By the age of 40, women enter a perimenopausal stage. Periods may start to become more erratic, may become longer or heavier, or lighter and shorter. A woman can be perimenopausal for a number of years (2-8), still remain fertile until her periods finally stop. After one year has passed with no periods this is known as the menopause. The average age in the UK for women to reach menopause is 51.
So what does the perimenopause and menopause mean in terms of psychological, hormonal and physical changes and can you relate to any of them? Here is a brief summary...
Hormonal: About one year prior to menopause, estrogen (oestrogen) levels drop. During perimenopause progesterone levels reduce too and there may be a slow decline in testosterone levels.
Psychological: Many women experience a decrease in sex drive during perimenopause but this isn't directly related to hormones. It is more to do with mid life often becoming a period of reflection of their lives, relationships and sexuality. If there are unresolved issues or unmet needs in their lives then this can affect libido until steps are taken to make changes. Female sexual desire has a much wider context and deserves an article in its own right. Suffice to say that many women (regardless of age) don't experience spontaneous sexual desire but desire may be a follow on response to a partner's advance, in the right setting when they feel emotionally connected and aroused. Feeling sexual as a woman therefore often involves the heart, body and mind and is not just about physical connection with a partner.
Going back to the menopause - feeling sexual can also be more about self perception. If a woman has a misconception that her sexy years are over because she has reached menopause and no longer views herself as desirable/attractive or is too old to have sex, this limiting belief will affect her sex drive, body image and self esteem. Sometimes it is worth thinking about where these messages have come from. Many women continue to be sexually active in their sixties, seventies and even eighties.
Physical: Estrogen levels can cause changes in nerve function and can numb body parts that previously were sensitive e.g. the vagina. Changes in blood circulation may slow down arousal when stimulated which means it may take longer to reach orgasm. Both progesterone and estrogen are important for maintaining a healthy collagen layer in the skin. What is noticed is reduced lubrication (vaginal dryness) during sexual arousal and a thinning/shrinkage of the vaginal and urethal tissue. Both of these factors can lead to painful sex unless a woman is fully aroused or adequately lubricated. Taking the focus off penetrative sex and enjoying caressing and manual stimulation will help as well as using a lubricant which can be purchased from supermarkets, pharmacists etc. There are other products such as 'Replens' which is a longer lasting vaginal moisturiser than you can get on prescription or from your pharmacy.
Other common symptoms that can happen during perimenopause and for an average of 4 years post menopause include hot flushes, night sweats, difficulty sleeping and mood changes (low mood/anxiety).
For more information
- Speak to your GP
- 'The Wisdom of the Menopause' by Christine Northup
- NHS Choices website
To gain help with sexual difficulties please arrange an appointment with Yvette at Sexual Wellbeing UK