Menopause and sex

What is menopause?

Menopause is your final period. As you approach menopause, your reproductive hormones (e.g. oestrogen) drop. Most women reach menopause between the ages of 45 and 55. In Australia, the average age to reach menopause is 51 to 52.

How does menopause affect your sex life?

Changes around the time of menopause can affect your sex drive (libido) and sexual experience.

Physical changes with menopause

Menopause symptoms

You may be less interested in sex due to symptoms such as hot flushes, night sweats, low energy levels, sleep problems and low mood.

Vaginal changes

A drop in oestrogen levels causes the walls of the vagina to be thinner and drier, which may cause vaginal irritation and pain during sex.

Bladder and pelvic floor changes

Changes to bladder tissues and pelvic floor muscles can cause continence problems (e.g. wee leakage), which can reduce sexual desire.

Sexual experience

Physical changes and lower sexual desire can make it harder to have an orgasm and sexual experiences may feel less pleasurable.

Body image and menopause

You might feel differently about your body around the time of menopause. This may be due to:

• social attitudes – modern society rarely portrays older women as sexual or desirable, which can affect the way women feel about themselves
• weight gain – many women gain weight around their belly (abdomen) at this stage of life, which may make them feel less sexually attractive.

Life stages

Other factors can affect your sexual desire at this stage of life. For example:

• poor health
• anxiety and depression
• medicines and their side effects
• sexual problems (e.g. partner's erection issues).

Other factors may include:

• relationship issues
• loss of a partner through death, separation or divorce
• work and financial pressures
• caring for elderly parents.

Managing low sexual desire

If you’re concerned about how menopause is affecting your sexual desire, talk to your doctor. They may suggest menopausal hormone therapy (MHT), vaginal moisturisers, lubricants or oestrogen to improve vaginal dryness.

Testosterone therapy

Some women become very distressed about their loss of sexual desire, which may be a condition called hypoactive sexual desire disorder (HSDD). Testosterone therapy may help. This therapy should be supervised by your doctor.

Pelvic floor physiotherapy

Sometimes pelvic floor muscles can tighten or lose tone at menopause. This can cause painful sex, aching, incontinence or prolapse (i.e. the bladder, uterus or bowel protrudes into the vagina). A pelvic floor physiotherapist can teach you pelvic floor muscle exercises and show you techniques to help reduce pain.

Other practical ideas

There are practical things you can do to help maintain or improve your sex life after menopause. For example, if you have a partner:

• talk to them about your symptoms and how they affect you
• try different ways to be intimate, like spending time together doing things you both enjoy
• consider relationship counselling if needed.

Contraception

As you age, your fertility declines. But it’s still possible to get pregnant in your late 40s or early 50s if you’re still having periods.

If you’re under 50 and don’t want to get pregnant, you should use contraception for at least 2 years after your final period. If you are 50 or older and don’t want to get pregnant, you should use contraception for at least one year after your final period.

You can talk to your doctor about different contraception options.

Note that MHT is used to manage menopausal symptoms, it's not a contraceptive.

When to see your doctor

Talk to your doctor if menopausal symptoms affect your daily life. For example:

• if symptoms affect your sex life
• if sex is painful
• if you have urinary or vaginal problems
• if you are distressed about your loss of sex drive
• if you are experience anxiety, depression or big mood swings.

More information

For more detailed information, related resources, articles and podcasts, visit Jean Hailes for Women's Health.

Where to get help

• GP (doctor)
• Gynaecologist
• A pelvic floor physiotherapist
• A relationships counsellor
• A local family planning clinic
• Sexual Health Victoria
• Jean Hailes for Women’s Health