Sex after perimenopause and menopause: What you should know

Published May 2025 | 5 min read
Expert contributors: Dr Tonia Mezzini, Sexual Health Physician, East Obstetrics and Gynaecology; Dr Lina Safro, GP, Family Planning Australia
Words by Trudie McConnochie

Irritability, poor sleep and pain can all impact your desire for sex during perimenopause and after menopause. Here’s why, and what you can do.

Megan Hayward, 45, had always enjoyed a great sex life with her husband, so when perimenopause started to derail activity in the bedroom, it came as a shock. A combination of symptoms starting around age 40, including dryness and discomfort in and around her vagina, made having sex increasingly difficult. Erratic periods, including one that lasted for six months without stopping, contributed to the challenge.

“Not being able to get properly stimulated using lubricants, and then starting to have sex, then having to stop because it was too painful ... and then I’d get a UTI or just bleed afterwards – all fed into my absolute lack of desire,” says Megan, who is now a perimenopause and menopause educator.

When enjoying sex became difficult, then eventually impossible, Megan’s distress increased.

“I felt betrayed by my body, because it wasn’t doing what I wanted it to do,” she recalls. “I felt confusion and shame. I was angry with myself and also felt a real sense of loss.”

It also impacted her relationship. Megan says she felt such shame about what was happening she started to shut down, leaving her husband in the dark. The tension between them became so great they considered separating.

“I just didn’t know how to explain what was happening, so it was easier for me to pick a fight with him about something stupid, like not packing the dishwasher properly, so that I didn't have to have sex,” she explains.

How do perimenopause and menopause affect your sex life?

While Megan’s experience is at the more severe end of the spectrum, Sexual Health Physician Dr Tonia Mezzini says it’s not uncommon for the menopause transition to disrupt sexual function and pleasure to some degree.

Perimenopause, the stage leading up to menopause, can cause see-sawing hormones, mood changes and body image issues that can all affect your libido and ability to enjoy sex. Approximately 10 to 15% of perimenopausal women experience a lack of sexual desire.

“Hormonal fluctuations and deficiencies can have a profound impact on a woman's wellbeing and energy levels,” says Dr Mezzini. “These changes can initially be subtle, and many other lifestyle factors contribute to these difficulties.”

Lower levels of oestrogen and testosterone can impact sleep patterns, energy levels, mental health and biological drives for intimacy, he adds.

Perimenopause, which usually begins in your 40s and can last up to 10 years, is when your ovaries start to run out of eggs. As a result, oestrogen levels fluctuate, causing physical, mental and emotional symptoms. Perimenopause finishes when you reach menopause, which is defined as the time of life when your menstrual cycle has officially stopped for a year. Most women in Australia reach menopause between the ages of 45 and 55.

Some of the perimenopause and menopause symptoms that can affect sexual function include:

• hormonal changes that decrease your ability to orgasm and enjoy sex
• mood changes, which can diminish interest in sex and include feelings of irritability, sadness, anxiety and depression
• tissue changes in the vagina caused by a drop in oestrogen, leading to dryness, irritation and painful sex
• bladder and pelvic floor challenges, including increased likelihood of urinary tract infections (UTIs) and continence problems
• body image issues, due to menopause-related weight gain or negative perceptions of the ageing process
• low energy, night sweats and hot flushes.

How do perimenopause and menopause affect your mental health?

The relationship between mental health, sexual function and perimenopause and menopause is complex. On the one hand, problems with sexual function can negatively impact your mood, self-esteem and quality of life. Poor mental health can also decrease your desire for sex.

In addition, your mental health can be affected by other pressures that typically increase during this life stage, explains Dr Lina Safro, GP and board member of the Australasian Menopause Society.

“Mood [changes] are usually hormonal but can also be a big mix of social things – being the ‘meat in the sandwich’ of caring teenagers and ageing parents, financial insecurity and trying to deal with menopause at work,” she says.

Dr Safro says it’s important not to ignore mental health struggles and think ‘it’s just menopause’. “When your mood changes and you can’t really explain it, it’s probably time to see the doctor.”

If you feel like your symptoms could be impacting your mental health, eligible HCF members^* can access a free annual telehealth HealthyMinds Check-in with a PSYCH2U psychologist.

Supporting your sex life

If perimenopause or menopause is affecting your sex life, Dr Safro says it’s important to see a doctor who specialises in this field. She recommends searching for doctors who are members of the Australasian Menopause Society and booking a longer appointment.

“You need someone who understands and validates your symptoms. Someone who wants to listen to you and try to sort out what it is,” she says. “Usually I find that by the time women come to see me, they’ve already had two or three unsuccessful attempts at finding someone who can actually explain to them what's going on and their options.”

As a result, she adds, they feel a bit disempowered and sick of the whole process. That’s why it's important to find a doctor you trust and open up to.

During a consultation, a healthcare professional might recommend any or all of the following options.

• Medications. These may include menopausal hormone therapy (MHT, formerly known as hormone replacement therapy) and certain antidepressants. “We know that hormones and neurotransmitters work together to keep our brains working well,” says Dr Mezzini.
• Medical interventions to manage symptoms. For example, certain creams to assist with irritation. “We’ve got excellent creams and pessaries for vaginal dryness, and they’re not being used as widely as they should be, especially post-menopause,” says Dr Safro.
• Lifestyle changes. These aim to improve your overall health. Dr Safro says limiting alcohol, maintaining physical activity and good sleep hygiene can be helpful. “Without any doubt, general fitness means better sexual function,” she says.
• Changing your mindset around sex. Focus on the quality, not the quantity, of intimacy, advises Dr Mezzini. Don’t forget about contraception, she adds. If your last period was before the age of 50, you need to continue using contraception until you haven’t had a period for 24 months. For women over the age of 50, you need contraception for 12 months. “See a family planning clinic, gynaecologist or GP with an interest in women’s health for advice on contraception,” she says.

Sex after menopause

Growing older doesn’t automatically mean sex becomes less important for some people. In fact, an Australian study suggests that 72% of Aussies older than 60 still maintain active sex lives.

However, as our bodies change as we age, especially during perimenopause, is important to speak to a health professional if you experience any pain or difficulties linked to sex. You may also want to speak to them about protection from STDs if you don’t have a long-term partner.

If you’re looking to improve your sex life, communicating openly with your partner about your perimenopause symptoms can be helpful. Together you can explore different forms of intimacy and consider relationship counselling if needed.

Helping relationships thrive during perimenopause and menopause

For Megan, a combination of treatments have helped ease her symptoms. While her sex life is still not what it was pre-perimenopause, one positive outcome has been a stronger bond with her husband.

“We’ve both worked really hard on communicating what we need and when, and how we are feeling and why,” she says. “He always says, ‘it’s not a problem, just so long as you let me know what’s going on, and we’re both on the same page, everything’s fine’. Having an empathetic and supportive partner has made these changes easier to navigate.”

Dr Mezzini says it can also be helpful to focus on the positive aspects of menopause, despite the challenges.

“Hopefully as we age we have learnt more about ourselves, what we need in terms of intimacy, and we can focus on pleasure and connection, rather than waiting for libido or a biological drive to influence our behaviour,” she says.

“It can be a time of grief and feelings of loss, but it’s really important that we challenge that narrative and see ‘the change of life’ as a time of liberation. We are wiser, more emotionally attuned and have so much more to offer and appreciate.”

How to thrive in perimenopause and menopause

The journey through perimenopause and menopause can be a challenging but also liberating time – physically, mentally and emotionally. In our Menopause Matters podcast, join host Alison Brahe-Daddo as she unpacks the experience of this life-changing yet entirely normal part of life.

In episode three, Menopause and your sex life: Reclaiming your relationship, Alison sheds light on issues faced by many women when it comes to menopause and sex, in particular keeping your relationship and sex life thriving while dealing with menopausal symptoms.