Menopause and intimacy: managing dryness, desire and changes
Quick answer
Falling hormone levels around perimenopause and menopause can cause vaginal dryness, discomfort during sex, lower desire, poor sleep and mood changes. These effects are common and treatable: options include lubricants, vaginal moisturisers, local vaginal oestrogen and hormone replacement therapy (HRT). Contraception is still needed for a time after periods stop.
Key points
- Menopause usually happens between 45 and 55, and perimenopause symptoms can begin several years before periods stop.
- Vaginal dryness and discomfort are common and, unlike hot flushes, often do not improve on their own without treatment.
- Lubricants, vaginal moisturisers, local vaginal oestrogen and HRT can all help; a clinician can advise what suits you.
- Tiredness, poor sleep and low mood can affect desire as much as physical changes do.
- Pregnancy is still possible in perimenopause, so keep using contraception until a clinician advises you can stop.
What are perimenopause and menopause?
Menopause is when periods stop for good because the ovaries no longer release eggs and produce much less oestrogen. It is confirmed once you have had no periods for 12 months. Perimenopause is the time leading up to it, when hormone levels fluctuate and periods often become irregular. This stage can last several years.
Most people reach menopause between the ages of 45 and 55. It can happen earlier, either naturally or because of surgery or some cancer treatments. Trans men and non-binary people who have ovaries can also experience perimenopause and menopause.
How can menopause affect sex and intimacy?
Changes in hormones affect people differently. Some notice very little change in their sex life, while others find intimacy harder for a while. Common effects include:
- Vaginal dryness, itching or soreness, because lower oestrogen makes vaginal tissues thinner and less elastic.
- Discomfort or pain during sex, which can in turn reduce interest in sex.
- Lower desire, sometimes linked to hormonal changes and sometimes to tiredness or stress.
- Poor sleep caused by night sweats, which can leave you exhausted.
- Mood changes, anxiety or low mood, and changes in how you feel about your body.
- More frequent urinary tract infections or needing to pass urine more urgently.
What options might a clinician discuss?
Several effective treatments are available, and you can use more than one. A GP, practice nurse or menopause specialist can help you weigh up the benefits and risks for your own health history.
- Lubricants, used during sex to reduce friction and discomfort. Water-based and silicone-based products are widely available.
- Vaginal moisturisers, used regularly (not only around sex) to keep tissues more comfortable day to day.
- Local vaginal oestrogen, available as creams, gels, tablets or a ring. It acts mainly on the vaginal tissues and very little is absorbed into the rest of the body.
- Hormone replacement therapy (HRT), which replaces oestrogen throughout the body and can ease hot flushes, sleep problems and mood symptoms as well as dryness.
- Talking therapies such as cognitive behavioural therapy, which can help with low mood, anxiety and some menopause symptoms.
Do you still need contraception around menopause?
Yes. Fertility falls during perimenopause, but pregnancy is still possible while periods continue, even if they are irregular. NHS guidance is to keep using contraception until two years after your last period if you are under 50, or one year after your last period if you are 50 or over.
Some hormonal methods can stop periods or mask the signs of menopause, which makes it harder to know when you can stop. Ask a clinician for advice before stopping. Remember that contraception does not protect against STIs, so condoms are still important with a new partner.
How can couples stay close through menopause?
Talking openly about what has changed, what feels comfortable and what you each need can reduce worry on both sides. Intimacy does not have to mean penetrative sex; touch, affection and time together all matter.
If low mood, anxiety or relationship strain is building up, counselling or psychosexual therapy can help. If you ever feel unable to cope or unsafe, contact your GP, a mental health crisis line or emergency services straight away.
When to see a doctor
- See a doctor promptly if you have any vaginal bleeding after menopause (12 months or more after your last period).
- Get help straight away if you have thoughts of harming yourself or feel unable to cope.
- Book a GP appointment if menopause symptoms are affecting your daily life, sleep, mood or relationship.
- Ask for advice if dryness or pain continues despite using over-the-counter lubricants or moisturisers.
Frequently asked questions
Does vaginal dryness after menopause go away on its own?
Often it does not. Unlike hot flushes, which tend to ease over time, vaginal dryness linked to lower oestrogen can continue or gradually worsen. The good news is that treatments such as vaginal moisturisers and local vaginal oestrogen work well for many people, and they can usually be used long term under a clinician's guidance.
Is local vaginal oestrogen the same as HRT?
Not quite. Local vaginal oestrogen is applied directly to the vagina in a low dose and acts mainly on the tissues there, with very little reaching the rest of the body. HRT works throughout the body and treats a wider range of symptoms. Some people use one, some use both. A clinician can explain which is suitable for you.
When can I stop using contraception during menopause?
NHS guidance is to continue contraception until two years after your last period if you are under 50, or one year after your last period if you are 50 or older. Because some hormonal methods affect periods, it can be hard to tell when this point is reached, so speak to a clinician before stopping.