To many women, menopause may seem like a time when almost nothing goes right. A woman may experience hot flushes, sleeplessness, mood swings, vaginal dryness, and loss of sexual desire, among other physical and mental disturbances.

During this time, her children are most likely reaching adulthood and moving away, leaving behind the dreaded "empty nest." And as physical beauty inevitably wanes, a woman may also notice that her sexual relationship with her partner suffers from a grinding, unexciting sameness.

With such a scenario, is there any chance that sexual pleasure and satisfaction can be sustained, let alone improved after menopause? Surprisingly, the answer is yes.

A recent large European study, soon to be reported in the scientific literature, found that as many postmenopausal women did well sexually as did poorly. Not all women go through the plethora of possible menopausal symptoms mentioned above. Most symptoms of menopause are due to the dramatic reduction in estrogen production as the ovaries shut down. In many women, these symptoms can be effectively treated with estrogen replacement regimens.

Loss of sexual desire is not due to menopause, as most people believe, but to reductions in the hormone testosterone associated with aging. Physicians can prescribe replacement testosterone just as they prescribe replacement estrogens, although this avenue of treatment is sought much less frequently. And with concerns about pregnancy and monthly periods in the past, many women feel much freer to enjoy sex. Postmenopausal couples can finally focus fully on sexual gratification for the first time in decades.

Sometimes the problem is not experienced by the postmenopausal woman herself but resides in her partner. Often, male partners of the same age experience physical maladies that may undercut their sexual functioning. Here, too, there is hope in the half-dozen or so drugs now available for men. Nearly 70 percent of men with erectile problems respond to these treatments.

Menopause is not synonymous with physical and mental discomfort and a lackluster sex life. With a little effort to deal with symptoms as they arise, the results may well be worth it.