How to have better sex after menopause

Going through menopause? It will probably come as absolutely no surprise that up to half of all women report sexual problems during and after menopause, according to the North American Menopause Society. And for that you can blame your tanking estrogen levels: "It not only lowers desire, it decreases blood flow to the vagina, which in turn affects lubrication and arousal," explained Dr. Lauren Streicher, an ob-gyn at the Feinberg School of Medicine in Chicago and author of “Sex Rx: Hormones, Health, and Your Best Sex Ever.”

But it's not all doom and gloom for good. Here are four options that both research and real women swear works to make sex feel great again.

"It took some time to find the right lube."

If you've got mild to moderate dryness, lube is the place to start. But it might take some experimentation to find the right one. Over-the-counter silicone-based lubricants like this version of Astroglide or Wet Platinum Premium Lubricant work by reducing friction associated with thin, dry down-there tissue, says Streicher. But if that's not doing enough for you, add a vaginal moisturizer like Replens, which is absorbed into your skin and sticks to your vaginal lining (unlike lubricants, you use this every day, not just before sex). You can also try a warming gel like Zestra, which is not a lubricant per se, but increases sensation when you apply it to your clitoris and has research to show it enhances sexual response. (One couple’s solution to a happy marriage? Living in separate houses. Here’s their fascinating story.)

Watch out! Stick to water- or silicone-based lubes: Oil-based ones like petroleum jelly and mineral oil can actually increase risk of vaginal irritation and infection, warns Streicher. And if you're trying Zestra, be cautious: "I definitely felt more aroused using it, but I had burning and stinging for a couple days afterward," Natalie, 53, from Fairfield, CT, said. (Check out these 7 things to never do before or after sex.)

"I couldn't get in the mood."

"Once I started to go through menopause, I experienced a lot of pain with sex and a noticed a big change in both my sex drive and my orgasms," Beth, 54, from San Francisco said.

Hormone therapy helped with the former, but didn't boost the latter at all.

"I didn't want to try any other medications, like off-label testosterone, so I was really looking for a non-drug option," she explained.

She tried Fiera, a new-to-the-market device that uses suction to stimulate your clitoris (it's hands-free, so you just insert and go on to enjoy your foreplay).

"Fiera really helped because it sort of preps me and allows me to 'get ready' for having sex with my husband. It also seems to allow me to have more intense orgasms," she said. (Here are 9 more sex toys experts love.)

Watch out! Make sure you clean it after each use with mild soap and warm water and dry it thoroughly with a cloth; otherwise it can harbor bacteria that can cause infection.

MORE: Try A New Sex Position Tonight

"Sex hurt."

A laser to your vagina may sound like pure torture, but several have gotten FDA-cleared, and post-menopausal women across the country are swearing it saved their sex lives.

"Lasers work by stimulating collagen production inside your vagina, which helps to build up tissue again and make it moist," Streicher said.

Both the MonaLisa Touch and FemiLift require three treatments (spaced a month apart) and cost about $3,000. One small Stanford university study of 30 women found that all of them responded positively to a MonaLisa Touch treatment. They showed "highly statistically significant improvement" in symptoms—including dryness, pain, itching, painful urination, and painful intercourse—after the first treatment. The procedure itself doesn't hurt: "It feels like a small vibration for about five minutes," Sara Marsini, 52, a nurse in Naples, FL, said. "Even after the first treatment, the results were pretty dramatic—I went from having searing pain during sex to feeling absolutely no discomfort," she said, adding that her partner also noticed a difference. "He said my vagina felt more plump, like the walls had some thickening."

It does require an annual maintenance treatment.

Watch out! Beware of unscrupulous doctors hawking lasers.

"MonaLisa Touch is the only one that has clinical research to prove it's safe and effective," Streicher (who has no financial interest in the company) said.

You also shouldn't undergo laser therapy until you've had an updated pap test and a thorough exam by your doctor to ensure that there are no other medical issues such as fibroids causing your pain. (Discover how to balance your hormones and lose up to 15 pounds in just 3 weeks!)

"Nothing else worked."

Last August, the FDA approved Addyi (flibanserin) to treat low sex drive. Unlike Viagra, which increases blood flow to the nether regions, Addyi works on your brain to boost neurotransmitters and thus sexual desire. While it's currently only approved for pre-menopausal women, a 2014 George Washington University study shows that it's safe and effective in post-menopausal women as well.

"Anecdotally, in my practice it's a bit of a wild card—some women completely respond to it, while it seems to do nothing in others," Streicher said.

Watch out! Addyi can cause side effects such as nausea, dizziness and sleepiness. As a result, the FDA recommends drinking zero alcohol while on it (safety data showed a few subjects passed out after washing it down with a half bottle of wine), and taking it at night.

This article originally appeared on Prevention.com.