Safe sex and menopause

Advice on contraception and preventing STIs

• Sex has health benefits, including relieving stress and improving mood and sleep
• Incidence of STIs in the over 45s is on the increase
• How to practice safe sex during perimenopause and menopause

Perimenopause and menopause can be a time of sexual liberation. You may be more experienced sexually, and if you have children, they may be growing up fast or have flown the nest altogether, so you may have more time.

Perhaps you have started a new relationship or are enjoying dating. It is really important to think about safe sex and using contraception to safeguard against sexually transmitted infections (STIs).

Here, we take a closer look at all things related to sex and perimenopause and menopause, including the benefits of a healthy sex life, tips on how to practice safe sex, plus advice on what to do if you suspect you have an STI.

RELATED: sex and the menopause: Samantha Evans and Dr Louise Newson

Why sex can be good for you

Sex is often misunderstood as having to be penetrative in nature or include a partner. However, sex is whatever gives you erotic sensual pleasure, with or without a partner, with or without intercourse or orgasm.

Sex has many benefits for your physical and mental health. It helps to relieve stress and improves mood, sleep and self-confidence. As well as this it can improve your immune function, is a form of physical exercise and can help in creating and maintaining intimacy in relationships.

How perimenopause and menopause can impact your sex life

The hormones oestradiol (oestrogen) and testosterone are both important for your sex drive (also known as libido).

The amount of these hormones produced by your body declines during perimenopause and menopause and with increasing age, and this can lead to changes such as low libido, reduced arousal and difficultly achieving orgasm.

RELATED: How does menopause affect my sex drive?

A lack of hormones can also lead to changes in your vulva and vagina, making the tissue thin and more sensitive. As a result, you may experience dryness, discomfort, itchiness and pain during sex. Some women also have recurrent urinary tract infections or cystitis after sex.

RELATED: Vaginal dryness: why you don’t need to suffer

In addition, the impact of low hormones can lead to other symptoms, including hot flushes and night sweats, poor sleep and fatigue, headaches, low mood and irritability, plus joint and muscle aches and pains, which can all reduce your desire for sex.

Low libido and vaginal dryness: how can I tackle these symptoms?

Hormone replacement therapy (HRT) is the first-line treatment to replace hormones, ease symptoms and improve your libido too. Some women may also need to take testosterone replacement to help their libido and other symptoms such as mood, energy and joint pains [1].

Newson Health carried out an audit in its clinics of 1,200 perimenopausal and postmenopausal women prescribed transdermal testosterone for at least three months. It found that 52% of women reported an improvement in libido, and 47% reported an improvement in their mood [2].

If you are suffering from vaginal dryness or soreness, then you may also need vaginal hormones (also known as local or topical hormones) – which can be used with or without HRT – to manage symptoms. Local hormones are applied directly on the affected area in the form of a pessary, gel, ring or cream. Local hormones can usually be taken safely for a long time with no associated risks.

RELATED: Vaginal hormones: what you need to know

As well as vaginal hormones, you can use moisturisers and lubricants that do not contain hormones but help to hydrate your vaginal tissues and make them feel less sore. These can be brought over the counter.

Why safe sex is key during perimenopause and menopause

STIs are infections that pass to another person through unprotected vaginal, anal or oral sex or by genital contact. They aren’t just an issue for younger people: incidence of STIs in people aged 45 years and older has increased over the last two decades [3].

This is likely due to a number of reasons, including new sexual partners, and there is assumption that condoms are no longer required to prevent pregnancy [4]. In addition, you may not have had any form of sex education since your school days.

RELATED: Menopause and relationships – a guide for partners

What are the most common STIs?

Common STIs include:

• Genital warts
• Chlamydia
• Genital herpes
• Gonorrhoea
• Syphilis
• HIV [5]

Not everyone who has a sexually transmitted infection has symptoms: two thirds of women with chlamydia don’t notice any symptoms, for example [6]. Sometimes symptoms don’t appear for weeks or months and sometimes they go away, but you can still have the infection and pass it on to someone else.

What STI symptoms should I look out for?

Symptoms that may be related to an STI and should be investigated include vaginal discharge, pain when passing urine, blisters and sores around the genitals, abnormal vaginal bleeding (such as bleeding between periods, or bleeding after sex).

In addition, women who are sexually active can acquire the human papillomavirus (HPV). HPV can increase the risk of genital warts, and abnormal changes in the cells that can sometimes turn into cancer, including cervical cancer. Cervical screening, or smear tests, check for high-risk types of HPV, so it’s important to keep up to date with your screening appointments.

When should I be tested for an STI?

If you’re concerned you may have an STI, you should go for a check-up at a sexual health clinic as soon as you can. You can see a GP, but they’ll likely refer you to a sexual health clinic if they think you may have an STI.

You can usually turn up without an appointment and will often get test results quicker than from the GP and you may not have to pay a prescription fee for treatment. If you live in England you can find details of your nearest sexual health clinic here.

How can I practise safe sex?

It’s important to remember you don’t need lots of partners to get an STI.

Condoms are the most effective barrier method to avoid getting an STI, but it’s also important to speak to new sexual partners about their history and consider having a check before the start of a new relationship.

Do I still need birth control during perimenopause and menopause?

Your fertility naturally decreases with age, and although getting pregnant is less likely during perimenopause and menopause, it is still possible. You can still ovulate (produce an egg) when you are having periods, even when they are irregular, so contraception is important if you want to prevent pregnancy.

The current guidelines are that if you are under 50 years of age then you should use contraception for at least two years, following your last menstrual period. If you are over 50, then you should use contraception for at least a year following your last menstrual period [7, 8].

You can stop using birth control at 55, as getting pregnant after this age is exceptionally rare, even in women still having periods.

RELATED: Contraception during menopause and perimenopause

Can HRT be used for contraception?

As HRT contains very low levels of hormones, it does not usually work as a contraceptive. If you are taking HRT, you can also take the progesterone-­only pill, or have a Mirena coil inserted, or use an alternative method of contraception, if you require contraception. However, if you are taking a type of HRT that does not lead to periods then contraception is usually not necessary.

References

1. NICE [NG23] (2024), Menopause: identification and management
2. Glynne S., Kamal A., Kamel A.M. et al. (2024), ‘Effect of transdermal testosterone therapy on mood and cognitive symptoms in peri- and postmenopausal women: a pilot study‘, Arch Womens Ment Health. https://doi.org/10.1007/s00737-024-01513-6
3. Camacho C. et al. (2022), ‘Trends and projections in sexually transmitted infections in people aged 45 years and older in England: analysis of national surveillance data’, Perspectives in Public Health, doi.org/10.1177/17579139221106348
4. Terrence Higgins Trust (2018), ‘Still got it: sexual health of the over 50s’
5. NHS.uk: Sexually transmitted infections (STIs)
6. NHS.uk: Chlamydia
7.  FSRH guideline: Contraception for women aged over 40 years
8. Cucinella L, Tiranini L, Nappi RE. Sexual health and contraception in the menopause journey. Best Pract Res Clin Endocrinol Metab. 2024 Jan;38(1):101822. doi: 10.1016/j.beem.2023.101822. Epub 2023 Sep 19. PMID: 37748960.