Sex & menopause
Research from the National Ageing Research Institute and the University of Melbourne, called the 'Women's Healthy Ageing Project' (a large study of women begun in 1990) found that as women transition through menopause, there can be a significant decline in sexual functioning.
They found the decline is associated with a reduction in the hormone oestradiol (a form of oestrogen), but not testosterone. The exact relationship between hormone levels and sexual dysfunction is still not clear, and appears to be quite complex. Researchers have identified that sexual problems are worse for women with early/premature menopause or surgical menopause. This may be due to the sudden drop in hormones that happens with these types of menopause.
At midlife and menopause many things are likely to be happening, both to your body and in your relationships. There are partners, children, ageing or unwell parents to consider, as well as work demands and even your sense of identity as a woman. These changes can affect your sexuality, and together with the hormonal changes, sexual problems may occur.
Dr Elizabeth Farrell, Medical Director of Jean Hailes Medical Centre and Gynaecologist, shares five things to know about sex in later life in this video.
The impact of symptoms
One of the key symptoms of menopause is a dry vagina.
Lower levels of oestrogen directly affect your vagina and can make it thinner, drier and less elastic. Testosterone levels fall gradually with age and this can have an impact on your sex life at menopause.
The domino effect of menopause symptoms such as hot flushes, sleeplessness and fatigue can make it less likely you want sex as much
Some women are concerned by the changes menopause causes to their sexual lives and others are not so worried. It really depends on you, your attitude to sex, your age, how menopause has affected you, whether you are in a relationship, whether you want to have sex and whether there are other things happening in your life you are more concerned about.
Different types of menopause can also affect your sex life. If you have had a surgical or chemotherapy induced menopause, symptoms can be worse due to the sudden drop in oestrogen and testosterone.
Management & treatment of sexual problems at menopause
Dry vagina treatments
There are several options to treat changes to your vagina caused by menopause.
Because a dry vagina makes sex painful, even thinking about sex can make you anxious and then you can start to fear sex. This can set up a negative 'pain cycle' where you fear sex, avoid sex, get frustrated and anxious and then sex is likely to hurt more. If this is happening, treat the physical symptoms first to reduce the pain and then the fear of pain during sex may also reduce.
However, some women find even though they feel physically better after treatment, they still fear sex will hurt and they may become anxious even thinking about sexual activity. This is common. If this happens to you, it can be helpful to:
- learn and practise relaxation exercises
- talk to a psychologist or sex therapist who specialises in sexual problems in women – you may only need 1 or 2 sessions, but understanding what you can do to help yourself and your partner in this situation may stop a problem becoming bigger
There are many reasons we find ourselves having difficulty when it comes to sex. For more information please see our webpages on sex and sexual health.
Libido at menopause
Libido (sexual desire) tends to be lowered in some women at perimenopause and menopause. It is difficult to have desire if:
- you have experienced pain because of a dry vagina
- you are exhausted because of menopause symptoms
- you feel moody or frustrated by all the changes
- you feel you do not want to be touched as much
Some women may improve with a trial of hormone replacement therapy (HRT) or with use of vaginal oestrogen or vaginal moisturisers to improve vaginal dryness. A libido problem is an important issue to discuss with your doctor.
Testosterone for libido
As with any treatment options including hormone and testosterone therapy, it is important for each woman to explore her own needs, thoughts and experiences and seek a range of qualified opinions from reputable sources.
The area of wellbeing and libido is very complex and research tells us these are likely to be influenced by psychological factors more than testosterone. For example, a woman's individual situation, her relationship status and satisfaction, her past experience of problems and whether she is experiencing anxiety or depression are important influences.
Managing contraception during menopause
Changes to your period during the transition to menopause often prompt women to ask; 'How long should I use contraception?' Most women are aware fertility naturally declines with age.
The possibility of pregnancy in women 45-49 years is estimated to be two to three per cent per year. After age 50, it is less than one per cent. While this is low, the fertility of individual women is extremely variable. Perimenopausal women can ovulate twice within one cycle, and women can still ovulate up to three months before their final period, so contraception remains an important consideration.
When is it safe to stop contraception?
For women younger than 50, contraception is recommended for at least two years after the final period.
For women 50 and above, contraception is recommended for at least one year after the final period.
In early postmenopausal women, there is a small chance of spontaneous ovulation. Some women may wish to continue to use barrier methods like condoms or diaphragms after this time if they want to take as little risk as possible.
It's important to carefully consider your contraception options as there are many different types available. It is a personal choice but it is best to have a discussion with your doctor to help work out what is the most appropriate option for you.
Please note that HRT is not a contraceptive.
It is hard to know if menopause influences the relationship with your partner or the relationship you have with your partner influences the experience of menopause.
At midlife and menopause women may be at different stages of their relationships. These may be long-term or new relationships, satisfying or unsatisfying relationships.
Women who have an early or induced menopause have other issues that affect their relationship. Menopause symptoms and a chronic illness can take their toll making communication one of the most important things to do at this time.
Any relationship difficulties a woman may experience during menopause can negatively affect mood.
Partner attitudes to menopause are important and having an informed, supportive partner can help during this time.
Help your partner access good objective information about menopause and discuss your own experiences to help their understanding.
What can you do to help your relationship?
One of the most important things is to be able to discuss your thoughts and problems openly.
If this is difficult perhaps your partner could visit the doctor with you and you can discuss your concerns together. Another alternative is visiting a psychologist who specialises in couple's therapy. You may only have to go for one or two sessions but the therapist should be able to help support you in your communication.
If sexual problems are causing difficulties in the relationship, it is helpful to sort out how much are due to the physical symptoms of menopause and how much might relate to other issues or both. When you have worked this out, then you can seek the help you might need. For help on how you can assist your partner to understand about menopause and how to help there is a special section for partners.
This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at March 2014.