering message for women navigating this stage of life.
“What I want every woman to know is that menopause does not mean the end of sexual pleasure,” she said. With her work focused on helping women redefine pleasure in midlife, she urged the audience to start by asking themselves a simple question: “What does pleasure mean to you?”
Espinosa pointed out that many women have spent their lives deprioritizing their own pleasure in favor of others, and menopause is the perfect time to reclaim it.
“It all starts with you—getting to know yourself, exploring what brings you joy, and redefining pleasure on your own terms,” she said. Her advice was clear: “Take a moment for that deep inner reflection. So much of our lives has been about giving our pleasure away, making sure everyone else is enjoying besides us. Now, it’s your time.”
Sexual Health Is Health—Period
The conversation quickly turned to the broader issue of sexual health, with Javaid emphasizing that sexual health care is a basic human right.
“It’s beyond treating infection, contraception or fertility. We need to talk about women’s pleasure, arousal, orgasm, pain, lubrication and satisfaction,” Javaid said, echoing the sentiment that sex is an integral part of overall health.
Whalen agreed and added a key takeaway for the audience: “If your doctor tells you, ‘This is just how it’s going to be now,’ don’t take no for an answer.”
She stressed that women deserve to maintain the same sexual life they had before menopause. “We deserve to continue with the same sexual life that we had in our premenopausal years,” she said.
How to Talk to Your Doctor About Sex and Menopause
For women struggling to address sexual health with their healthcare providers, Javaid offered practical advice.
“First, find the right provider,” she said, mentioning the International Society for the Study of Women’s Sexual Health (ISSWSH) as a resource for finding specialists who understand sexual health in midlife. She also recommended that women take the Female Sexual Function Index (FSFI), a 19-question assessment they can bring to their doctor to help guide the conversation.
Javaid acknowledged that finding time to discuss sexual health with doctors can be challenging, especially when some only have seven minutes per appointment.
“You need a doctor who has more than five minutes to spend with you,” she said. “Find the right provider, find the right environment and go in prepared. That’s when the magic happens—because there are options.”
Know Your Anatomy: Befriend Your Vulva
In a humorous yet vital moment, Espinosa urged women to become intimately familiar with their bodies. “What is your relationship with your vulva?” she asked the audience. She emphasized that knowledge of one’s sexual anatomy is crucial, particularly as menopause brings about changes.
“Ignorance is not bliss. Knowledge is power,” she said, encouraging women to “befriend” their vulva.
Her advice? “Take out a mirror. Have a good look. If you need a glass of wine, go ahead.”
Knowing what’s normal for your body, Espinosa explained, allows you to communicate any changes to your doctor and advocate for your own health and pleasure.
Vaginal Estrogen 101: The Facts You Need
One of the most critical tools for addressing sexual health during menopause is vaginal estrogen. Jackson offered a simple explanation: “99% of women can use vaginal estrogen. It’s very low dose, and it’s preventative and restorative.”
Jackson pointed out that despite an outdated FDA warning linking vaginal estrogen to cancer and dementia, the treatment is incredibly safe and effective.
“It should be as common as brushing your teeth,” she said, underscoring the importance of taking care of vaginal health, especially as it becomes more sensitive post-menopause. Unfortunately, many women face obstacles with insurance coverage, which can make the treatment costly.
“Insurance is terrible on this,” she noted. “But it’s important for your health.”
Testosterone for Women: What You Need to Know
The panel also touched on testosterone therapy, which isn’t FDA-approved for women but is often prescribed for hypoactive sexual desire disorder (HSDD). Whalen explained that testosterone can increase desire and improve energy, mood and sexual response.
“It improves sex drive in four different ways in our brain,” she said, noting that although testosterone isn’t FDA-approved for women, it’s widely used in treatment.
While the therapy can have side effects like hair growth or irritability, Whalen emphasized that these risks are preventable with proper monitoring.
“We prescribe 1/10th of what a man would use,” she said, advising that patients work with doctors to get their testosterone levels checked regularly.
Bringing Men Into the Conversation
Finally, the panel addressed the importance of involving partners in the conversation about menopause and sexual health. Espinosa acknowledged that talking about menopause with a partner can feel vulnerable, but it’s essential for maintaining intimacy.
“Menopause causes changes in my body and my desire,” she suggested as a starting point for the conversation. “Ask for what you need, whether it’s more time, gentleness or emotional support.”
The evening ended with a clear message: Menopause is not the end of pleasure, health or intimacy—it’s a transition that women can navigate with the right knowledge, tools and support. As Javaid put it, “Find the right provider, know your body and advocate for your pleasure.”