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’).
Christina didnt want her partner near her when she was having a hot sweat
Have you been in a relationship at all during this time?
I have and it’s been embarrassing and its like, “Will you go away please?”, “You’re making me too hot.” And in the end the relationship split up so I don’t know whether it was because he couldn’t handle me pushing him away and he’s feeling rejected about it, but I just couldn’t have anybody that close to me.
Did you talk about that?
I did but of course, he’s a man. And they don’t understand, it’s their feelings of rejection and, “No, can’t cope with this.” And, “You don’t want to be anywhere near me.” And everything else, so the understanding isn’t there about what we’re going through. What I’m going through.
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.
Karens moods badly affected her relationship
I think probably my moods affected him more than anything. I was being a very unreasonable lady and he’s got a short fuse, much shorter than mine, so it wasn’t good for us.
Because I think you do sort of shut in on yourself a bit, you’ve got a problem, your husband doesn’t particularly want to know about your female problems, or at least mine didn’t, he’s still very macho man and you haven’t always got someone just to have a chat with.
So did you talk to him about it at all?
Not terribly. He was doing sometimes twelve hour days, he would come home from work, he didn’t want to hear my problems and we’ve got two kids that were squabbling, doing their homework, television programmes going on all over the place. He didn’t want that, he didn’t need it and I’m the sort of person that feels I can deal with things. I’ve always dealt with things myself.
Susan describes how her partner dealt with her mood swings
So [partner] is fine and I think she’s beginning to notice little changes in her cycle now but so no, we’re on the advent of [partner’s] [menopause], we’re on the brink of it while I’m coming out of it. But she was very good, extremely understanding, extremely patient. Her mother had had a particularly bad menopause so that [partner] was really very sympathetic and knew what I was going through. She wasn’t always patient with it and she did have to take the brunt of some of it and was happier with my moodiness and could cope with me being emotional and tearful better than obviously when I would go into a fit of stupid rage about something. But she was always there and always supportive and always kind of pro-active in helping. Would have found out is there anything that could help. Encouraging me out on walks, that sort of thing, always so it was good to have a supportive partner. And a woman who understood probably from her own perspective, of course from her own perspective even though she hasn’t experienced the menopause but certainly who knew her mother’s situation and was able to kind of support me because she understood it. As indeed her mother did. It was great. So it’s great to be part of a community of women who support each other through the menopause, it is I think very, very important.
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.
It is hard for her husband to empathise with how Jackie is feeling
And I think he was scared and worried with me. Definitely. He came to the doctors with me a few times, he even came into the surgery when I was at my worst where I, because I was so overly emotional as well. I mean that’s the bit that the hormones level out, they stop you from feeling like you want to burst into tears all the time. I certainly was feeling that. The least bit thing and I would fill up and I always assumed that I would start going to pieces once I went into the doctor’s surgery and talked about it. I managed still to get my point across really. But [husband] came in with me a few times and he’s tried to understand but I think it’s very difficult to get it, how can they? They don’t feel things in the same way that they don’t feel the sensations that you’re feeling, like that they’re putting you into panic mode. But he’s probably more aware and more supportive than a lot of partners would be. But there’s times when he’ll maybe switch off a bit and I find it hard going getting him to. It’s all like because I’m a bit better, as though I’ve got to be like right, that’s it get on with it kind of thing. But he wouldn’t say that but I could tell by his attitude that he would perhaps think I should just be able to act as though nothing’s happening. But it’s not like that.
Do you think it’s affected your relationship?
Well it has but I’ve learnt to live with that because I’ve been living with it since I had my hysterectomy really. I would say the way we are together we’ve got a challenging relationship anyway, but because we’ve been together such a long time we’ll always work on finding ways to get over those challenges and so far we’ve managed that.
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’).
Charlottes hot sweats and heavy bleeding affect love-making
How did it affect your relationship with your husband?
He was very very good. Because certainly it’s very visible, he could see how challenging it was and he’d tease me and things like that. Certainly if we were having sex or anything I would be very hot and so it did kind of interrupt in that way or it certainly I think it would have had an impact on love making. Not in a negative way just trying to find a way around it because “Oh I’m too hot, lie like that” or “Oh don’t come near me”, that kind of thing because obviously that would be another trigger. I could get hot flushes if we were making love, that kind of thing. So, yes, but it didn’t affect our relationship in terms of how we relate to each other because he’s a very very sensitive person like that. He could see it was horrid.
And was it the same when all the bleeding was going on, before you had the treatment?
Yeah, he would be very tolerant. That would interrupt obviously and he’d say, “Oh we look forward, we’re going on holiday”. Because that was another trigger if I went on an aeroplane, “we look forward to going on holiday” but he’d say, “We know what will be coming, you’ll be having your period for the whole holiday” and that kind of thing. So fair dos to him, he has coped well with it. And he has never ever put pressure on me to have a hysterectomy although I think he feels probably it’s the most sensible course of action for me now. But he certainly has let it go at my pace. He hasn’t been a pressure.
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.
Denise, whose lessened interest in sex coincided with her partners midlife crisis, stresses the...
So have you noticed any change in your interest in sex?
Well, definitely a decreased interest, yes. I would be quite happy, as they say, with hugs and cuddles but that’s about it, but no, definitely decreased. And again it’s one of those things you think, oh, dear. Do you go to the doctor for, what do you do? So it’s a difficult area because not everyone’s content or happy with talking about it.
And have you spoken to your husband about it at all?
We tend to laugh about it, yes. Yes, again it coincides very often with the partner’s midlife crisis as well regarding perhaps their work and things so I think as long as you talk, they perhaps look for different things so it’s something you just have to keep open the channels of communication, I presume it could be difficult.
So was your loss of interest related to the vaginal dryness?
No, I think that was just general yes, yes. That didn’t help, I have to say but no, that would be fairly general probably in the last couple of years, yes.
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.
Sharon fears her lack of interest in sex may jeopardize her relationship
I’ve always had very good skin but all of a sudden I’ve noticed my skin’s gone extremely dry and with the dryness I’ve also dried up in other places, I don’t know whether that’s going to be relevant if we’re talking about that side of it.
Now that’s really started to turn sour when I thought I was going through the menopause and it’s a shame because I’ve been very very active, my husband and I have been with each other for nearly thirty years and then to have suddenly sort of not feel like it, don’t want it and have pain with it, phew, don’t want that. And that’s another big issue when it comes to your relationships because then that starts to go downhill and when your relationship starts to go downhill and your husband wants to go out and you’re wondering where they’re going and then you think “Oh my God, and I’ve got the menopause, I’m not smoking” and so you turn to have a pint then.
And I think that’s one of the hardest things because that’s where if you read magazines and, not that I do I never have time, but it’s always the man who’ll go off with someone younger. Why, because that younger person not only looks better but they probably give them so much more affection. Well sometimes I just can’t cope with all that nonsense because you’re worrying about what you’re coping with yourself. And it is difficult, it’s bloody hard. A lot of my friends are divorced and they all went through their divorce around about their late 40s after the children had grown up or after the children were becoming in their teens and becoming independent and then when the female was possibly either starting to go through menopause or starting to realise that things weren’t as taut and as supple as they used to be. And they went off sex, that’s the big thing, the big issue. And I’d like to find this, if there was something for women out there, I know they’ve got the Viagra but I don’t want to really take any more tablets. You just have to put up with it.
Cultural practices which stipulate times of the month when couples can touch and have sex may also strain relationships.
Brenda, an Orthodox Jewish woman, discusses how loss of interest in sex and her inability to...
Well the year is just about over if it’s not over and from being very regular I’ve become extremely irregular and sometimes I think “Oh well, a couple of months have passed and my periods are stopping” and then I suddenly get an incredibly heavy period and then another one a couple of weeks later. So it’s all very disorganised. And where the Orthodox Jewish side of things comes in is that we, the husband and wife, don’t sleep together when the woman’s having a period and then when the period finishes we have five days and then seven days and then the woman goes to the mikvah [a bath for purification of women after menstruation]. And in those five days and seven days we don’t touch and embrace. And therefore if one is having periods every 10 days one never gets to the mikvah and one never gets to touch and embrace. And in addition I’m finding sex is extremely not what I want to do. So in addition to not being able to, I don’t want to and so there’s been a lot of friction in our marriage because of that and actually it was very helpful when I began to read up about the menopause to discover, to start to sort out that some things were physical, not that I was going off my husband, I was going off my husband in one way but I began to realise that that’s quite a normal thing to do. And we’re having to work through that. But I would quite like to be period free and then I could like stop having all this worry about starting and stopping in between.
And I am very pleased that I’ve read books now about the menopause and I see that it’s quite a normal thing because it’s very strange to have these feelings of I don’t want anything to do with sex and you think why, is it something to do with emotional changes. But I see now it’s not and it’s physical. I see also there are physical things you can do to help which is good news. And that made me feel a bit better. I feel less uptight about it because of that.
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.
Annette was on the pill and had started the menopause when she fell pregnant with her son
But then when I actually had my last son it was like I didn’t even know I was pregnant for a while, I’d been not myself at all and I just thought, “Oh I’m going through the menopause, taking the pill, I’m fine. So I met the baby’s Dad after ten years and then found out I was pregnant. Not very happy about it, I know he’s here and he’s here to stay now, but I actually got very upset about it. For the simple reason was I’d already brought three children up on my own, they were at the age going to secondary school. I had these offers of three jobs which was breakfast club, dinner time, and after school care at the time, which I was doing.
How did you know you were pregnant?
I didn’t. And he kept on telling me, he, the baby’s Dad actually, and he kept on saying to me, you’ve got to be pregnant, I said, “No, it’s just that I’m tired and I haven’t been feeling very well.” I’ve not always kept food down anyway. And he goes, “You sure you’re not pregnant?” I went, “No.” I’ve always known, I’ve always known, I mean even having a miscarriage at three months pregnant, I knew I was pregnant before I lost the baby, I knew, but he just kept on saying to me like you now, “You are.” And he actually got me a tester from Tesco’s, I says to him after, we had a joke about it after because he bought the most expensive tester, whereas you could’ve got one for £2.99, he paid 25 pounds for it. And within, I woke up the next morning, five o’clock in the morning before I get up usually. First time, that first wee, and I found out I was pregnant, absolutely sob, none of the children were up, sobbed my eyes out, absolutely broke my heart.
But not being with anybody for ten years, told that this is my time, in my head as well, I just thought, “Well just get on with it.” But like I said it was a big shock when I got pregnant. More so than any of my other children, with this one. Because being on my own for such a long time as well, it was like, “No, I can’t do this again.” But I would never ever abort. I don’t believe in it.
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.
Dr Sally Hope talks about the controversy surrounding the use of the contraceptive pill during...
What about the contraceptive pill? Is that any use to menopausal women?
There is quite a lot of controversy about the contraceptive pill. The problem is once you’re over 40 the risks of heart attacks and strokes and clots in the legs for the combined contraceptive pill do go up. So most GPs are very unhappy about women taking the combined oral contraceptive pill right up to the age of 50. Although experts in the pill like [name] say it’s safe, I think women have to weigh up the pros and the cons to them for it. There is the mini-pill, which is a progesterone only pill, that you can take up to the menopause and is equally safe in this age group, the over 40 age group. And then as we said, there are hormone coils. There are non-hormone coils. There are contraceptive injections and there are implants as well as good old condoms and caps, if you want a barrier method.
Sonia had a Mirena coil fitted to regulate her periods and for contraception
So you decided on the Mirena coil? And how was that fitted?
Again, I had to go back up to the women’s clinic and go up there and that was quite painful actually having that fitted.
And how long until that had positive effects for you?
It took at least six months. I was still having periods up until six months after and then all of a sudden they just stopped.
Were they as bad all that time as they were?
Yeah, they were actually. They weren’t that great, I was still bleeding irregularly.
Did they tell you it would take some time?
Yeah, they did. They said it could take at least six months for it to get into your system and to work properly because obviously it releases the hormone very slowly. So it has to get into the system. But after the six months, by the end of the year, that first year, nothing.
And did they talk about the contraceptive effects that that would have as well?
Yeah, they said it’s a contraception.
So how long will you have that Mirena coil? Do you have to have it replaced regularly?
It’s five-yearly intervals. I’ve got a check-up coming up soon. So that’s after two, three years, yeah. So they check it every so often but after five years it has to be replaced.
Maria has had problems with a contraceptive implant in her arm
What about your periods? What’s happening there?
They’re very erratic at the moment. I have recently changed to the implant which I have in my arm and I had that last February just gone and I think it’s made it worse.
That’s a contraceptive.
It’s a contraceptive, yes yes. Prior to that I was on the Depo [provera] which is the injection every three months which had settled me. I’d been on that for about twelve years so since being divorced and everything and I was settled with that and since I’ve had this implant I am up, down, long, short. I don’t know if I’m coming or going. I’m actually going back to the doctor’s in a month to maybe have it taken out or discuss something different because this implant is not for me.
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.
Dr Sally Hope talks about the increase in sexually transmitted diseases among older people and...
You’re more at risk of acquiring sexually transmitted diseases because you’re more at risk of getting slight, tiny cuts in your vagina because you’re not so lubricated and you’re not so elastic and so it’s actually very important, ladies, if you are sleeping with somebody you don’t know very well, like a new partner, to make them use a condom. Because actually, in the UK at the moment the largest rate of increase in sexual transmitted diseases is actually, in the over 70s and you think, “Well, that’s impressive.” But it’s because they may have got divorced or their partner may have died and they’re footloose and fancy free, go off to the Costa del Sol, meet somebody and they don’t think about safe sex because they’re way past contraception and get STIs [sexually transmitted infections]. But we do see them in perimenopausal women because, again, it’s a time, it’s quite often for people to stay together until the children leave home or until they’ve left school. And so it is unfortunately a time of marital break-up and people are thinking about contraception or not for the first time in possibly twenty, thirty years, if their husband had a vasectomy in the 1970s and they’ve just genuinely forgotten that they do need contraception. So it’s actually very important to practice safe sex, unless you know your partner extremely well, and to think about contraception.
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.
Last reviewed July 2018.