Sex and the menopause – what really happens?

Far from being 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 number of reasons, but the impact it can have on your relationship is probably pretty high on the list.

The reality is, 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.

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 review in the Journal of Women’s Health 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 kept their stress levels in check, and who exercised frequently, 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.

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 making it prone to inflammation, and sex uncomfortable.⁵ 

It can also lead to the tissues around the vagina becoming thinner, dryer and inflamed, making sex painful or uncomfortable.

Vaginal dryness 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, 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.

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. This can mean pain during sex, bleeding, and frequent urinary tract infections.⁹

What to try: Regular sex makes this less likely – orgasm encourages blood flow to the vagina, helping to maintain the thickness of the vaginal wall.¹⁰ Using a good lubricant during sex can also help, such as YES.

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 flushes and night sweats during menopause.¹¹

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.¹² These lightly mimic the effects of oestrogen in the body and can reduce the frequency and severity of hot flushes in some women.¹³

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.¹⁴

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

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.¹⁵

Don’t forget that menopause may coincide with other changes too, from children flying the nest to fewer money worries and a better work-life balance. Sex can finally be given 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!

Last updated: 24 March 2021

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