The menopause can affect your relationships and sex life in ways that may be positive or negative. It’s important to know that you can get help and support if you need it.

Although the menopause is natural, you don’t need to put up with unwanted symptoms or accept them as just part of life.

Being in a good relationship is associated with positive outcomes including better health and wellbeing, reduced rates of anxiety and depression and higher self-esteem. People with strong and healthy relationships may have a stronger immune system and live longer¹. Even if you’re not in a relationship, enjoying sex or masturbation can improve aspects of your health and wellbeing.

During menopause and perimenopause (the time leading up to menopause), lower levels of the hormones oestrogen and testosterone, as well as other things going on in your life, can affect how you feel about sex. You may have less interest in sex, or may find you enjoy it more. Everyone’s different and how you feel will vary over time.

A partner may also experience medical, physical or life changes that affect your relationship.

Sex and relationships aren’t always easy to talk about. But with good communication, you can find ways around any challenges. Even if it feels difficult to talk to a partner, it’s worth talking with a healthcare professional about options to help.

Sexual wellbeing is about your overall sexual health, as well as sexual pleasure and how positive you feel about sex and your sexual relationships.

Sexual wellbeing can be affected by different, but related, factors² including:

• physical (like your body and hormones)
• psychological (like mood, self-esteem, identity and trauma)
• social (like relationships, work, culture, religion and the expectations of society)

When it comes to sex, what’s normal varies from person to person. Changes to your body, feelings and sex drive are only an issue if you’re unhappy or uncomfortable with them, or if you or a partner feel that they’re affecting your relationship.

Libido is another word for your sex drive, meaning your overall desire to have sex. Some people find that changes during menopause can affect their libido. A loss of libido can be caused by a variety of factors, not just by menopause.

Physical, psychological, social and lifestyle factors during menopause can all affect you.

One of the main changes is a fall in the levels of the hormones oestrogen and testosterone. These both play a part in feeling aroused and ready for sex. So falling levels can sometimes affect your response to sex and how you feel about sexual activity.

Everyone’s different. It’s common and normal for your sex drive to decrease but also normal if it increases or stays the same.

Other things going on in your life can also affect how you feel about sex right now, including:

• work stress
• illness or surgery, especially if this causes an early menopause
• starting a new relationship
• children growing up and leaving home – or you may still be looking after young children
• looking after ageing parents

As hormone levels fluctuate and drop, it can cause:

• Changes to libido (sex drive). Psychological and emotional changes can also affect your libido
• Changes to your vulva and vagina (also known as genitourinary symptoms) such as:
  • a drier vagina, leading to pain during sex
  • the clitoris reducing in size and losing sensitivity, affecting arousal and orgasm
  • leaking urine, which may cause embarrassment during sex
• Hot flushes, which may affect your enjoyment of sex
• Mood changes, which can affect sex drive and how you feel about sex
• Vaginismus (where the muscles in the vagina tighten on their own). This can lead to pain during sex or being unable to have penetrative sex
• Weaker pelvic floor, leading to weaker orgasms
• Prolapse (where the uterus, bladder or rectum bulge down into the vagina, due to weaker muscles) which can make sex uncomfortable and affect body image
• Higher chance of getting a urinary tract infection after sex, putting you off having sex

Many psychological factors can affect how you feel about sex, such as:

• Body image and how you feel about changes to your body
• Changes in your identity (for example how you feel about no longer being fertile, or how you feel about children leaving home) can affect your sexual identity
• Reduced self-esteem
• Loss of fertility
• Anxiety
• Sources of stress, such as ageing parents, children leaving home, work or financial stress.
• Trauma. This may be current or recent trauma or trauma from the past, which can often resurface during menopause

Social aspects can also affect relationships and sex. These include:

• The state of a relationship. Relationships need to be worked on. If the relationship is struggling this can have an impact on sexual desire. Even in strong relationships, sexual interest may be linked to novelty which may fall in long-term relationships – also see What about my relationships?
• A partner’s health and wellbeing can affect and influence your own
• External factors, such as what’s happening in the world or at work
• Culture and religion can affect how you feel about your relationship and sex

If you’re struggling with any symptoms, visit your GP surgery to talk through what options might suit you. Try to see someone with an interest in menopause. If you don’t get the help you need at first, you can ask to see someone else or to be referred to a menopause clinic.

There’s no “one size fits all” way to manage menopause. Options include:

Treatment for physical symptoms

• HRT: This includes oestrogen and progestogen which can treat some physical symptoms.
  HRT can improve hot flushes, urinary symptoms, mood changes, low libido (sex drive), and vaginal changes. This can increase your self-confidence which may improve your relationship and sexual satisfaction.
• Testosterone: If HRT doesn’t help improve your sex drive, testosterone may be offered. You usually start with a 3- to 6-month trial to see if it helps. Testosterone is not currently licensed (officially approved) for use in women, but guidelines are clear it can be considered.

Not all prescribers will be able to or feel confident offering it so you may be referred to a menopause clinic.

See FPA’s guide to the Menopause for more detailed information.

Other treatment for vaginal symptoms

Vaginal symptoms such as reduced sensation, dryness, irritation and soreness are very common during and after menopause. They can be uncomfortable and cause pain and discomfort, affecting your enjoyment of sex. As well as HRT, there are other treatment options.

• Vaginal moisturisers and lubricants (lubes): 

These can help treat dryness and irritation. It’s important to use gentle formulas that won’t irritate the area or cause other problems. A simple, unperfumed emollient can be used as a soap substitute and as a moisturiser. It can be massaged into the skin around the vagina entrance to help stop any cracking.

Vaginal moisturisers without irritants, such as YES, can be prescribed by your GP or bought from a pharmacy. Use them on a regular basis, like you’d moisturise your skin. Simple natural oils, such as coconut oil, can also be used.

Lube can be used during vaginal sex. Some people find it helps to use oil-based lube in the vagina and water-based lube on a penis, fingers or sex toy – this is called the double glide effect. Always use water-based lube if you’re using condoms. Oil-based lube can damage the condom so it’s not effective.

• Vaginal oestrogens:

These work well at reducing vaginal dryness, which can help reduce painful sex and increase sensation. They are a very low dose oestrogen, so even if you can’t take HRT, they may still be an option. They can also be used alongside HRT.

You’ll get a cream, pessaries (tablets to put in the vagina) or vaginal ring with instructions on how to use it. It’s safe to use vaginal oestrogen long-term if you want to. Symptoms usually come back if you stop using it.

Vaginal oestrogen is available on prescription or you can buy pessaries from a pharmacy.

• Other vaginal treatments:

Some non-oestrogen treatments are available on prescription. They’re available as pessaries or tablets to swallow and can reduce vaginal dryness and painful sex.

Treatment for pelvic floor weakness or prolapse

Pelvic floor exercises are important in both perimenopause and menopause. Strengthening the pelvic floor can help with incontinence, prolapse, and even improve orgasm. The exercises can also improve vaginal tone, which can improve sex.

Do the exercises 3 times a day if possible. They don’t need to take long. They can be done when driving, watching TV or lying in bed.

• Find a position that works for you. It might be sitting, standing, on all fours, or lying down
• To squeeze your pelvic floor muscles, try to feel like you’re holding in pee and stopping yourself passing wind at the same time
• Then do 10 quick squeezes and relaxations
• Once you’re used to it, try holding each squeeze for up to 5 seconds. Try to build up to do 10 holds for up to 10 seconds
• Then build up to doing this 3 times a day. Make sure you completely relax in between each squeeze. If you don’t relax properly this can lead to problems as well
• Breathe normally while doing the exercises – try not to hold your breath
• If you’re clenching your upper stomach muscles and buttock muscles, you’re holding too hard
• Don’t worry if you don’t feel any different at the beginning. It can take 6 to 12 weeks for the muscles to strengthen
• There’s a useful NHS app called Squeezy which reminds you to do the exercises

If you think you may have a prolapse, see a GP. Pelvic floor exercises are an important treatment. A GP may suggest other treatments or refer you to a women’s health physiotherapist or gynaecologist.

Review other medication

Certain groups of medicines, such as some antidepressants (SSRIs), blood pressure tablets and antihistamines, can affect arousal, lubrication and libido. If your libido or responses have changed in a way you’re unhappy with, it’s a good idea to review all medication with a GP.

Look after your health and your partner’s health

Make sure both you and your partner(s) are as fit and well as possible. Things you can do to keep healthy, keep your blood pressure lower and help keep your heart healthy include:

• Eat a healthy, balanced diet
• Aim to do at least 2.5 hours of exercise a week
• Keep alcohol to a minimum
• Stop smoking

In long-term relationships, you usually know your partner(s) very well. But relationships and sexual desire often thrive on change and novelty. Early in a relationship, sexual interest and bonding is often driven by changes to hormones and brain chemicals. But levels change naturally over time.

Practical things that can help revitalise your relationship and increase desire for sex include:

• Spend time apart sometimes and have some activities you do without a partner
• Non-sexual touch, like hand holding, massage, and even long-lasting eye contact, can increase hormone levels that help you to bond
• Do things you did early on in your relationship, like date nights, texting and flirting
• Masturbate on your own to build confidence and help get to know your body better

Communication is important. Your partner may not understand the changes you’re going through and how it’s affecting you and your sexual desire.

Because it can feel uncomfortable or embarrassing talking about sex, it can be easy to avoid talking about any issues. Sometimes you may end up avoiding any situation which could lead to sex. In some cases, this can lead to a complete loss of intimacy, such as going to bed at different times or avoiding hugging or any body contact.

The first step is to acknowledge there’s an issue and try to talk about it, making sure you both get a chance to say how you’re feeling. Talking and listening can help keep your relationship strong.

It can help to remember that a relationship isn’t only about sexual intimacy. There are other ways to stay connected with your partner, such as going for a walk or having a meal together.

If you’re having sex, it can help if you try and make pleasure, not orgasm, the focus. As well as making sure sex feels good for both partners, this can help take things at a pace that suits you both and reduce the pressure you may feel to have penetrative sex or have an orgasm.

Counselling

Counselling, on your own or with a partner, can be helpful, usually in combination with treatment for any physical symptoms.

Relationship counselling or psychosexual counselling (counselling that aims to help you with any difficulties you’re having with sex and relationships) can help you find ways to communicate with your partner and talk about any sexual problems.

Cognitive behaviour therapy (CBT) can help with things like anxiety and stress and may also help you cope with menopause symptoms. For a factsheet on CBT and menopause, search for ‘CBT’ at womens-health-concern.org.

After a major illness or operation, your body image and confidence can change and this can affect relationships and sex.

A diagnosis of a serious illness, such as cancer, can have a huge psychological impact, and having surgery can affect how you feel physically, as well as self-confidence and self-esteem.

Some cancer treatments can lead to an early or temporary menopause and may also cause other side effects that can affect how you feel about sex.

When you have a serious illness, it may not be possible to take treatment such as HRT so some menopause symptoms may be difficult to treat.

There are some alternatives to HRT. They can be useful for symptoms such as hot flushes and mood changes, but won’t usually help with loss of libido. Low dose vaginal oestrogen may be suitable and can make a huge difference. A GP or your oncologist can discuss your options.

Cognitive behaviour therapy (CBT) can help some people cope with their feelings about the illness and help with some symptoms.

If you’re using contraception to avoid pregnancy, it needs to be used for 1 year after your last natural period if you’re aged over 50, or 2 years after your last natural period if aged under 50.

HRT will not prevent pregnancy unless you’re using a Mirena, Levosert or Benilexa hormonal IUD as part of your HRT.

If you’re aged 50 or over, it’s advised:

• not to use contraception with oestrogen, such as the combined pill, vaginal ring and contraceptive patch
• not to use the contraceptive injection

Other methods of contraception can be used up to the age of 55 include:

• A copper IUD – also called a copper coil or copper intrauterine device
• A hormonal IUD – also called hormonal coil or IUS. There are different types. A Mirena, Levosert or Benilexa hormonal IUD can be used as the progestogen part of HRT
• Contraceptive implant and progestogen-only pill. These methods can be used alongside HRT, but not as the progestogen part of HRT

Most methods of contraception won’t help protect you from sexually transmitted infections (STIs), so consider using condoms as well.

Oil-based lubes and other products can weaken latex condoms and make them less effective. Use water-based products instead.

After age 55, you’re extremely unlikely to get pregnant even if you haven’t reached menopause. Contraception isn’t needed, but consider using condoms to help protect you from STIs.

Everyone is different and will have different feelings. You may feel pleased you don’t have to worry about pregnancy, happy not to have periods any more, sad you’ve reached the end of your fertile years or a mix of different feelings.

If you wanted to have children, or have more children, this can make menopause a very difficult time. This may be especially hard if you have an early menopause. Dealing with feelings about not being able to get pregnant, alongside symptoms of menopause can be really difficult.

There are some useful resources to help, including:

• the Daisy Network, DaisyNetwork.org
• the Fertility Network, FertilityNetworkuk.org

There’s no “one size fits all” solution when talking about sex, sexual desire and menopause.

Everyone experiences perimenopause and menopause differently and has different needs and expectations.

HRT and testosterone can help some people, but there are many complicated factors which can have an impact on your sexual desire and relationship.

There’s no “right answer” on how to successfully navigate these changes and all partnerships will be different. The most important thing you can do is communicate with each other. It’s a huge learning curve for everybody, and it will really help if you’re able to be open and honest with each other about your feelings.

You don’t have to go through this alone. If you or a partner feel like you’re struggling to cope or are worried about the impact that changes are having on your relationship, sex life or mental health, ask for help and support from your partner, friends or family, see a healthcare professional or try some of the following resources.

Websites:

• Maggie’s (cancer care), Maggies.org
• Menopause Matters, MenopauseMatters.co.uk
• OMGYes, omgyes.com (requires payment)
• Queer / LGBTQIA+ Menopause, QueerMenopause.com
• Rock My Menopause, RockMyMenopause.com
• Women’s Health Concern, Womens-Health-Concern.org

Apps:

• Ferly, WeAreFerly.com (requires payment)

Books:

• Better sex through mindfulness by Lori A. Brotto
• The menopause manifesto by Dr Jen Gunter
• Mind the gap by Dr Karen Gurney
• Living well through the menopause by Myra Hunter and Melanie Smith
• Becoming cliterate by Laurie Mintz
• Come as you are by Emily Nagoski
• Mating in captivity by Esther Perel

Finding a counsellor or therapist:

• College of Sexual and Relationship Therapists, cosrt.org.uk
• Institute of Psychosexual Medicine, ipm.org.uk
• NHS counselling, NHS.uk/counselling
• Relate, Relate.org
• You can also ask your local sexual health service about psychosexual counselling.