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Navigating sexual difficulties through the menopause transition

Navigating sexual difficulties through the menopause transition



What Is Happening Inside My Body?

If you’re experiencing menopause-related sexual difficulties, please be assured that this is a common experience and is often caused by natural changes in your hormones and body.  

Although around 68–86% of women in menopause experience sexual difficulties and a decrease in sexual desire (or low libido), only around 12% of women experience distress over it. So, while the symptom may be present, you can choose whether it is something that is necessary for you to try to change.  While menopause symptoms do vary from woman to woman, some of the most common sexual difficulties during menopause may include:  

  • vaginal dryness 
  • pain during sex 
  • difficulties reaching orgasm 
  • low or no sexual arousal 
  • lessened interest in sex (or low libido) 
  • possible light bleeding with intercourse 

And here are some of the changes in your body and other factors that might cause these sexual difficulties: 

  1. Changing hormone levels: significantly decreasing oestrogen and testosterone levels, which are correlated with libido and vaginal changes. 
  2. Other (peri)menopause symptoms: genitourinary syndrome of menopause refers to vaginal dryness and atrophy, which can cause painful intercourse, bleeding during sex, and recurrent UTIs. Other menopause symptoms include sleep disturbances, which might negatively impact your physical and emotional energy, and mental health difficulties like experiencing depression and/or anxiety, all of which may contribute to decreased libido.  
  3. Side effects of certain medications: especially antidepressants 
  4. Psychological factors: your attitudes towards sex are based on cultural, religious, and social factors. Experiencing relationship stress and changes might affect your sex drive as well. 
  5. Certain surgeries and medical treatments: like an oophorectomy (or when you have your ovaries surgically removed) or chemotherapy, which can trigger early menopause due to the immediate decrease in oestrogen and testosterone. Women who experience early menopause tend to report reduced sexual desire than those who experience regular menopause.  

The overall research on low libido and sexual difficulties during menopause is quite complex — so let’s explore how it might affect your day-to-day and long-term health.

What Does It Mean For Me?

If you’re in (peri)menopause and are wondering how it might affect your libido, you’re not alone. Overall, it’s an individualised picture when it comes to how women in menopause experience symptoms like low libido and sexual difficulties — especially since these are linked to factors like your relationships and overall health.  

For example, some women might even experience their sexual desire increasing during their menopause years. This might be due to factors like the newfound privacy of an “empty nest” or no longer needing to use contraception.  

But on the other hand, around 12.3% of women between the ages of 45–64 experience hypoactive sexual desire disorder. This means that they’re: 

  • experiencing a persistent lack of sexual desire 
  • feeling distressed about it  
  • finding that it affects their day-to-day living 
  • Another study in the US found that women were more likely to feel distressed about the loss of sexual desire if they were:  
  • between 35–64 years old 
  • in a relationship 
  • experiencing depression 

This suggests that some factors affecting low sexual desire might be biological factors and life stressors — including conflicts with their partners, other health conditions, and more.  

Our libidos are linked to our sense of sexuality and self — it’s understandable if you feel that a change in it could reduce your overall satisfaction and quality of life. For example, you might worry that when you don't experience sexual arousal, it might frustrate your partner and create difficulties in your relationship.  

We understand how difficult it can be to speak up about sexual difficulties with your healthcare provider, partner, or friends. Let’s explore what treatment options might work best for you, both from a medication and self-care standpoint, so that you can feel more comfortable and confident during a conversation.

Getting to confidence

While not all women experience (peri)menopause-related sexual difficulties or feel distressed about them, it can be difficult to speak up about them all the same — especially if they’re making you feel upset or worried. You’ve taken an excellent step toward keeping yourself informed about the changes your body is going through and how you can manage them.  

Your libido and sexuality are normal, healthy parts of your overall identity. Practical steps like prioritising intimacy with your partner, learning how natural these changes are, and speaking about them with a supportive community can go a long way. This is one step towards drawing visibility to and normalising its more “taboo” aspects.  

(Peri)menopause symptoms affect many aspects of women’s lives — and with our content, we’d like to create a safe space for women to share their experiences with others and help them feel empowered, confident, and connected. We’re here to support you with the information you need to confidently navigate and manage your symptoms.  


What medical options are available?

 When you’re experiencing changes to your libido or sexual difficulties in menopause, it’s understandable if you feel hesitant sharing your experiences with your healthcare provider. But getting professional support for these experiences can go a long way — and not just through medication.  

Whether you’ve been formally diagnosed with hypoactive sexual desire disorder or not, your healthcare provider might still take routine steps to screen your overall health. For example, they might recommend a blood test to check your hormone levels and other health conditions, like diabetes or high cholesterol, which might also affect your libido. They might also recommend:  

  1. A pelvic exam: to examine your reproductive organs for signs like thinning vaginal tissue or vaginal dryness to check for genitourinary syndrome of menopause  
  2. Vaginal hormone supplements: including oestrogen tablets, creams, or a ring, which are easy to insert and, in addition to addressing sexual difficulties, can also help with urinary difficulties 
  3. A specialist: like a couple's counsellor or a sex therapist. A sex therapist might provide the education you need on sexual responses and techniques, including how to prioritise your own pleasure. A couple’s counsellor can help you understand the relationship difficulties that might underlie your lowering sex drive and any possible relationship difficulties

Managing your sexual difficulties with medication can be effective, if you’ve found one that works for you. It’s important to keep in mind your individual needs and risk factors. Treatment options like hormone therapy and certain medications include various side effects; not every woman might respond to them the same way. It’s highly recommended to explore your options with your healthcare provider.

What self-care options are there?

If you’re feeling upset or distressed at menopause-related sexual difficulties, we’d like to emphasise that the responsibility of addressing your symptoms shouldn’t fall on you alone. Other factors in your life can also play a role — especially your relationships and even beliefs about sex that we learn from society.  

Since sexual difficulties during (peri)menopause are linked to various factors in your health and life, it might make more sense to try taking some of the following aspects into your own hands: 

  1. Regular exercise: which can help reduce stress and help you feel more empowered on your (peri)menopause journey. It can also lift your mood, help you feel more comfortable and confident in your body, and even improve your libido. You could consider a combination of resistance and aerobic exercises to see the best results. 
  2. Prioritising 1–2 stress reduction techniques: these need to make sense for you and be easy to maintain, like mindfulness meditation, yoga, or journaling. These can help you relax, process your emotions, and focus on the present moment — which in turn can enhance your sex drive. 
  3. Working on your communication with your partner: this can help you feel more connected and decrease relationship stress. Being open about your sexual desires and what feels good (and what doesn’t) can help them understand how to meet your needs better and improve your relationship's intimacy. Making romantic gestures a priority can also help, in whatever love language speaks best to you and your partner. 
  4. Learning what feels good for you: prioritising your own pleasure and learning what feels good (and what doesn’t) is an empowering step and can help you feel more connected to your body. You could consider working with a sex therapist as a starting point. 
  5. Along with the support of a specialised professional, building a few practical healthy habits and keeping communication in your relationship open can go a long way. They can help address your sexual difficulties at their root and in holistically managing your (peri)menopause symptoms.



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