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2 feet at the end of a bed under a beige duvet

Sex and the menopause: what to expect

03 Jul 2023 • 9 min read

Far from the end of your sex life, the menopause can signal the start of a new (and liberating) phase in your relationship.

Many women worry about the menopause for a few reasons, but the impact it can have on your relationship is probably pretty high on the list. The reality is that menopause affects everyone differently; some women breeze through it, discovering a renewed passion for sex, while many can develop symptoms that sap their sex drive.

In fact, a 2018 US survey found that a third of women going through menopause felt unattractive, and 62% had less interest in sex than previously.1 But there are a few tricks that can help you manage your sex life during the menopause, and we’ll give you the details on 5 of our favourites:

1. Boost low libido

1. Boost low libido

Yes, dwindling oestrogen levels can definitely reduce the desire for sex. Often, though, it’s the physical symptoms of menopause that are the biggest turn-off. A 2010 Journal of Women’s Health review found that night sweats, hot flushes, insomnia, fatigue, and depression were all linked to reduced libido.2

What to try: the same study revealed that women who regularly kept their stress levels in check and exercised reported greater sexual desire.3 Hormone replacement therapy (HRT) can also work to improve libido. There are many different types and doses of HRT, so it’s important to find the right one for you.

2. Beat vaginal dryness

2. Beat vaginal dryness

Your sex drive isn’t the only thing often affected during the menopause. Lower oestrogen levels can prevent the lining of your vagina from secreting natural lubricants. This makes it prone to inflammation, thinner and dryer, which can make sex feel quite uncomfortable and sometimes painful.5

Vaginal dryness symptoms can cause pain and discomfort during the day, too, not just if you’re sexually active. As many as 34% of women aged 57-69 experience vaginal dryness, according to a 2018 study in menopause.6 However, half of those women didn’t report it to their doctor, and less than 4% used any kind of treatment.7

What to try: A good lubricant may be all you need to ease menopause dryness, or your doctor can recommend an oestrogen cream or HRT to ease the problem.8 Often, a combination of the two can work really well.

3. Tackle vaginal atrophy

As oestrogen levels drop, the walls of the vagina can thin and become more sensitive to irritation. The skin around the neck of your bladder and urethra can also change, thinning and weakening, which can mean pain during sex, bleeding, and frequent urinary tract infections.9 This is known as vaginal or endometrial atrophy. It is important that if you experience any of these signs, visit your GP – they’ll be able to offer you help with a proper diagnosis and support with treatment.10

What to try: Regular sex makes these vaginal atrophy symptoms less likely – orgasm encourages blood flow to the vagina, helping to maintain the thickness of the vaginal wall.11 Using a good lubricant during sex can also help, such as YES.

4. Say goodbye to night sweats

4. Say goodbye to night sweats

Unfortunately, things can heat up in the bedroom for the wrong reasons, with around 70% of women affected by hot flashes and night sweats during menopause.12

What to try: Dietary changes can help, so avoid hot-flush triggers such as alcohol, caffeine, and spicy foods, and include plenty of plant oestrogens in your diet, like soya and flaxseeds.13 These lightly mimic the effects of oestrogen in the body and can reduce the frequency and severity of hot flushes in some women.14

5. Bin the bad body image

Negative attitudes to ageing mean some women associate going through the menopause with no longer being attractive. It can also lead to weight gain, as muscle mass decreases and metabolism slows – another reason to stay active in your 40s and 50s.15

What to try: Self-esteem is so entwined with sexual enjoyment, so it’s essential to be honest with your partner about the changes you’re experiencing; this can help your partner support your needs and boost your confidence.

How HRT could improve your libido

Hormone replacement therapy (HRT) is thought to help improve libido by restoring some of the hormones that your body no longer makes during menopause. The main 2 hormones used in HRT are oestrogen and progestogen, and you can either take a combination of these hormones (combined HRT) or just oestrogen (oestrogen-only HRT), which is usually recommended if you have had a hysterectomy.16

There are many different types and doses of HRT, like tablets, the Mirena coil and more, so finding the right one is important. Tablets are the most common form, as both types of HRT are available as tablets, but other forms, like the Mirena coil, deliver a supply of just one hormone. The Mirena coil, in particular, delivers a constant supply of progestogen for 4 years to help minimise the PMS-like symptoms of menopause. But, as it contains only progestogen, it will need to be supplemented with oestrogen.17

It is important to note, though, that most forms of HRT are not contraceptives, so you will still need to use a form of contraception, like condoms, as it is still possible to get pregnant while taking HRT.16

You should still use contraception until 2 years after your last period if you're under the age of 50 or for 1 year after the age of 50.16 The Mirena coil is currently one of the only exceptions. HRT is normally prescribed by your GP or by a pharmacist, so if this sounds like something you’d be interested in, talk to your GP for more information and advice.

And the more positive side to sex in the menopause?

While the end of your fertile years might be an uncomfortable reminder that you’re getting older, think of it more as a liberating new phase in your sex life; a 2015 survey by the University of Manchester found that 85% of sexually active women aged 50-69 are still very much enjoying sex.18

Don’t forget that menopause may coincide with other changes, from children flying the nest to fewer money worries and a better work-life balance. You can finally give sex the time and energy it deserves without the worry of getting pregnant, having to get up early for work, or children walking in without knocking!

Written by Beth Gibbons on December 30, 2018
Reviewed by Dr Louise Newson on January 6, 2019

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