Nowhere To Hide: What Perimenopause Reveals About Intimacy That Nobody Talks About
While I’m primarily speaking to heterosexual dynamics in this piece, many of these patterns discussed can show up across different types of relationships. I used AI to help me with structure but all words are my own.
In perimenopause, the physiological, mental, emotional, energetic changes that we go through impact our desire and arousal. Very broadly speaking, this happens in two main ways…
Over time, perimenopause releases the parts of you that have held you back from having your needs met, so you’re able to be open about what you want and ask directly for it with no qualms about making demands and putting your needs first. You’re able to hold your boundaries, and care less about what others think. The wild, fierce part of you who has been suppressed is unleashed so you no longer give a damn and want to have a good time—and you go for it. This is the reason why many women say that they have a sexual awakening in midlife.
For whatever reasons (there are some below) this doesn’t happen and desire and sexual enjoyment limps along or drops away, leaving women experiencing unsatisfying - often very painful sex - that does nothing for them. Many, many women are in this position, and this is what I’m talking about in this blog.
Of course, it’s not as clear cut as this and there’ll be plenty of you having sex that sits somewhere between the two. But others really are not. For them it's got stale, formulaic, too quick, and something like a box-ticking exercise—wholly unexciting, maybe for partners too.
Let me be clear: this is not a partner-bashing blog piece. It’s not anyone’s fault. There are a multitude of factors; not wanting to offend, and not having the language to communicate this issue being at the heart of it.
Still, the fact is that many women feel somewhat hopeless and stuck, and stuff their naturally wild, sensuous and erotic potential in a sealed box, shoving it under the bed or somewhere hard to reach, and resigning themselves to the status quo. They may question if this is really the best sex they’ll get to experience (maybe while knowing, on some level, that there could be so much more). They wonder whether should they leave their partners and look elsewhere for the depth of intimacy their soul craves, or stay put and suck it up (some often do leave, such is the cost of settling). They wonder what delights they are missing out on, and reminisce about the sex they’ve had in the past—or they indulge in impossible, but deeply erotic, fantasies to keep them going.
The sex that many women tend to have is not aligned with how female desire and pleasure works.
When our sex drive and libido slows down or disappears altogether (remember, very often it doesn’t and women find the absolute opposite), so often the focus is on testosterone. In online forums this tends to be the only solution (tackling the real problem is an effort, and applying testosterone cream is so much easier). And testosterone can help with drive and mood. But we're too hasty to focus on that as the sole intervention. Again, there are multiple factors that play into desire - but how good sex is, is a big, fat major one which isn’t discussed enough.
Many women realise that sex isn’t fulfilling and enjoyable, but they’re not clear why.
Before the solutions, here’s some acknowledgment of the complexity of desire in midlife, and how perimenopause can be a perfect storm:
The drop in oestrogen changes the environment in the vagina so that for many, intercourse becomes incredibly painful. Not sexy.
Even in a loving relationship, it may feel too harsh or difficult to reveal that you’re not enjoying sex; it’s tough, without professional guidance, to find the words to express this safely and respectfully (to you both). We’re also conditioned to be agreeable, to not make a fuss, or place demands, or ask for much, and keep everyone else happy and smooth things over - so revealing that sex isn’t doing it for you, or taking the lead or asking for something specific, may feel way too scary and awkward. It may feel too vulnerable.
Perimenopause, which happens through our 40’s, is a pinch point for multiple sources of life stress. Ageing parents, careers in full flush, young children to care for, teenagers pushing the boundaries; for these demands the onus is usually on us. If you’ve got too much going on, your physiology will work against you (cortisol is a major dampener of sex drive), and make it much harder to respond and feel erotic. Especially when there isn’t enough time to warm up. It’s tricky to feel open to an intimate exchange when you’re run ragged and, when your capacity is zilch, how do you engage in the erotic depth you want?
Similarly, in long-term relationships, it’s typical for excitement to fade and the effort it takes to keep an intimate relationship charged can get subsumed by the pressures of life when other priorities seem more immediate - for both partners.
Not only are there multiple sources of stress, but as progesterone falls, the buffer to those stresses declines too (buffering being one of progesterone’s major benefits), so the effects of the stress lands more heavily, which can leave us feeling frazzled and overwhelmed in situations we could manage well before. Again, how sexy can you feel when you’re an anxious mess?
Maybe related to both these points: you’re probably the one who does the invisible work at home, and are the emotional regulator of the family. Female desire needs space and time to open and expand. When the emotional load is too much, where is the space, time, and bandwidth to nurture your desires and be open to sex?
As your hormones are changing, so too is your body. Wrinkles develop, maybe there’s a little extra weight, you could be less toned and fit, and possibly beginning to droop or wobble in places you wish you weren’t. You may not feel nearly as attractive as your body evolves—which is especially challenging when our whole lives the pressure has been to be attractive and youthful, for as long as possible. So it feels as if that’s slipping through our fingers and we’re going to be invisible, passed over and even less than. Very scary, hardly sexy.
And a big one, again with our body changing in function; it can be difficult to sleep well so you might be extremely fatigued. Often IBS kicks in or get worse, you may develop headaches or migraines, bones may ache, you may have hot flushes. Your periods may come every 3 weeks or be especially heavy, or you may be getting infections such as thrush or UTIs which make sex painful or difficult. Again, being bloated and gassy, or constipated, or aching, very much is not a turn on. (If you are experiencing any of these btw, you need to come and see me.)
Through perimenopause, increasingly there will be months when you don’t ovulate, and when you stop ovulating altogether. So there are fewer and fewer opportunities to benefit from that natural uptick in arousal and interest which so often peaks mid-cycle.
Another big one: even if you’re not in a long-term relationship, the dynamics between a couple can stagnate. Life is busy and we have to make an effort to talk, be interested in each others lives, ambitions, ideas, support each other through problems and grow as a couple; tend to the union and stoke the closeness that is not directly related to sex, but is so important for it. If this isn’t happening, or isn’t being reciprocated, why would you open up and feel vulnerable? You wouldn’t.
Equally, many women find that they’ve reached the limit with the acquiescing, putting the needs and feelings of others above their own, staying small and agreeable, and not rocking the boat, and make it known clearly, with words or actions, or, lash out, no longer able to put up with the bullshit. This may precipitate the sexual awakening mentioned at the beginning. Or, they may shut down and stop caring. The rage and lashing out is not only scary for many women (who has a healthy female role model for expressing rage, anyone?), but can be extremely shame- and guilt-inducing, given the conditioning I mentioned. And of course your partner may not understand this, and it impacts your relationship dynamics. Plus, it risks being labelled as ‘too much’. Sexy? Nope.
Perimenopause, for many women, is a time of major identity shift. The result of declining oestrogen and progesterone is that we see things more clearly; the accommodating veil from hormones is lifted. This can leave us feeling exposed, vulnerable, rage-full, weepy, questioning who we are and everything in between. This may lead to some women being more open to experiment as they play with who they are becoming. Others need safety, trust and emotional intimacy—which they may not be getting because few partners, who are not either also going through it or have gone through it, may understand.
Though it’s complicated and nuanced, the truth still stands - sex must evolve to stay enjoyable.
If the sex isn't good, if it isn’t evolving and refining and as a woman you're struggling with desire, in perimenopause there is nowhere to hide.
Perimenopause is a truth teller. It's no longer possible to go through the motions on autopilot, or go along with it as always, and expect the body to respond and people please to keep a partner happy.
The trouble is, so much of what we think of as 'normal' sex is outcome focused and porn informed - which isn't what tends to create desire for women. Let's call it goal-oriented sex.
In perimenopause, and I may be speaking for too many here - we're all different - what becomes so important for female desire is the quality of the experience. That means slowing down, being 100% present and intentional in each moment. Taking your time creates charge. We LOVE erotic charge. It creates emotional and erotic depth, and opens up levels of arousal and pleasure that goal-oriented sex simply cannot access. It’s about a more feminine way of lovemaking - meandering and dwelling in sensation.
Crucially, this benefits both of you—this is not swapping the centring of one sex for the other here. Let's call it experience-oriented pleasure and it’s expansive, for both of you. As I understand it, Tantra epitomises this. So if it's a kiss, make it a truly stomach-flipping one. If it's stroking, make it super sensual.
Slowing down really is so important. Most women exist in caring, mothering, over-giving modes for so many hours of the day, and it takes time and space to switch into lover mode.
Remember that perimenopause doesn't signal the end of your sexual potential - there are endless accounts from older women about how liberating, enjoyable and free it can be, without the bother of periods, without the chance of pregnancy. You can expect fabulous sex in your 80's; it’s entirely possible.
If this piece resonates with you, know that perimenopause is an opportunity. It can get better - so much better. Here’s how…
You can expect to have sex that fulfils and excites you. Slow, sensual, erotic and expansive sex - or sex that you love, doesn’t have to be a dream; it really is possible, even though it may feel somewhat hard to reach.
The ingredients to that shift include:
If vaginal changes like pain, thinness and dryness are an issue for you, speak to your doctor and consider vaginal oestrogen pessaries, which can make all the difference. And use a good lubricant (see below).
Build up your strength and capacity, for your own benefit of course but also because for the vast majority it’ll be up to us to trigger the change. It has to be - it comes down to our power having been suppressed (see patriarchal/capitalist context) so it’s up to us to take it back, and enjoy the satisfaction, self esteem, and power from having done that. But this may take a little effort and you have to have gas in the tank for that. So:
Commit to time out; time alone to recharge and remember what being you feels like
Jettison anything non essential that drains your energy—and delegate your chores
Make sure you’re seeing your friends and people who fill you up and make you laugh, i.e. find ways to play in other, non-sexual, ways
Get help improving your sleep, digestion, recurring infections, and/or diet if physical symptoms are also draining you
Make having some daily rest - even for 15 minutes - a non-negotiable. It sets a good standard for children, and works wonders for your strength. This isn’t lying on your bed and scrolling, messaging or watching anything. It’s listening to music or a guided meditation, or just practicing some belly breathing.
Do some exercise that you enjoy and make you feel good. I can’t recommend weight training more. The increased muscle boosts testosterone, which in turn boosts drive and energy, it’s awesome to feel strong as a woman, and you’ll be looking after your metabolic and bone health too. If you’re not sure, search for a female-only gym or sessions— they feel much more welcoming than an open, unisex gym.
My personal favourite way to build up my reserves is Traditional Chinese Medicine Acupuncture, a therapy that has helped so many of my clients to feel vital again.
Nurture your own desire, just for you and nobody else. Read erotica, indulge in fantasy, buy lingerie that you think is hot and you wear for yourself. You could start a daily orgasm practice to build that desire, get to know yourself and, because it might have changed, explore what you like - with lube.
Have an honest chat with your partner. This may be all that’s needed to kickstart the changes you need. Chances are that if you find a way to communicate clearly and kindly, frame it as needing to evolve as a couple now that your changing is body instead of apportioning blame, taking ownership where appropriate, and listen to them in turn, they will respond really positively. I’ve typed up some example phrases you can use, which you can find here soon.
Brush up on techniques and find out what new stuff might be going on that intrigues or excites you - at your pace. Explore Tantric sex, which is a slower form of lovemaking, that results in amplified connection, arousal, and increased pleasure - including even spiritual connection.
Get professional help if you’re struggling. There are plenty of people who have expertise in this area, and, personally I highly recommend Sarah Rose Bright.
What a partner can do:
Your perimenopausal lady has been told all her life that her value as a woman expires as her youth fades, so when her skin begins to wrinkle, and her body softens, she may struggle to feel attractive and desirable. You can really help her with this, even if she doesn’t openly have wobbles, by reflecting back to her the ways in which you find her attractive and sexy. Not in a performative, general way, like ‘you’re so gorgeous’, but in a genuine, specific way: what you love about her, what part of her body you love most and are turned on by, what you’d like to experience with her. Women love to feel your desire; as a woman, it is so hot to be wanted.
Read up about how women’s bodies work and what makes them tick. It’s easy to get stuck in a rut so brushing up on ideas and techniques, especially in a long-term relationship, is a great thing, so get curious about what pleasure-oriented sex means. And learn what works for her - it might have changed. After all, it’s about your evolution together, not about ‘fixing’ something broken.
Her readiness to feel open to sex is directly related to her capacity and bandwidth, so if you’re married or living together, own your responsibilities and don’t load her up unnecessarily. That means know when the bins go out, if you have kids when their PE days are, book your own dentist appointments, look for your own keys, check the dishwasher salt yourself, and take charge of your own diary.
On that note, with her body, mind and soul going through a major life change, she needs more space and time to herself - support her with that, help her carve out that time and protect it. Take a turn juggling the chaos of life so that she doesn’t have to all the time.
Show up for her in non-intimate ways. She is changing and refining - so too may her dreams, ambitions, priorities and opinions, so ask her about them; find out more about her inner world, share yours too, and nurture that connection between the two of you.
Be willing to slow down and take your time during sex, and prioritise her arousal and pleasure (if you aren’t already) and be open to the idea that this isn’t foreplay before the real thing, but the thing itself - and it can be very pleasurable for you, too. Remember that it can take time for a woman to switch from plate-spinning mode into lover mode.
If she is opening up and being vulnerable with you, hold that carefully (it can be terrifying to give feedback), and try not to take it as criticism or be defensive. Likewise, be open yourself, and share your own vulnerabilities - you’d be surprised what can happen when you do...
Resources
Luckily there are resources to help you in the discovery, re-awakening process, and these are just some of them.
OMGYES is a platform dedicated to the study - and sharing about - female pleasure. It’s full of videos and animations about how to do…all sorts of things. You pay once and have access to the library for life.
A good lubricant is absolutely essential, not optional. Check out YES WB, which is clean and won’t disrupt the delicate vaginal pH or microbiome.
Come as You Are, by Dr Emily Nagoski, is a great and validating guide to female sex drive.
Want: Sexual Fantasies by Anonymous, collected by Gillian Anderson. This is a collection of sexual fantasies from women around the world, an exploration of how women feel about sex when they can be totally free and anonymous - compelling and great for firing up arousal.
The Heart of Tantric Sex, by Diana Richardson, is a brilliant and accessible introduction to tantric sex.
Non-Violent Communication, by Dr Marshall B Rosenberg, is an excellent book for learning how to communicate effectively.
For gorgeous underwear for sparking your flame Understatement Underwear, Fleur Du Mal, Cosabella, Bravissimo.
Sexy and Gorgeous Flower Essence for Self Confidence by Saskia’s Flower Essences is surprisingly effective for helping you feel sexy, shine and feel good about yourself.
For those who are really into manifestation, and consciousness, check out Leanne Rose, a somatic psychotherapist who also channels the Galayla Collective, who is a wonderful guide in this area, and who has inspired so much for me personally.