Surprising as it seems, sex does get better for some women around menopause. They're more experienced and know what they like and are willing to ask for it. With children out of the house, they may have less stress and more time to foster their intimate relationships. As your hormone levels fluctuate, you may even experience a surge of "free testosterone" that increases your sex drive.
But your hormones can work against you. Some women experience a real drop in sexual desire during the menopause transition. They never seem to be in the mood anymore. Others may have trouble achieving orgasm as regularly or, perhaps, they just feel less sexual. Menopausal symptoms—hot flashes, vaginal dryness, sleeplessness, moodiness, excessive and erratic bleeding—can also make you feel pretty unsexy. Other issues that may play a role include how you feel about getting older, your appearance and physical fitness, the availability and health of a partner, and medications you're taking.
The best advice doctors give about menopause and sex is this: use it or lose it. Women who continue to have frequent sex during the menopause transition have fewer sexual problems than those who cut back or stop. Part of the reason is physiological. The more sex you have, the more you encourage blood flow to the vaginal region, which helps keep the tissues healthier. Vaginal lubrication is also more plentiful in women who often have intercourse. Pelvic muscles that are used often are more likely to be strong and responsive. In addition, having regular sex encourages you to keep thinking of yourself as a sexual being no matter what your age.
Some researchers theorize that the body may respond to high levels of sexual activity by producing more hormones. Australian sex researcher Lorraine Dennerstein has always been fascinated by the small subset of women who have sex every day. She's found that no matter which treatment group these women are randomized into during clinical trials, they never report any vaginal problems. Other sex researchers have found similar results. That doesn't mean that every woman going through the menopause transition has to have sex every day, but it does show that a positive attitude about maintaining a good sex life can help a lot.
It's also important to realize that both men and women tend to feel less sexual desire as they get older. Over time, you may find that it takes you longer to feel aroused or to reach orgasm. Foreplay may need to become more direct and focused. Many couples discover that sex can be even more fun once they negotiate the obstacles. If you and your partner feel happy with yourselves and each other, good sex will follow—at any age.