Perimenopause vs. Menopause
Perimenopause. What do you feel when you read that word? It’s something roughly half the population deals with, yet it remains, to an extent, shrouded in mystery. Whether you or your partner is anticipating—or undergoing—perimenopause (and menopause itself), it’s something everyone should know more about. Because, while perimenopause is a physical experience, it also affects your mental and emotional well-being.
And yes—it can impact your intimate life, too.
Part of that effect comes from a feeling of confusion, fear, and helplessness. Here’s the thing: You have options. While we can’t stop perimenopause or menopause, we can address it through a variety of different treatments, including therapy. And though your life may change, that change doesn’t have to permanently derail a happy, healthy sex life and relationship with your partner.
Perimenopause vs. Menopause: Here’s What You need to know
To recap some basics, let’s go over the differences between perimenopause and menopause. Menopause is the process through which a woman’s body permanently stops menstruating. Perimenopause is the period shortly before menopause. For most women, this process begins in their forties (though it can begin earlier or later). It’s a big deal, yes—but not everyone experiences it in the exact same way. Symptoms and their severity can range greatly, and there isn’t a way to precisely predict what will happen to any individual.
We break perimenopause into four different stages. These include:
Very early perimenopause transition.
Early transition.
Late transition.
Late perimenopause.
Below are some of the most common signs of perimenopause:
Heavier, inconsistent periods (which eventually cease entirely)
Weight gain
Brain fog
Fatigue
Vaginal dryness
Aches and pains
Hot flashes
Night sweats
You may also notice worsened PMS symptoms, mood swings, migraines, breast pain, new allergies, and a few other quirks. They can come and go. So yes—it’s hard to pin down what you should expect from perimenopause. But we do have an idea of how it can impact your intimate life and how we can help make the transition easier.
How Perimenopause Can Affect Your Sex Life
Like any big physical change, perimenopause can make a big difference in your sex life. People going through perimenopause might feel quite different about their bodies, and perhaps less sexy or in tune with themselves. Plus, many cultures treat perimenopause as a bad or shameful thing, rather than a normal part of life. It’s no wonder that women often report feeling like they’ve been “sexually retired” by the time they reach menopause.
Naturally, perimenopause and menopause can change your relationship with your partner. One survey indicated that 38% of spouses of menopausal women felt their relationships and sex lives had been affected by menopause. If you’re one of those partners, don’t beat yourself up. Both perimenopause and menopause may lower your other half’s sexual desire, and it’s normal for you to feel rejected or confused. But know that a hormonal shift doesn’t mean you aren’t wanted or loved. And it doesn’t mean any lull has to be permanent.
For that matter, not everyone is negatively affected by perimenopause. Some people find that the prospect of menopause removes a lot of pressure. Periods, PMS and pregnancy (which may bring mixed emotions for some) are in your rearview mirror. But nonetheless, you may need to reframe some of what society has told you about what menopause means, and those who have struggled with infertility may need to grieve not being able to conceive and birth children anymore.
Addressing Perimenopause and Menopause
You’ve probably heard about the medications used to treat the symptoms of perimenopause. These include hormone replacement therapies, birth control, antidepressants, and more. Methods like these can be effective in treating the physical symptoms of the process, and if you’re interested, you should speak to your physician.
However, not everyone is comfortable with these treatments—and even if you are, they won’t necessarily address the emotional consequences. No matter how good you feel, your body is changing, and you may need to adjust your approach to your relationship and intimacy. That’s why we recommend working with a sex therapist.
Recent studies suggest that intimacy issues during or after perimenopause are just as linked to your mental health as your physical experience—sometimes even more. Therefore, therapy can be hugely helpful for you and your partner, especially when you work with a sex therapist. Sex therapists have the experience necessary to zoom in on what’s affecting your relationship on a micro-level—and can offer strategies to help address those issues.
How Sex Therapy Can Help
Sex therapy addresses the psychological effects of perimenopause and menopause, not just for you, but for your relationship. You and your partner can talk about your concerns and learn how to develop new coping strategies, while strengthening your communication in a safe space. Your therapist can help you learn how to talk about things that frankly, many are told to keep quiet about.
At the same time, because a sex therapist is a specialized expert, you can work directly on improving your sex life. A sex therapist can provide guidance and suggested plans tailored to your specific needs.
Some of the strategies you may discuss with a sex therapist include:
The sensate focus or “touch” technique. Your therapist can offer advice about how to make touch fun and low-pressure again. Often, when a person experiences a lowered sex drive due to perimenopause and menopause, sex begins to feel high-pressure, and so do other types of intimacy including kissing and hugging. They may feel like they’re failing their partner, even if their partner understands in theory. The touch technique encourages sensual touching, which may at first exclude areas like the breasts and genitals. It’s about slowly making that intimacy appealing again, while communicating your desires verbally.
Trying new positions. This may seem obvious to some, but when you’re in a routine with your partner, it might be a little intimidating at first. Even with medication, people going through perimenopause might not love the sex positions or acts they once did. Fortunately, there are lots of alternatives for you to try—and it can be a ton of fun!
In Conclusion
Here's the good news: Many people report their sexual desire increasing after perimenopause and menopause. But that’s not the case for everyone, and even those that do have that increased desire often have to clear some hurdles first. Sex therapy can help you get there—ideally faster, and with fewer bumps along the road.
Perimenopause and menopause are both inevitable, but a dissatisfactory intimate relationship does not have to come with it. By being proactive, you can ensure that you and your partner come out of this with a stronger relationship than ever before.
Sources
Eden, K.J., Wylie, K.R. (2009). Quality of Sexual Life and Menopause. Women’s Health, 5(4), 385-396. https://journals.sagepub.com/doi/10.2217/WHE.09.24
Green, S.M., Furtado, M. (2021). Cognitive Behavioral Therapy for Sexual Concerns During Perimenopause: A Four Session Study Protocol. Frontiers in Global Women’s Health 2(744748). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593941/
Khalesi, Z.B., Jafarzadeh-Kenarsari, F., Mobarrez, Y.D., Abedinzade, M. (2020). The impact of menopause on sexual function in women and their spouses. African Health Sciences, 20(4), 1979-1984. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351832/
Ussher, J.M., Perz, J., Parton, C. (2015). Sex and the menopausal woman: A critical review and analysis. Feminine and Psychology 25(4), 449-469.
