Sex & Relationships in Peri/Menopause
The journey through perimenopause is unique and often unpredictable. Hot flushes and brain fog may get the headlines, but for many, the most confronting changes show up in the bedroom and in relationships. Understanding and managing these shifts can help maintain fulfilling connections, deepen intimacy, and protect your overall wellbeing.
Will Perimenopause Change Things?
The short answer: it might - but not always in the ways you think.
Some studies show a decline in sexual interest or enjoyment during perimenopause, while others find that people report greater fulfilment and freedom. The difference often lies in perspective. Those who describe a satisfying sex life tend to see sexuality as a vital part of their wellbeing. They stay curious, communicate openly with partners, and make space for self-exploration.
For some, this even includes same-gender experiences or redefining what intimacy means in midlife.
There are plenty of reasons sex can feel more satisfying during this stage of life:
The relief of no longer worrying about unwanted pregnancy.
A shift away from performative sex towards pleasure, connection and authenticity.
Greater confidence in expressing desires and boundaries.
Freedom from the sexual objectification that coloured earlier decades.
Importantly, a recent study found that social and cultural factors—like relationship status, sexual history, and personal beliefs about sex—often shape satisfaction more than hormonal changes alone. In other words, menopause is only one piece of the puzzle.
Libido and Sexual Wellbeing
Sexual desire is influenced by both body and mind, which is why a biopsychosocial approach is recommended.
Some non-hormonal factors that impact intimacy and sexual wellbeing include:
Feeling less attractive or struggling with body image.
Midlife stress and the relentless demands of work and family.
Limited time or energy for partners.
Changing family dynamics (e.g. children leaving home, ageing parents).
A partner going through their own sexual health changes.
Medical conditions or medications that affect desire and arousal.
On top of this, perimenopause brings hormonal shifts that can make sex feel inconsistent:
Vaginal dryness or discomfort due to oestrogen decline.
Sleep problems leading to fatigue and low interest.
Mood swings or anxiety that dampen confidence.
Fluctuating libido - sometimes a surge early in perimenopause, followed by dips later.
For many, sexuality is an important part of identity and wellbeing. Addressing what gets in the way - whether it’s physical discomfort, relationship tensions, or resurfacing past experiences—is a step toward reclaiming pleasure and connection.
Symptoms
Perimenopause can change how sex and intimacy feel in your body, your mind and your relationships. Symptoms can be physical, psychological and relational, and they often overlap. Not everyone will experience all of these, and intensity can ebb and flow across the transition.
What you might notice physically
Vaginal and vulval dryness or irritation associated with oestrogen decline, sometimes called genitourinary syndrome of menopause.
Pain with penetration or friction, microtears, burning or itching during or after sex (dyspareunia).
Reduced natural lubrication and slower arousal.
Pelvic floor tension or pain, including spasms or a sense of tightness.
Urinary changes such as urgency, frequency or recurrent UTIs that make intimacy feel less appealing.
Breast tenderness, headaches, joint aches, hot flushes and sleep disruption, which can dampen desire simply because you are exhausted.
Changes in sexual function
Desire shifts. Spontaneous desire may dip, while responsive desire can remain intact, which means desire often follows context, touch and connection.
Arousal changes, including difficulty becoming or staying aroused.
Orgasm changes. It may take longer to climax, orgasms may feel less intense or less frequent.
Sensitivity changes in the genitals or a general sense that your body is not “switching on” in the way it used to.
Emotional and cognitive symptoms that affect sex
Mood swings, anxiety or low mood, which can reduce sexual confidence or interest.
Body image concerns or feeling less attractive, which can lead to avoidance or self-consciousness during intimacy.
Brain fog and fatigue that make it harder to be present or playful.
Identity shifts that stir questions about who you are now, and what you want from sex, intimacy and relationships.
Relationship and contextual symptoms
Avoiding intimacy due to fear of pain or dryness.
Mismatch in desire between partners, creating tension or misunderstanding.
Communication breakdowns, especially if sex has become stressful or feels like pressure.
Partner factors such as their own sexual health changes, stress, or medical issues.
Invisible load stressors. Caring for kids or ageing parents, work demands and mental load can drain time, energy and libido.
Red flags to discuss with a health professional
Bleeding after sex, new or worsening pelvic pain, persistent severe pain, or recurrent UTIs.
Any symptom that is distressing, persistent or escalating despite self-care.
A quick note on what this means for you
Symptoms do not mean your sexual self is gone. They are signals. With the right support, most people find relief from dryness and pain, rebuild confidence and discover more satisfying, pressure-free ways to experience intimacy in midlife.
If these symptoms sound familiar…
You do not have to white-knuckle it. Our team at All About Her: The Centre for Menopause can help you understand what is changing, relieve physical discomfort and rebuild connection and pleasure in ways that suit your body now.
Improving Sexual and Relationship Health
Addressing sex and relationships in perimenopause usually requires a multi-layered approach, combining lifestyle, psychological, relational, and medical supports.
Enhancing Intimacy Practices
Taking the focus off intercourse can relieve pressure and invite playfulness back into relationships. Exploring what feels good, finding new ways to connect, and giving yourself permission to redefine intimacy are all important steps.
Lifestyle and Self-Care
A healthy lifestyle doesn’t just ease hot flushes it also supports sexual wellbeing. Helpful practices include:
Eating a balanced diet and moving your body regularly.
Limiting alcohol and caffeine, which can worsen symptoms.
Prioritising rest and sleep.
Embracing stress-reducing activities such as yoga, meditation or mindfulness.
Pelvic Health
Pelvic floor physiotherapists can teach relaxation, stretching and massage techniques that ease discomfort from muscle tightness and help restore confidence in sexual activity.
Psychological Support
Perimenopause often stirs up more than just physical changes. Old wounds, sexual shame, and relationship patterns can resurface. Speaking with a psychologist who understands both menopause and sexual health can help you:
Rebuild confidence and sexual self-esteem.
Explore unhelpful beliefs or fears around intimacy.
Improve communication with partners.
Work through resurfacing trauma or relational challenges.
Therapies like Schema Therapy, Cognitive Behavioural Therapy (CBT), Sensate Focus, and Emotion-Focused Therapy can provide practical, evidence-based support.
Medical Treatments
For vaginal dryness and discomfort, local oestrogen therapy, moisturisers, and lubricants can be life-changing. Hormone therapy may help regulate desire, arousal and satisfaction, and in some cases, testosterone treatment can benefit those with a significant drop in libido.
All treatments should be tailored by a health professional to your needs, as no two perimenopause experiences are alike.
A Final Word
Perimenopause isn’t the end of your sexual self—it’s a chance to create a new story. With the right support, intimacy and connection can not only survive this transition, but thrive.
Ready to Take the Next Step?
At All About Her: The Centre for Menopause, we support women and people with ovaries through the challenges and opportunities of perimenopause. Our team of psychologists and health professionals can help you navigate changes in sex, relationships, intimacy and identity with evidence-based care, practical strategies, and a deep understanding of midlife.
*All About Her - The Centre for Menopause acknowledges that all people born with ovaries and who live long enough will experience the menopause transition. This includes cisgender women, transgender men, non-binary individuals, and any other individual with ovaries. We use the terms
individuals/people to be inclusive of the many who do not identify as women, but who will nonetheless experience this significant life stage.
Disclaimer: The information presented is for general understanding only and should not substitute professional medical advice. If you are concerned about your health, talk to your doctor or healthcare team for personalised guidance.
© All About Her Centre 2024