‘I still love sex’: Menopause, desire and finding fulfilment in midlife

For Martha Mok, leaving a relationship after almost two decades, at 40 years old, heralded a new period of sexual freedom in her life.

Mok’s ex-husband was the first and only man she had ever been with.

But this new era for the Sydney-based professional make-up artist, now 47, coincided with another pivotal shift in many women’s lives: the menopause.

How menopause can affect sex

Menopause, and the decades that follow it, are commonly thought of as a transition leading to a lower libido and the end of sex.

Professor Susan Davis AO, head of the Monash University Women’s Health Research Program, says some of the symptoms that come with hormonal changes during menopause, like hot flushes, poor sleep and night sweats, can affect desire.

Genitourinary syndrome, a manifestation of the changes that come with menopause including vaginal dryness, thinning of the vulval skin and vaginal shortening and narrowing, is also common and can have a direct impact on sexual function.

A Monash University-led study of more than 5500 women, published in July, found moderate to severe vasomotor symptoms (such as hot flushes and night sweats) and moderate to severe vaginal dryness to be the “most defining symptom[s] of perimenopause”, being five and 2½ times more prevalent respectively compared with premenopause.

Indeed, low desire is common during this time, with 30 to 50 per cent of women experiencing sexual difficulty post-menopause, which can adversely impact their intimate relationships, wellbeing, social functioning and overall quality of life.

However, Davis says the idea of changing testosterone levels during menopause, often attributed to changes in libido, is a “widespread misconception”.

“Testosterone blood levels do not change at menopause, they change with age,” she says.

“If there are changes in sexual function, they are either related to women feeling horrible because of all the symptoms, or because of the change in oestrogen and that having effects in the brain.”

Does libido decrease with age?

Today, more conversations around ageing, menopause and sex are being had, in part fuelled by popular and celebrity culture.

Miranda July’s 2024 novel All Fours followed a perimenopausal woman who embarks on an extramarital affair. Gillian Anderson has opened up about a “whole new world of pleasure” after menopause, while earlier this month, 50-year-old Charlize Theron spoke about finding greater sexual freedom in her 40s and dating much younger men.

A landmark study from 2007 found that while sexual activity tends to decrease with age, libido does not.

Clinical psychosexual therapist Jacqueline Hellyer believes the idea of sexual decline with age is a myth, and that it’s impossible to paint all humans with the same brush.

“You can’t really say how it [menopause] is going to affect people. Like pregnancy, some women don’t have sex at all, and for others it’s the horniest time of their life. It’s really, really varied.”

Hellyer thinks the reason some women may experience low libido during and after menopause has more to do with social rather than physiological conditions.

“When you think about what women are experiencing in our culture once they’re getting into their late 40s and 50s, it’s normally a time of enormous pressure,” she says.

“You’ve got teenagers, you’re peaking in your career, you still owe money on your mortgage. There can be an awful lot of stress there.”

In her two decades of working with couples, Hellyer finds it’s often men, not women, who tend to lose interest in sex with age.

‘When you think about what women are experiencing in our culture once they’re getting into their late 40s and 50s, it’s normally a time of enormous pressure.’

Clinical psychosexual therapist Jacqueline Hellyer

Mok, who went through menopause at 42, is now in a happy relationship. The director of the Yeah the Girls 40 Plus community, she says sex has only got better with age.

“I still love sex,” she says, attributing a healthy post-menopause sex life to the effort she and her partner put into their relationship.

“A lot of women at our age, they’re just too tired, too frustrated, constantly asking for things that they don’t see returned, and they lose that fun in them. And that’s why it’s affecting their sex life and intimacy,” she says.

“That is one of the biggest things in my current relationship. We constantly remind each other of the love we have and the fun we had when we met.”

Davis says that “sexual self-image is really important for women” and, for some, physical changes that come with menopause and ageing can be difficult.

Trisha Avery, a business performance coach from Melbourne, went through clinical menopause in her 30s following a hysterectomy.

While she says the procedure, a relatively rare one at the time, was traumatic, it did little to affect her libido.

“I was young, and because my frame of reference wasn’t necessarily that I was needing to be sexually inactive or had lost my sensuality, it really didn’t matter at that time,” she says.

Now in her 60s, Avery, who is single, continues to enjoy an active sex life. But she says her understanding of sexuality has evolved with age.

“I would have talked about myself as sexual when I was younger. I never use that term any more. I like to talk about myself as a sensual being, as well as many other things,” she says.

“Once past menopause, the sensuality of your body, of your ability to find ways of creating feelings of pleasure and having an orgasm, masturbating, being with somebody, is different.”

For Avery, sensuality over sexuality can mean exploring different forms of intimacy.

“You’re just not as athletic as you used to be. And also because of things like vaginal dryness and the differences in men in terms of their capacity to maintain erections and other things, it’s a slower build, if you like. There are more important things than penetrative sex,” she says.

Fostering wellbeing

A small but growing body of research is looking at the importance of sex not just for pleasure but wellbeing.

Some studies suggest sex or masturbation can mitigate symptoms of menopause.

The findings of a 2025 study of Japanese women, published in Menopause, revealed an association between regular sexual activity and a lower prevalence of genitourinary symptoms during menopause like vulvar pain, dryness and arousal.

Similarly, in a 2024 survey from The Kinsey Institute funded by sexual wellness brand Womanizer, 36.2 per cent of menopausal women reported experiencing improved symptoms through masturbation.

But Davis warns such studies were not able to show a causative relationship, or the direction of the relationship.

“You’d have to do a double-blind, randomised trial to prove this,” she says.

Still, Davis says sexual dissatisfaction has been associated with lower wellbeing in women.

For Mok, a fulfilling sex life and happy relationship has been key to alleviating many of the transition’s most uncomfortable symptoms.

“Before I met Malcolm I had really bad mood swings and hot flushes … but after, these symptoms went away, because I’m happy. We have a really good relationship. We communicate, we support each other, and my symptoms really went down.”

Mok thinks the dopamine release she gets from cuddling, kissing and sex play a role in this, too.

Dr Suzanne Belton, a medical anthropologist at Flinders University with a research interest in sexual and reproductive health, points out the medical approach to menopause and sex tends to stop at making intimacy more comfortable.

“This is basically the discourse I hear when I read the medical stuff, which is, ‘if we can make it less painful for you, maybe you’ll want to do it [have sex]’. That’s the bare minimum. Actually, what we would really like is to have orgasms at the same rate as blokes: sexual equality.”

How to have better sex during and after menopause

For some people, medical treatments (such as hormone replacement therapies, including vaginal oestrogen) can help alleviate symptoms that affect sexual function, says Davis. But there is no one-size-fits-all approach.

“If you’re getting hot flushes, no sleep and low mood and vaginal dryness, go and talk to a doctor and get your symptoms treated because if you’re feeling like rubbish you won’t feel like sex,” she says.

Testosterone therapy can also be useful for those for whom oestrogen therapy is not effective, says Davis.

Finally, Davis encourages having open conversations with your partner about the changes you’re experiencing.

“What can go wrong here is that the woman is feeling terrible, experiencing symptoms, and doesn’t explain that their withdrawal from sex is not related to their lack of affection for their partner … A lot of relationships fall apart because the partner feels rejected.”

Hellyer recommends moving towards a “responsive type of arousal”, rather than waiting until the mood strikes, which she thinks happens less as we age

Finding time to create intimacy, rather than focusing on the act of sex itself, can remove pressure from the situation.

“We should be focusing on the conditions that couples need in order to feel that level of connection with each other,” she says.

National Sexual Assault, Domestic Family Violence Counselling Service 1800RESPECT

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