Menopause isn’t as simple as ending your menstrual cycle. Aside from hot flashes, night sweats, and other symptoms, a decrease in estrogen levels can also have a major impact on your sex life.

You may feel uncomfortable talking about sex with your doctors, but you should be prepared to talk about your problems and concerns to get the most out of your visit.

Before your appointment, make a list of questions to ask and take it with you. Here are eight questions to get you started.

What’s causing my symptoms?

Most symptoms of menopause are related to a decline in estrogen levels. Without estrogen, vaginal tissue becomes thinner, drier, and more fragile. Understanding this link can give you a better idea of what to expect as time goes on.

Learning about the cause of your menopausal symptoms can also help you determine which symptoms are a result of menopause, and which symptoms may be the result of another health condition.

What symptoms should I be concerned about?

Every woman experiences symptoms of menopause. Most are mild and temporary, but some symptoms are more concerning.

Changes in the vagina can increase your risk of vaginal infections and urinary tract infections. This can also lead to urinary incontinence (involuntary leakage). Vaginal bleeding at any time after menopause is also a cause for concern. Ask your doctor what symptoms to look out for.

What should I do if sex becomes painful?

Doctors are aware that menopause can cause vaginal dryness and inflammation, which can make sex painful. Medically, this is referred to as dyspareunia. It’s a fairly common issue — one study estimates that nearly half of menopausal women experience pain and discomfort during sex.

But researchers have also learned that most doctors don’t bring up the topic with their patients because they expect the patient to bring it up with them.

Even if you’re not experiencing pain during sex right now, there’s a good chance you will at some point. Ask your doctor how to choose a good over-the-counter, water-based vaginal lubricant or moisturizer. Depending on the severity of your symptoms, your doctor may also recommend a prescription medication.

Do you recommend hormone replacement therapies?

Not every woman will need a prescription medication to deal with sex and vaginal issues. But if you do, there are many useful medications available, such as hormone replacement therapy.

Oral estrogen therapy is an effective treatment for relieving hot flashes and other menopause symptoms. To relieve vaginal dryness, topical estrogen can also be applied directly to the vagina using a cream, tablet, or ring.

Hormone replacement therapies are available only by prescription. Your doctor will discuss the risks and benefits of hormone therapy. You’ll also want to make sure it won’t interact with any medications you’re currently taking. You and your doctor can decide if hormone therapy is a safe choice for you.

What other vaginal changes should I expect?

After menopause, vaginal dryness and discomfort during sex are common issues, as well as a decreased sex drive. You may also experience changes that affect your urinary tract and surrounding tissues, such as strong urges to urinate or incontinence.

What can be done for changes in sex drive (libido)?

Many women become less interested in sex after menopause. A drop in hormone levels, coupled with vaginal dryness and pain, can make sex less desirable. Thyroid problems and prescription medications may also play a role. For some women, a reduced libido could be the result of low self-esteem caused by postmenopausal weight gain.

It’s important to discuss libido issues with your doctor. They can evaluate the medications you’re taking and run tests before making treatment recommendations.

Should I see a specialist?

There are several underlying medical conditions that could be affecting your sexual health after menopause. Depending on your situation, your doctor might refer you to a specialist for treatment.

This could include seeing a sex therapist, mental health professional, or an endocrine specialist. Your doctor might even recommend that you have an interdisciplinary team to address all underlying factors.

Are there any alternative therapies I should try?

There are many alternative therapies promoted on the internet for managing menopausal symptoms like painful sex, but few have the evidence to back up their claims.

Ask your doctor if there are any safe alternative or complementary treatments that might help. Your doctor might also be able to give you tips on relieving stress and maintaining a healthy diet for a more holistic approach to treating menopause.

The takeaway

Sex doesn’t have to become painful and undesirable after menopause. Your doctor is there to help you, but you can’t always expect your doctor to start the conversation.

Until you see a doctor, you won’t know the cause and the potential treatments for painful sex and vaginal changes after menopause. Though it may feel embarrassing at first, it’s important to start an honest and open dialogue with your doctor. Being proactive allows you to be fully involved in your long-term health.