Relationships, sex and contraception and the menopause

In any relationship there are times when couples face challenges. The menopause can be one such time. Faced with a loss of sex drive and other symptoms which make them feel hot, anxious and uncomfortable, women may find they no longer want to have sex as much as they did before the menopause. Communication can become strained, with partners feeling rejected and at a loss to know how best to support their menopausal partner. Women told us how their symptoms affected their relationships, and about sex and contraception during the menopause.

How symptoms affect relationships
Menopausal symptoms are often at odds with a harmonious relationship. From a woman’s perspective, having to share a bed can add to the heat she’s experiencing with hot flushes (see ‘Hot flushes and night sweats’). Embarrassed and uncomfortable, her instinct is to get away, to find a cool spot to recover. Yet the double bed symbolises togetherness, and pushing a partner away or leaving the room, can be felt as rejection. Moreover hot flushes and sweats interrupt the partner’s sleep, with tiredness adding to tensions in the relationship (see ‘Sleep’).

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Mood swings, premenstrual tension (PMT), and emotional problems can also create a volatile atmosphere in the home. Women may act irrationally, be quick to anger, and feel as if they are nit-picking or constantly nagging. Or, in the interests of keeping the peace they may try to keep a lid on their emotions, removing themselves from tense situations and adding further to the pressure they’re feeling. Partners are left in a ‘no win’ situation. To respond may lead to ‘stonking rows’; to retreat and ‘keep their mouth shut’ risks creating distance in the relationship. Some women wondered why their partners couldn’t give them the support and understanding they badly needed.

With good communication, couples in established relationships may find ways of getting over these challenges. However, starting a new relationship during the menopause can be difficult. Women said that physical and emotional symptoms got in the way of them looking and feeling their best. They felt this put strain on the relationship. One woman, suffering from menopausal depression, was not surprised when her partner met somebody else.

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Sex and intimacy
For many couples, sex remains an important aspect of relationships throughout the menopause and beyond. Some women talked of sexual freedom and greater enjoyment of sex once they no longer had periods and risked pregnancy. However, symptoms such as hot flushes and sweats, heavy bleeding, loss of sex drive, and vaginal dryness can destroy women’s interest in sex (see ‘Libido, vaginal dryness and urinary problems’, ‘Hot flushes and night sweats’, ‘Changes in periods’).

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Loss of interest in sex may not always be problematic, nor do women always need penetrative sex. As one woman remarked, ‘intimacy is not just intercourse’. In some couples, the woman’s declining interest in sex was matched by her partner’s loss of sex drive. Women talked about maintaining a loving relationship by sharing ‘personal private things’, enjoying ‘kisses and cuddles’ or a massage. Good communication and adapting to changing needs can ensure that couples remain close.

Tensions in the relationship may arise when women cannot meet their partner’s needs. One woman recounted how her lack of interest in sex, at odds with her husband’s high sex drive, made life ‘quite fractious’ until they sorted it out. Another said she had to make a ‘conscious effort’ to remember her partner’s needs to prevent them drifting apart. Despite a lack of desire, some women may find that they ‘thoroughly enjoy making love’ once their partner instigates it.

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Cultural practices which stipulate times of the month when couples can touch and have sex may also strain relationships.

Contraception around the menopause
Some women mistakenly believe that they can’t get pregnant during the menopause. Although fertility declines after the age of 35, pregnancy can and does happen. For this reason, the Family Planning Association (FPA) advises women under 50 to continue contraception for two years after the menopause, and those over 50 for one year after the menopause.

A range of contraceptive methods can be used, including barrier methods such as condoms and caps, the mini-pill (a progesterone only pill), and sterilisation. Hormone coils, such as the Mirena coil, which are inserted into the uterus, can help with heavy bleeding as well as act as a contraceptive. The rhythm method of natural family planning is unreliable during the menopause because the periods are unpredictable.

The risk of sexually transmitted infections (STIs) is increased during the menopause and postmenopausal period; vaginal dryness makes women more susceptible to infection. Practising safe sex by using condoms is particularly important in having sex with a new partner.

Relationships are rarely easy. Around the menopause, couples may need to respond not only to the effect of menopausal symptoms and changing sexual desires, but also to a range of health and social factors which can threaten their well-being (see ‘Family, health and life events’). Finding a way through this can be challenging. The topic ‘Advice to partners’, offers a range of suggestions on how partners can best respond to the difficulties which confront women at this stage of their lives.

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Last reviewed July 2018.


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