Management & treatment of sexual problems at menopause

Research from the National Ageing Research Institute and the University of Melbourne, called the ‘Women’s Healthy Ageing Project’ (a large study of women begun in 1990) found that as women transition through menopause, there can be a significant decline in sexual functioning.

Sex & menopause

The study found the decline is associated with a reduction in the hormone oestradiol (the main oestrogen), but not testosterone. The exact relationship between hormone levels and sexual dysfunction is still not clear, and it appears to be quite complex.

Researchers have identified that sexual problems are worse for women with early/premature menopause or surgical menopause. This might be due to a larger, sudden drop in hormones that happens with these types of menopause.

At midlife and menopause, many things are likely to be happening, both to your body and in your relationships. There might be partners, children and ageing or unwell parents to consider, as well as work demands and even your sense of identity as a woman. These changes can affect your sexuality and, together with the hormonal changes, sexual problems may occur.

The impact of symptoms

One of the key symptoms of menopause is a dry vagina.

Lower levels of oestrogen directly affect your vagina and can make the skin thinner, drier and less elastic. Testosterone levels fall gradually with age and this can have an impact on your sexual function and libido after menopause.

The domino effect of menopausal symptoms such as hot flushes, sleeplessness and fatigue can make it less likely you will want sex as much.

Some women are concerned by the changes menopause causes to their sexual lives, and others are not so worried. It really depends on you, your attitude to sex, your age, how menopause has affected you, whether you are in a relationship, whether you want to have sex and whether there are other things happening in your life you are more concerned about.

Different types of menopause can also affect your sex life. If you have had a surgical or chemotherapy-induced menopause, symptoms can be worse due to a more rapid drop in oestrogen and testosterone.

Dry vagina treatments

There are several options to treat changes to your vagina caused by menopause. Go to ‘Menopause management’.

Painful sex

Because a dry vagina makes sex painful, even thinking about sex can make you anxious, and then you can start to fear sex. This can set up a negative ‘pain cycle’ where you fear sex, avoid sex, get frustrated and anxious, and then sex is likely to hurt more. If this is happening, treat the physical symptoms first to reduce the pain, and then the fear of pain during sex may also decrease.

However, some women find that although they feel physically better after treatment, they still fear sex will hurt, and they might become anxious even thinking about sexual activity.

This is common. If this happens to you, it can be helpful to:

  • learn and practise relaxation exercises
  • see a pelvic floor physiotherapist to learn pelvic floor relaxation, as these muscles often become tight, increasing sexual pain
  • talk to a psychologist or sex therapist who specialises in sexual problems in women – you may need only one or two sessions, but understanding what you can do to help yourself and your partner in this situation may stop a problem becoming more serious.

There are many reasons we find ourselves having difficulty when it comes to sex. For more information, please see our webpages on ‘Sex and sexual health’.

Libido at menopause

Libido (sexual desire) tends to be lowered in some women at perimenopause and menopause.

It is difficult to have desire if:

  • you have experienced pain because of a dry vagina
  • you are exhausted because of menopausal symptoms
  • you feel moody or frustrated by all the changes
  • you feel like you do not want to be touched as much.

Some women may improve with a trial of menopausal hormone therapy (MHT) or with use of vaginal moisturisers/lubricants or vaginal oestrogen to improve vaginal dryness. It is an important issue to discuss with your doctor.

Testosterone for libido

As with any treatment options including hormone and testosterone therapy, it is important for each woman to explore her own needs, thoughts and experiences and seek a range of qualified opinions from reputable sources.

The area of wellbeing and libido is very complex, and research tells us these are likely to be influenced by psychological factors more than testosterone. For example, a woman’s individual situation, her relationship status and satisfaction, her past experience of problems and whether she is experiencing anxiety or depression are important influences.

After a surgical menopause, testosterone therapy, usually as a transdermal cream, may be recommended because it may improve impaired sexual function.

Managing contraception during menopause

Changes to your period during the transition to menopause often prompt women to ask, ‘how long should I use contraception for?’ Most women are aware fertility naturally declines with age.

The possibility of pregnancy in women 45-49 years is estimated to be 2-3% per year. After the age of 50, it is less than 1%. This is low, but the fertility of individual women is extremely variable. Perimenopausal women can ovulate twice within one cycle, and women can still ovulate up to three months before their final period, so contraception remains an important consideration.

When is it safe to stop contraception?

For women younger than 50, contraception is recommended for at least two years after the final period.

For women 50 and older, contraception is recommended for at least one year after the final period.

It is important to carefully consider your contraception options, as there are many different types available. It is a personal choice, but it is best to have a discussion with your doctor to help work out what is the most appropriate option for you.

Please note that MHT is not a contraceptive.


It is hard to know if menopause influences your relationship with your partner, or if the relationship you have with your partner influences your experience of menopause.

Partner attitudes to menopause have an impact on your experience of menopause. Having an informed, supportive partner can help during this time. Help your partner to gain access to good objective information about menopause, and discuss your own experiences to help their understanding.

At midlife and menopause, different women are at different stages of their relationships. Relationships can be long-term or new, satisfying or unsatisfying. Any relationship difficulties a woman may experience during menopause can negatively affect her mood.

Menopausal symptoms and a chronic illness or premature menopause can take their toll on a woman and her relationship, making good communication in the relationship vital at this time.

What can you do to help your relationship?

One of the most important things is to be able to discuss your thoughts and problems openly in your relationship.

If this is difficult, perhaps your partner could visit your doctor with you and you can discuss your concerns together. Or, you could both visit a psychologist who specialises in couple’s therapy. You might have to go for only one or two sessions, but the therapist should be able to help support you in your communication.

If sexual problems are causing difficulties in your relationship, it is helpful to sort out how many of them are due to the physical symptoms of menopause, and how many might relate to other issues, or both. When you have worked this out, then you can seek the appropriate help.

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