How hormonal changes during perimenopause and menopause affect desire, relationships and sex

We need to talk about sex. Sex and intimacy, and how they can be impacted by the perimenopause and menopause, that is.

The menopausal transition can impact every area of a woman’s life, including her intimate relationships. Indeed, according to the findings of Menopause Dialogues - The Census, a survey carried out by CanesMeno¹, the impact of perimenopause and menopause extends to women’s sex lives, with over one-third (38%) of all affected women reporting a negative impact, making this one of the most significant, yet under-discussed, consequences of midlife hormonal change.

Navigating changes in libido, vaginal dryness, confidence and body image can be challenging for women. Talking about those changes can be difficult, too. Dr Louise Fitzgerald, a Dublin GP with a special interest in menopause, has found that in her menopause clinics many women report to “just putting up” with sex that is uncomfortable or even painful.

Sexual discomfort is a very common impact of the menopausal transition, and a subject, in Dr Fitzgerald’s view, that merits a more open conversation. “In my experience many women feel that sexual wellbeing is a taboo subject, or they fail to see the link between intimacy issues and the menopause,” she says.

Menopause Dialogues – The Census revealed that 46%¹ of menopausal women surveyed reported a negative impact on their sex lives, with factors including loss of libido, hot flushes, night sweats, anxiety and fatigue cited as contributing factors.¹ “And then there is the issue of vaginal dryness, which can lead to a lot of discomfort,” says Dr Fitzgerald. “It’s understandable that women’s interest in sexual intimacy would decrease when they face the prospect of genuine discomfort.”

The GP explains there is a firm biological basis for these changes. “In perimenopause, oestrogen is fluctuating,” she says. “So oestrogen might drop before we have our period, and then after menopause, the oestrogen drops down to a very low level.” Vaginas are “very sensitive”, she says, to these fluctuations.

“As oestrogen levels drop the tissue in the vagina can become thinner, less elastic, and often very dry, so that’s what gives you this discomfort during sex, such as the burning and irritation,” explains Dr Fitzgerald. “Under a microscope, you can see these changes in the architecture of the vagina.

“What I frequently see is our nurses picking up these signs during a smear test,” Dr Fitzgerald says. “They’ll notice this vaginal atrophy, which is the medical term for the drying of the vagina and the thinning of the vagina.”

Despite more open conversations on the reality of midlife hormonal changes, menopause can be an isolating time, Dr Fitzgerald believes, and particularly so when it comes to issues of sex and intimacy. Accurate information and empathetic support are essential, she says.

Canesten has developed CanesMeno Hydration & Comfort Gel for fast relief from vaginal atrophy symptoms such as dryness, burning and itching with long-lasting effect for up to five days. The gel helps to reduce pain experienced during sexual intercourse and helps to maintain the pH balance inside the vagina. It has also created the CanesMeno Hub, a free digital resource including a comprehensive library of articles that aim to answer the most frequently asked questions about menopause.

Dr Fitzgerald is happy to signpost her patients towards the CanesMeno Hub as a useful source of information for questions that may arise at the onset of perimenopause, to menopause and beyond.

“One of the CanesMeno philosophies is to have trusted information for women as they navigate their way through this phase and the stage of their life, but particularly around intimate health and intimacy,” she says.

“Of course, having a GP with whom you can discuss these hormonal changes is fundamentally important, while a local pharmacist is another source of advice,” she says. The CanesMeno range including food supplements is available from pharmacies only, nationwide in Ireland.

Dr Fitzgerald urges women to mention any and all symptoms to their GP, without shame or embarrassment. “It’s really important that we’re discussing signs of perimenopause and menopause, and it’s important that women volunteer their experiences,” she says. “It’s important as GPs that we are asking women about it as well, and we’re asking them if they are having any problems with vaginal signs. And the follow-on to that is how we address that.”

The good news is that there are plenty of options that are easily accessible and can make a huge difference. “In terms of vaginal dryness and making sex more comfortable, I can recommend CanesMeno Hydration Comfort Gel,” Dr Fitzgerald says. “It’s designed by Canesten, which is a brand that’s very familiar to us as it’s Ireland’s number one women’s intimate health brand*. Crucially, the gel complements systemic hormone replacement therapy without interfering with it, she notes.

¹ Research conducted by Empathy Research on behalf of Canesten, August 2025. n=279 (perimenopausal n=87, menopausal n=65, postmenopausal n=127).

CanesMeno products are available in pharmacies nationwide and the CanesMeno Hub is completely free to access here

*To verify, please contact info.ireland@bayer.com.

CanesMeno Hydration and Comfort Gel is a medical device. The CanesMeno Hub provides education on menopause, it is not intended to be a substitute for advice from a doctor and it is not a diagnostic tool