Sex and the menopause: what to expect

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:

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.

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.

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.

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

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.

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