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    It's Not Your Mother's Menopause

    Help for Painful Sex

    After menopause, the inside of your vagina can get dry. That takes the fun out of sex. A personal lubricant can help, but you have to pick the right one.

    “Water-based lubricants are a necessity if you use condoms, but women often tell me the water-based ones dry up quickly and are sticky,” Lynn says. "Try a silicone-based lubricant instead.”

    Daily vaginal moisturizers can help, even if you’re not having sex, Pregler says. “Think of it the way you think of moisturizing your skin. You use lotion every day, not just when you’re gardening.”

    Your vagina can get shorter, thinner, and less elastic after menopause. Generations ago, women might have considered that to be the end of their sex lives, but now doctors know that it’s “use it or lose it.”

    Have sex or use toys like vibrators inside your vagina to keep it in shape. If the changes have been severe or it’s been a long time since you got busy, your doctor may advise you to use vaginal dilators, gadgets that gradually stretch things out.

    You might also try physical therapy if sex is painful for you. If you tense up because you’re afraid of pain, your body learns to do that when you have sex. “The physical therapist can teach you how to relax your muscles,” Lynn says.

    Medication Can Help

    Hormone therapy is still the main menopause treatment, but the finer points have changed, Soutendijk says. “We’re using far lower doses than we used to. The goal is to take just enough to help relieve hot flashes and no more.”

    If you’d rather not take pills that affect your whole body but still need something to help with dryness and tone, your doctor may prescribe suppositories or a ring, cream, or gel that you put inside your vagina.

    “These don’t help hot flashes, but the advantage is that very little estrogen gets absorbed into the body, so they don’t have the same risks for breast cancer and blood clots as [traditional hormone therapy],” Lynn says.

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