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Menopause is when the final menstrual bleed (period) occurs.
This happens because the ovaries stop releasing eggs alongside hormone changes in the body. Once you have not had a period for 12 months, you are said to be postmenopausal. This usually occurs between 45-55 years of age.
Whilst the physical changes of menopause are important, so too is our sexual health, wellbeing and pleasure. Throughout our life, sexual health plays an important role in our general health and wellbeing.
Changes around the time of menopause can impact our desire to have sex (libido) and our experience of sex. These changes can be both physical and psychological.
How do our bodies change during menopause?
Oestrogen levels drop around the time of menopause. This causes the walls of the vagina to become thinner, drier and less stretchy, which in turn can cause irritation, not enough lubrication and pain during sex.
Testosterone also decreases as you get older. The changes in hormone levels can lead to reduced sexual desire, difficulties achieving an orgasm and can make sexual experiences feel less pleasurable.
Changes can also occur in the bladder and pelvic floor, causing continence problems (e.g. leakage of wee). Other aspects of menopause can also impact sexual desire including fatigue, joint pain, sleep problems, night sweats and mood changes.
Other factors at play?
Sexual desire is complex. As mentioned above, most people who are going through menopause are 45-55 years of age. At this stage of life, lots of other things can also impact your sexual desire. For example, issues with general health, chronic illness, pain, anxiety and depression, medication side effects, relationship issues, work and financial pressures or caring for elderly parents
The good news
The good news is that many people remain sexually active and have pleasurable experiences as they get older. However, what feels good for you may change. Around this stage of life, some people enjoy sex more. Others may find that their sexual desire and sexual experience is less pleasurable than before.
Not everyone is bothered by a lower sexual desire, infrequent sex or no sex at all. Others may choose to focus on sex that is non-penetrative (sometimes called outercourse).
Sexual activities are not the only ways of expressing physical love and staying connected. Other forms of intimacy, such as cuddling or massage, can also be fulfilling. It is possible to find ways to stay sexually active while supporting you and/or your partner/s’ changing needs. Maintaining open communication with your sexual partner/s is very important during this time. Communication is key as always to having pleasurable experiences.
Avoiding pregnancy
It is still possible to get pregnant in your late forties or early fifties, if you’re still having periods. If you are over 50 and want to avoid a pregnancy, you should use contraception for at least one year after your final period.
If you are under 50 and want to avoid a pregnancy, you should use contraception for at least two years after your final period.
It is important to know that Menopausal Hormonal Therapy (MHT) treats the symptoms of menopause and is not a form of contraception.
It’s also important to remember that you can get a sexually transmitted infection (STI) at any stage of life (condoms provide the best protection from STIs).
When to seek support
If you are bothered by a reduced sexual desire or pain during sex, it is important to speak to a doctor, sexual health nurse, pelvic floor physiotherapist or sexologist.
Vaginal moisturisers, lubricants, vaginal oestrogens or Menopausal Hormonal Therapy (MHT) may be recommended, depending on your symptoms and your health history.
A pelvic floor physiotherapist may also be able to teach you pelvic floor muscle exercises to help reduce pain, if there is an increase in (or loss of) pelvic floor muscle tension related to menopause.
Remember, it’s important to talk with your partner/s about sex, including how you are feeling and the impact of menopause.
Explore what’s enjoyable for you and your partner/s. Communication, as always, is key.
