Intimate Health and Sexual Wellness in Menopause

Your menopause journey begins long before your periods stop. Menopause itself is just one day - the final day of your last period, with the average age being 51. What comes before this is a longer, often misunderstood phase called perimenopause. This transition, which can start as early as your late 30s or early 40s, is when the most significant hormonal changes occur, often years before your periods end.

Understanding perimenopause is key. During this time, your menstrual cycle offers valuable insights into your fluctuating hormonal health, helping you prepare for and manage any symptoms that may arise during your menopause transition.

Your menstrual cycle is a powerful barometer of hormonal health. Irregular periods, heavier or lighter flows, and shorter or longer cycles are often early signs of perimenopause. These changes occur as the sex hormones oestrogen, progesterone, and testosterone start to fluctuate causing symptoms such as mood swings, disturbed sleep, anxiety, migraines, breast tenderness, or weight gain.

Tracking your cycle can help you spot patterns, giving you clarity and control over what’s happening in your body. By tuning into these changes, you can prepare for a smoother menopause transition.

Perimenopause is diagnosed based on age and symptoms - it cannot be confirmed with blood or hormone tests. If you’re over 37, still having regular cycles, and notice significant changes, it’s likely you’re in perimenopause. Symptoms may include:

• Noticeable changes to your periods: heavier bleeding, longer duration, or irregular flow
• Shorter menstrual cycles: periods arriving closer together
• Breast changes: tenderness, swelling, or lumps
• Sleep disruptions: waking in the night or very early
• Increased menstrual cramps
• Night sweats before your period
• Migraines: new or more frequent
• Mood swings: stronger or more frequent premenstrual changes
• Unexplained weight gain without lifestyle changes

Perimenopause is different from menopause because, during perimenopause, oestrogen levels can spike dramatically, whereas in menopause, oestrogen remains consistently low. This fluctuation is what makes perimenopause feel so hormonally chaotic.

In a regular menstrual cycle, oestrogen and progesterone work in harmony - oestrogen rises and falls at the right times, and progesterone steps in to balance the cycle. However, when you reach perimenopause this orderly rhythm begins to break down, leading to unpredictable patterns in your cycle and the onset of symptoms.

The good news? Being proactive and tracking your cycle and symptoms helps you make sense of this rollercoaster of hormonal highs and lows, giving you the insights you need to support yourself during this transition.

Perimenopause isn’t just about reproductive changes - it affects your overall health. Hormones influence everything from mood and energy to sleep and metabolism. Recognising these changes empowers you to take action.

This is a chance to reassess your lifestyle. Reducing stress, eating well, and staying active can help manage symptoms and create a positive foundation for ageing well. Working with your cycle allows you to better understand your body and feel more in tune with its needs.

Think of perimenopause as preparation. The habits you build now - prioritising rest, managing stress, staying active, and nourishing your body - can transform how you will experience your menopause transition. By taking small, consistent steps, you can lay the foundation for a healthy, fulfilling life post-menopause.

Your perimenopause journey is as unique as you are. By approaching this phase with awareness and self-compassion, it becomes an opportunity for positive change, empowerment, and self-discovery. Your body isn’t failing you - it’s evolving.

The power of touch can help to lower our stress levels, raise our feel-good hormones and provide us with a sense of safety, love and comfort. The following exercise helps you to connect with this, incorporating a little bit of breath, sound, movement and touch.

Setting up - start by taking a comfortable seat, feet flat on the floor, hands resting on your lap. Take a moment to notice how your feet are supported by the ground. Notice your hands, if you're holding any tension allow your hands to soften and open.

Dropping-in breaths - turn your gaze inwards and notice your breath without changing it in any way, before taking three dropping-in breaths. This is where you inhale in through the nose and then exhale slowly through the mouth. On the third exhale, try making a long sighing sound.

Awakening the body - next, join the palms together and rub them to generate warmth and energy in the hands. Slowly separate your hands and hover them just above your body, palms facing down, moving slowly from the face all the way down to the legs.

Flowing touch - take your fingertips and gently caress your skin like a painter's brush, along the arm, the armpit and the chest. Switch hands and do the other side. You can even do this along the face and down your whole body, moving in slow, flowing motions.

Grounding touch - take your hands and contour different parts of your body, using firm, grounding motions such as squeezing the arms and pressing gently on the chest. Pause in a particular area that may feel good.

Fiery touch - take the pads of your fingers again and tap the inner parts of your arms, the jawline and different parts of the body, wherever you're called to. As you bring your practice to a close, introduce a gentle swaying of the torso, maybe enjoy a stretch or shake out, before then coming to a pause and noticing how your body feels.

Affecting around 55% of women during or after the menopause, vaginal dryness (also referred to as the genitourinary syndrome of the menopause or GSM), is a symptom not often spoken out. Finding the right words, sharing information about treatments, and banishing embarrassment from the conversation, are the first steps to successfully managing the condition. So, let's talk.

Symptoms of vaginal dryness can occur during the perimenopause, menopause and post-menopause, however unlike other symptoms that tend to ease as you go through the transition, the genitourinary symptoms will not get better with time. In fact, they may get worse as you get older.

Caused by declining oestrogen levels, the tissues around the vagina, vulva and urinary tract become thinner and weaker and therefore more prone to infection and sensitivity. Signs you're suffering from GSM could include the skin in the area feeling dry, sore, red and itchy, you may find that sex is painful and that tiny paper-like cuts develop on the vulva. You might also notice increased frequency and urgency to pass urine and recurrent urinary tract infections.

The main treatment option for vaginal dryness is local oestrogen, which gives tiny amounts of oestrogen directly where it is needed, plumping out the tissues and reducing the risk of infection. It comes in many forms, including gels, creams, pessaries or a soft silicone ring, so it is important to work with your GP to find what works for you.

Other measures you can take to help reduce some of the effects of vaginal dryness include external vaginal moisturisers or oils, says menopause specialist Dr Shahzadi Harper, who runs The Harper Clinic in Harley Street, London. ‘Apply it not just on the vagina but to the vulva also and all the way back towards the perineum', she advises.

Anita Beardsley, a nutritional therapist in Bristol, recommends adding fermented foods to your diet such as kimchi, as well as prebiotic foods like onions, garlic and leeks to support the lactobacillus ‘good bacteria’ in the vagina. In addition, aim for two dessert spoons of ground flaxseeds a day for optimising oestrogen, and include plenty of zinc-rich foods and a sea buckthorn oil supplement for tissue integrity.

She admits that it, ‘can be overwhelming to make changes to your diet,’ but advises women to ‘take small steps, do the best you can and seek professional advice.’

Symptoms of the menopausal journey, family and work pressures, and the shame of talking about sex, often combine to shut down intimacy in midlife. If this sounds familiar, you're not alone. A study led by Professor Susan Davis revealed that reports of low libido and associated distress jumped from 24% for 35-39-year-olds, to 33.4% for 40-44-year olds, staying above 30%, until falling post-65.

If our libido goes AWOL at this stage, it doesn't occur to us to fight for it either and this is a loss in so many ways, the physical and mental benefits of sex being big ones.

Firstly, realise you have the power to start to change the situation. Our libido and experience of sex come from a wide bio-psycho-social picture – not only our hormones. Our overall health and self-care, beliefs about sex, knowledge of how arousal works, knowledge of our own body and what we need, and how we communicate, are just as important.

Having said that, a trip to the GP or medical specialist is a wise step. Don't be shy to report problems with sex. There are a range of options which can help. Consider your lifestyle overall too and practice self-care, prioritising having some private moments.

Upgrade your expectations of sex in midlife, taking yourself on an educational journey into sex science. What you learn about anatomy and how desire works can revolutionise your approach.

Then can come the trickiest bit – talking to your partner. Choose a private time when you are relaxed. Make the conversation about your shared sex life, what you used to appreciate about it, and how you’d like to get it back. Acknowledge if it’s embarrassing or uncomfortable to talk about. Share some of your favourite resources and let them know there is no rush to suddenly change. Reassure them this is a new journey of exploration you are on together.