Sex and menopause - while it's often painted as a match made in discomfort, it doesn't have to be that way, and it isn't the way for everyone. While some people struggle with menopause symptoms that make intimacy difficult (both mentally and physically), there are plenty of treatment options and tweaks to help make sex enjoyable.
For some, menopause can be a point of sexual liberation, says Heather Jeffcoat, DPT, and author of Sex Without Pain: A Self-Treatment Guide to the Sex Life You Deserve. "Menopause is just another point in life for self-exploration sexually. We do it in our 20s, 30s, and 40s. Sex doesn’t have to stop in menopause. Women just get another opportunity to grow sexually."
While there should never be any pressure from a partner or externally to have sex at any time in life, if you're having issues and you want to have sex in menopause, there are many ways forward - from the best sex toys and HRT to therapy and lifestyle changes.
Sex and menopause: What's the challenge?
When we are in perimenopause (the years leading up to menopause, which is defined as 12 months after your last period), our hormones are in flux with declining oestrogen and progesterone. "This can cause Genitourinary Syndrome of Menopause (GSM), a cluster of symptoms," explains Jeffcoat.
GSM can lead to urinary and bladder issues. It also often causes the most commonly known symptoms of menopause that might impact your sex life, such as vaginal dryness, pain during or after sex, low libido, and a loss of confidence.
Other perimenopause symptoms, like irregular or heavy periods, low mood, and anxiety, can naturally also contribute to the issues above.
Menopause is different for each individual who goes through it, and there isn't a one-size-fits-all approach, says OB/GYN and Associate Professor at the University of Queensland, Gino Pecoraro. This is why you should book an appointment with your gynaecologist or doctor to discuss the range of your symptoms.
In the meantime, we've spoken to the experts to highlight some of the changes in perimenopause you may be seeing that could be impacting your sex life:
Vaginal dryness
Before menopause, oestrogen helps to keep the vaginal tissues strong, just like any other tissue in our body. During perimenopause, as these hormones begin to decline, the tissue becomes thinner and is easily irritated (known as vaginal atrophy). As well as feeling dry and uncomfortable, this can lead to pain during sex.
Despite being rarely spoken about in comparison to symptoms like hot flushes, vaginal atrophy affects up to 60% of postmenopausal women.
The good news is, HRT is a proven effective treatment option for vaginal dryness, curing symptoms in up to 75% of cases. Oestrogen cream (estrodiol) and suppositories are even more effective (80 to 90%), according to research published in the International Journal of Women's Health.
For those who can't or don't want HRT, lubricants "like avocado or macadamia oils are useful as they mimic the natural protein content of vaginal secretions”, says Dr Pecoraro.
Changes to the pelvic floor
The pelvic floor is a string of muscles that sits between our pubic bone at the front and the tailbone at the back. These muscles, like any other muscle in the body, are impacted by declining oestrogen levels in menopause. They can become weak, leading to issues like chronic pelvic pain and an overactive bladder, which are both extremely uncomfortable.
But the fluctuations in hormones also affect collagen and elasticity in the area, explains Aleece Fosnight, PA, and medical advisor at Aeroflow Urology. "So it could be that your pelvic floor muscles are hypertonic, meaning they're too tense or too tight," she says.
However, it's essential to see a doctor to find out what the issue is. “There are so many reasons as to why that pain could be going on, and you really can’t know until you’ve explored the possible causes with your doctor,” she says.
Once you nail down the root cause, a medical professional will be able to advise the best treatment for you. It could be as simple as reducing the number of Kegel exercises you do every day to reduce the tension in your pelvic muscles.
Low libido
One of the most common mental blockers to sex in menopause is low libido - and that's hardly surprising, when you consider the cocktail of symptoms many women go through. Life events, like relationship changes or breakdowns, stress with work or family, and other health issues, will also naturally lead to a low libido in menopause.
However, low libido can be a hormonal issue in itself, says Dr Shirin Lakhani, a GP and menopause specialist. This time, it's about testosterone, which women and men have, but women tend to have in much lower amounts. Produced in the ovaries and the adrenal glands in women, it's "essential for sex drive, metabolism, muscle strength, and bone density in women," she tells woman&home.
"Symptoms of low testosterone include decreased sex drive or decreased sexual satisfaction, impaired cognition, fatigue, and low energy," she says.
Much like how HRT can replace oestrogen and progesterone, testosterone replacement is available via a specialist.
For the mental and emotional issues causing a low libido, Fosnight recommends delving into discovering what your “brakes” (what keeps you from engaging in sexual activity), and “accelerators” (what turns you on) are to improve your sex life.
"It could be as simple as the fact your partner has done the laundry for you that can be an accelerator,” she says. “We often think that it has to be a romantic dinner or that we have to be wooed or given flowers. That could work for some women, but not all the time."
Take some time to think about what turns you on and off. Allow your mind to wander into your sexual fantasies and open up to your partner about what you want. If you're shy about discussing sex with your other half, show them instead. There's a lot of ethical porn for women online, you can show your partner as an example of what you'd like to get up to in the bedroom.
Menopause doesn't have to result in a sexless marriage (unless you want it to, and if you two agree, that's totally fine too), but communication with your partner is key to helping boost your libido during this time.
Loss of confidence
While many of the symptoms that cause a problem with sex and menopause are down to fluctuating hormones, this one happens because of all the other symptoms put together - and this stage of life in general. From the constant pressure of the ever-changing societal beauty standards to feeling old, it’s hard for many to move past worry and simply embrace the natural ageing process.
If you don't feel comfortable and confident in your appearance or your partner's attraction to you, chances are, you're not going to be in the mood for sex.
By focusing on the positive aspects of menopause (no more periods, PMS, or pregnancy worries, for example), however, you may be able to be more confident again.
“Confidence is all about the attitude, really,” says Pauline Ryeland, a sex coach and educator. “Sometimes you have to fake it a little till you make it."
Ryeland's top tips include: wearing an outfit you love, wearing makeup that makes you feel good (if you usually wear makeup), and treating yourself to some new sexy lingerie (even under your casual clothes when hanging around at home). "It’s like your little secret, which is fun and flirty with yourself,” Ryeland adds.
She also suggests talking to yourself positively every single day. It might feel silly at first, showering yourself with compliments you might not believe to be true. But the more you do it, the more natural it will become and the more likely you are to truly feel great and show yourself some genuine self-love.
Increased libido
Yes, that's right. While some women experience unpleasant menopause symptoms that can impact their sex life, for others, this time comes with a newfound sense of sexual freedom. With no more periods to contend with, PMS, or unwanted pregnancy worries, post-menopause can feel new and exciting.
"Menopause can be a sexually liberating phase for many," Dr Katherine Hertlein, expert advisor at sex therapy app, Blueheart, told us.
"Even if, initially, you feel that your interest in sex has lulled, this is common in the initial stages of menopause. You’re coming to terms with a range of emotional and physical changes, and this can impact your energy levels and libido. But over the period of a few months, these feelings usually subside, and the process can be very liberating, on a personal level and a sexual level."
While it's not possible to get pregnant once you've been through menopause, you can still get pregnant before this, so it's important to continue using contraception in perimenopause. “This is the point leading up to the menopause when changes in hormones are occurring, which means that your periods are often irregular and some months an egg is released, whilst others it’s not," says Dr Lakhani. "So you can still get pregnant at this stage. Contraception should be used for 12-24 months after cessation of periods for this reason: 12 months if over 50, 24 months if under 50."
Tips for improving your sex life in menopause
- Talk to your partner: First things first, if your partner doesn't know you're having issues with sex in menopause and you regularly used to be intimate, then it may cause an unnecessary issue. Be open with them, share what's going on, and tell them how they can help you. It may help you have better sex in the months to come!
- Be open to experimentation: “Menopause might change what feels good during sex, but women can try experimenting with vibrators, sex toys, or masturbation to figure out what now works best for them," says Dr Lakhani.
- Consider therapy: "Couples or sex therapy can also be extremely beneficial for those who find that menopause is disrupting their relationship and sex life," Dr Hertlein says. "It can create a safe space to talk about things you may otherwise avoid, and lead to the creation of proactive strategies to help improve things. Such strategies might include using erotic material together, reinventing foreplay in your relationship, or expanding the sexual repertoire."
- Focus on intimacy without sex: If you're struggling with sex and menopause, whatever the reason, take the pressure off. Putting pressure on yourself to have sex as you go through perimenopause isn't going to make you have it - or enjoy it. So, instead, explore how to be intimate without sex.
- Do more exercise: Exercise boosts endorphins, those feel-good hormones. It's also been shown to boost self-confidence, help you sleep better, and generally improve quality of life in menopause. All of which can help you have a happier life in the bedroom.
- Speak to your doctor: It's 2025 - there's a solution to most symptoms of menopause, whether that's night sweats making it hard to get 'in the mood' or painful intercourse. Make an appointment with your GP.
No single product is going to supercharge your sex life. The best thing to do is see your doctor if menopause symptoms are getting in the way - but one of the best lubes may help ease things along. The Menopause Centre recommend the YES range can help lubricate the vagina alongside or as an alternative to vaginal oestrogen.
If you struggle with penetration, then one of the best clitoral vibrators may be a good idea. These wrap snugly around the clitoris and stimulate with air pulses rather than classic buzzing, replicating (to some extent) the feel of oral sex. Of course, a classic bullet vibrator works well too.
If you're thinking of ways to be intimate without physical touch, then a card game like this can get things going. The deck has three levels: Close, Closer, Closest, and covers all kinds of topics (so it doesn't even have to be a sexual conversation), helping you get to know your partner again.
