It is easier than ever to talk about and get help and information about perimenopause and menopause. But the effects on both body and mind can have a significant impact on relationships and sexual intimacy. Working through those challenges is an opportunity to reach deeper levels of understanding of ourselves and our relationships, and to learn more productive ways to communicate our needs.

Pippa, 45 and bisexual, has been perimenopausal for four years and is now on HRT. Her symptoms included low mood, vaginal dryness, and no libido. This had significant effects on her sex life: “My boyfriend stopped initiating because he was afraid of hurting me. I felt like I just wanted to get it over with. I have ADHD so I find it difficult to relax and focus on the sensation rather than thinking about what we’re doing tomorrow.”

“My clitoris doesn’t work as it did. I feel like my partner is pressing harder than usual even though he isn’t. I say ‘really, really light, like a feather’ but I don’t want to criticise and worry he will be put off by that. I also have a tendency to give up too early and say look, it’s just not happening tonight, let’s just do other things.”

Pippa’s experience of increased sensitivity and of brain fog – which includes a loss of focused attention – are common menopausal symptoms which can stop us relaxing and enjoying sexual pleasure. We might need to find other ways to relax and be more present in our body first, such as mindful meditation or ASMR. If we’re worried about how our partner might react to lots of instructions,  a conversation about this could be had at another time. We can start this by saying something like “I love the way you touch me, you’re really good at turning me on” and then “What’s the best way for me to communicate when it’s getting a bit sore down there?” or “Now the skin tissue down there is thinner, it would really help me to relax and enjoy it if we could decide on how I can communicate to you about what’s working and when to change what you’re doing. I’m worried I’ll put you off or that I’m saying it in the wrong way.” Oral sex is also a very good way to stimulate the clitoris without making it sore.

Pippa admits: “Whenever we have sex I say we should do this more often, it’s fun and it’s important. I haven’t initiated sex at all over last three years. That’s down to a lack of libido, not because I don’t love him or want to be close to him. We use ‘How tired are you tonight?’ as a euphemism.”

There are several useful principles here that apply to us all, regardless of age, as Ruth Ramsay, adult sex educator and coach, explains: “What Pippa describes – a lack of libido meaning she doesn’t initiate sex – is such a common situation. However, in a long-term relationship, if we wait until we feel like sex before initiating it, it might never happen! This is down to basics of arousal science and doesn’t mean there is anything ‘wrong’. As we get older, and as a relationship moves out of the honeymoon phase, our desire style shifts from ‘spontaneous’ to ‘responsive’. Instead of fancying sex out of the blue (spontaneous), we need to create a sexy environment for our libido to respond to (responsive). Pippa saying that whenever they do have sex it’s fun and she recognises the importance of it, illustrates this in action.

How we frame our communication about sex is also important. Ruth says: “If asking ‘How tired are you tonight?’ comes before a potentially-erotic scene has been set, the answer in that moment will likely be ‘too tired for sex’. However if it’s asked after half an hour of intimate time – for example with some massage, music you both find sexy, and some reminiscing about your past adventures – the answer may be the opposite. We need to actively and deliberately plan that intimate time, knowing that at the start of it we might not be feeling horny yet, to allow our desire to then arise in response to it. If we wait until we ‘feel like it’, we could be waiting a long time!”

Using a gain rather than a loss frame, we could rephrase Pippa’s question as “How energetic are you feeling tonight?” We can also use a mindful approach: become curious about and describe exactly what sensations we are experiencing, even from something very simple like our shoulder being stroked and how that feels different from, say, our hip being stroked. Then we are focusing on the positive – what feels relaxing and pleasurable – rather than what’s missing.

Orgasms can be affected by the menopause, too. A lack of testosterone that can be the result of low oestrogen can cause orgasms to be flat, less satisfying or hard to achieve. We may also feel uncomfortable about taking longer to reach an orgasm. Pippa says that her partner is “brilliant, he’s really patient, if it takes twenty minutes, I don’t feel under pressure. It’s pressure I put on myself and feeling obliged that I should have intercourse even if I don’t come.” Ruth is keen to reassure Pippa that “needing twenty minutes of dedicated stimulation to reach orgasm is clinically normal!”

HRT is recommended in the UK by NICE guidelines in many instances (although it isn’t for everyone and you need to seek advice from your GP in the first instance). Pippa has found a significant positive impact from taking it: “The last few weeks [since starting HRT] I’ve got my spark back, I don’t want to sleep and hide all the time, I’m more of an active participant in our relationship, my mood is better and that means I’m feeling more up for intimacy. Using a cream and hormonal pessaries has made a difference internally too.”

Stephanie, 51 and heterosexual, had become very frustrated about her orgasms during the perimenopause, which had suddenly become “pathetic, like damp squibs” that she found “deeply disappointing”. A combination of HRT at a higher dose prescribed by a gynaecologist and pelvic floor exercises taught at a bladder clinic restored a “fuller, more satisfying experience”. Stephanie was relieved to know it had a physiological cause and ditch the “incessant in-depth analysis with my partner, trying out different things each time and them not making any difference” which was making her anxious and despondent.

Helen Clare is a menopause coach who works in schools. At first, her perimenopausal symptoms were not treated appropriately and that affected her relationship: “When I first experienced symptoms of genitourinary syndrome of menopause (GUSM or GSM) at 42, I was in a long distance relationship. That ended. The GUSM was part of that – not so much because it affected our sex life, because that was back on track, but because it was misdiagnosed and I was dealing with the exhaustion of some pretty heavy pain drugs on top of the fatigue of perimenopause. It just all got too much and we saw each other less and less until I ended the relationship.”

Helen is now 56. Her conditions are vulval and urethral pain, and vaginal atrophy, as well as lichen sclerosus. Helen says they are all under control, although severity can vary, and none of them will ever go away. She diagnosed her perimenopausal symptoms herself and then asked for HRT and vaginal oestrogen which she says have made a “massive difference”.

Since diagnosis, Helen has found creative ways to adapt her sex life and how she communicates her needs to new sexual partners: “I’ve made sure it’s never affected me as a sexual person – if anything it’s had the opposite effect in that I’ve been determined not to let my sex life go. I’ve always been quite experimental sexually so that’s helped – and it means the kind of men I tend to have relationships with have different sexual interests and are not fixated on penetrative sex.”

Dating during the menopause does not need to be a problem as long as you are able to communicate your needs openly. Helen says: “I have had a few flings since it all started and a couple of relationships that have lasted a few years. I’ve tended to meet men online, so quite often I have that discussion with them either before we’ve met, or between meeting and deciding to have sex.”

How men react to this kind of conversation It can be a good test of other areas of compatibility or suitability for dating and relating: “I did see one man who took it as a personal affront, but he turned out to be self-absorbed in other ways so I should have taken it as more of a red flag.” The more we date, the more we can reflect on what to look out for and decide what are red flags for us.

For many, talking about our sexual needs when dating may not come easily. It can be embarrassing or we may not know which words our date is comfortable with. Helen suggests saying something like “the tissue down there is not as tough as it was when I was younger. I really like having sex, but we need to take it easy so I don’t get hurt, and we need to be bit creative sometimes”. The timing of this is important too. It’s perfectly ok to wait until we are in an intimate environment – perhaps kissing on the sofa – before raising it, rather than feeling we have to warn them before we meet.

Helen says “They usually ask more if that hasn’t put them off. Then we can get into the specifics. It’s my experience that a lot of men like you to be clear with them about what you like anyway.” Katie agrees: “In my experience, men like the challenge, are relieved at the honesty, and are excited to try out different ways to bring you pleasure.”

Helen has turned what some might find embarrassing into “a bit of a game”: she gets them “to look at my vulva and show them how I touch myself and what’s pleasurable and what isn’t.” Even on a first date, we can check beforehand whether they are happy with us making gentle suggestions and reassure them that it’s not a criticism but it’s because it is a very sensitive area. We could also explain that something might feel good, but not for too long. Sometimes being touched through our clothing can be more comfortable, especially at the beginning. Take longer to become aroused and enjoy longer periods of kissing, cuddling and stroking before you are touched in sensitive areas.

Being in control is key to reducing discomfort and can create opportunities for creative playfulness. Helen says: “When I have penetrative sex I prefer to be on top so I can control the speed, force, depth and duration. But penetrative sex is not the main thing, there’s much more time on foreplay which can be anything from lots of different touching, sensual massage, or frottage. If you’re going to need to take control, there’s always an opportunity to explore role play. Oral sex and anal sex are also sometimes part of the fun. Sometimes we  masturbate together and perhaps explore erotic literature or pornography as we do so.”

Don’t forget that men can also experience changes in libido and function. Helen says: “It’s also a mistake to assume that all men are desperate for or capable of constant rapacious sex. Some men have a low libido and are happy with fooling around from time to time. I had a brief fling with someone who was suffering from erectile dysfunction after a long illness. The relationship didn’t really take off in other ways but we had a lot of fun.” As we get older, we can work together to redefine intimacy and sexual fun, rather than getting fixated on orgasm as the only possible outcome.

Having a genuine conversation on an early date about sex is also a really good way to get the conversation down to a deeper level of connection. As Helen says, “It’s important to be open-minded about their desires and fantasies – after all I’m asking for flexibility from them – whether that means that we do those things, or we just talk about them while we touch ourselves and each other.” These kinds of conversations can be about so much more than sex: they are an opportunity to explore our values, our dreams, our relationship with pleasure and playfulness, our attitudes towards emotions and intimacy, and even our politics. You might consider signing up for one of Ruth Ramsay’s online coaching programmes to explore this further; or have some singles coaching or couples coaching with Rachel, which include plenty of resources to stimulate conversations on this and other subjects.

Finding ways to enjoy self-pleasure is also important for women at all stages of the menopause. Helen says “The trick for me is to get enough stimulation without getting sore, and I know many women in menopause have difficulty with orgasm. I use a clitoral suction stimulator which I would absolutely recommend. Mine’s a Lelo Sonic.”

The menopause can also transform men’s approach to intimacy. Daniel, 54 and heterosexual, reflects on how the menopause has changed the meaning of love and sex for him and his partner: “The menopause from my point of view means constant change.  Things can change in the way your partner feels and responds. These feelings can change suddenly, and unexpectedly, and there’s no point trying to predict what they’ll be. Sex that worked for her in the past might not work now.  You may have to learn new ways to be together in bed, and those new ways may be permanent, or they may continue to evolve and change. Things can change every week, every month, or over years.  Don’t assume that just because sex is difficult or unsatisfying or that your partner just isn’t interested in it today, that this means they’ll feel that way forever.  You’re in a process, you’re not at the end of it.  She may need continual reassurance about it. Remember times when things go well.  You may need to remind her of it when she can’t see a way through.”

It’s important for both of you to provide reassurance that you still love each other and to be specific about what you find attractive about your partner. Even though rationally you may both know this, emotionally you may both need reassurance. Daniel says: “You may feel like these changes are a reflection on you, her or your relationship – it’s easy to think you’re doing something wrong, or she is.  Neither are the case.  Don’t feel hurt, or angry.  Just treat it like a brand new relationship.  You might well discover new desires and new ways to fulfil them.” And as Tracey Cox says in her very useful book, Great sex starts at 50: “Don’t get all thingy if she wants something new. It doesn’t mean she didn’t ever enjoy the other way, just that her body has changed and she needs it done differently now.”

Of course, the menopause can also increase libido. Angela was surprised to find that at 49, something unexpected happened: “My libido went into overdrive! Rather than requiring time and effort to become aroused, I started to experience a strength and urgency of desire comparable to my late teenage years. Although my husband and I have always enjoyed a healthy sex life, he has been surprised and delighted by this boost, which so far has lasted two years. It has increased our sense of joy and vitality and strengthened our mutual connection and commitment.”

John, 56, recently started dating again after divorce, and was delighted to discover that menopausal women do not always have decreased libido as he’d assumed: ’It’s like we are both teenagers! I hadn’t felt alive, desired or ‘wanted’ for over a decade and it’s glorious.”

Author Christie Watson has just published her fifth book, Quilt on Fire. In it, she talks about her experiences of dating and the menopause. In this podcast episode from The Merry Menopause, she talks about how she had to re-evaluate her own identity at this new stage of her life and learn that aiming for perfection and control was not part of that. She also had to navigate an increased libido from taking HRT while dating.

The menopause is a great time to hone your dating behaviours and values. Jo Fuller, Menopause Coach and author of The Merry Menopause Bookclub Podcast series says: “During my perimenopause I learnt to become boundaried in all my relationships, and even more so in my romantic ones. I walked away from a relationship that looked great on paper but the reality was that my emotional needs weren’t being met. I didn’t feel supported or heard and previously I would have seen that as my a fault on my behalf and strung out the relationship for way too long focusing on the material/surface benefits, but  deep down I knew that having my needs met were so much more important that having a boyfriend who was generous with his money but not his heart. Perimenopause taught me the value of me and my self-worth and I now trust that the right relationship will show up at the right time.”

Although we all have our own individual and unique experiences and comparisons may not be helpful, it can be good to get support from being part of a community. The Menopause Cafes operate across the UK. The organisers of the café that runs in Crystal Palace, London, UK agree: “From our experience of running the Menopause Cafe South London, we have found that it gives women going through the menopause and perimenopause an outlet and network of support. Friendships have been built through sharing stories and ideas and many of the women who attend say that being able to talk freely and openly to other women on a regular basis helps take the pressure off their personal relationships. This means they can approach conversations with their partners in a more productive way about how the menopause is affecting them.”

So don’t lose hope. Perimenopause, menopause and postmenopause are all just stages in our life journey, each with challenges and rewards for our relationships with ourselves and with others. It might not feel like it right now, but things shift, hormones change and nothing is forever. If you have children, you know that what is challenging today will be replaced with a different challenge next week: it’s often not worth making big changes to accommodate the ever-shifting goalposts of children’s timetables, food fads, friends and emotions. Perhaps it’s the same with the menopause. So let’s keep asking our medical professionals to try something new if our medication isn’t working, researching expert advice and best practice, getting support from each other, talking openly to normalise it, and communicating our needs in healthy ways!

If you would like to talk through how the menopause is affecting your dating or relating, please get in touch with Rachel here.

Main image by Shawnee D on Unsplash

Some interviewees’ names have been changed. Gender and ethnic identities were not always provided and some did not disclose their sexual preferences, so these have been left out.

For medical advice about the menopause, please visit your GP in the first instance, having read up on the latest research and guidelines using the links below. (This paper provides a good overview that is used by doctors. Most but not all GPs are now better trained and equipped to understand menopause, but you may need to get support elsewhere, such as a private clinic like Dr Newson’s. Join a menopause Facebook group or visit a Menopause cafe to get support from others experiencing challenges with the NHS. Your symptoms may include high levels of anxiety, depression or brain fog which may reduce your motivation to get help or to believe help is possible. Please reach out to someone to get started.

Useful links

The Balance app

The Menopause Doctor

The British Menopause Society

Menopause Matters

The Menopause Cafe

Davina McCall: Sex, Myths and the Menopause

Davina McCall: Sex, Mind and the Menopause

https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/relationship-issues

From the Balance app: menopause and sex drive

https://www.theguardian.com/lifeandstyle/2020/dec/27/menopause-is-ruining-my-sex-life

https://www.pleasurepossibility.com

https://www.jodivine.com

https://www.ruthramsay.com

The Merry Menopause

Helen Clare, menopause coach for schools

Dr Nighat Arif on TikTok

Conversation between Dr Nighat Arif, Michelle Griffith-Robinson & Meera Bhogal about the menopause

Books

Men… Let’s Talk Menopause: What’s going on and what you can do about it by Ruth Devlin

Preparing for the Perimenopause and Menopause by Dr Louise Newson

Great Sex starts at 50 by Tracey Cox

My Menopausal Vagina by Jane Lewis

The Secret Female Hormone by Dr Kathy C. Maupin

Come as you are by Dr Emily Nagoski

Tell me what you want by Justin Lehmiller

Podcasts

Dr Louise Newson

The Merry Menopause

Black Menopause & Beyond

Trans men and the menopause

https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/resources

https://genderkit.org.uk/category/menstruation

https://rockmymenopause.com/get-informed/transgender-health/