• The impact of the menopause on women's psychological and physical health is being spoken about more than ever before

  • Couples' therapist Dr Clare Murray shares the three things she sees as common relationship issues in part caused by the menopause

  • If you are struggling with symptoms of the menopause, find a therapist here

It is estimated that in the UK today there are as many as 13 million women going through the menopause. Some 25 years ago research looking at the way the menopause was portrayed in the media highlighted a number of problems: 

1) the information available was found to be minimal and insufficient

2) menopause was almost always presented as a negative experience or disease, and

3) intervention advice for menopausal women was inconsistent and contradictory (Gannon & Stevens, 1998)

Recently we have started to see a small, positive shift, with the topic of the menopause shooting up the media agenda. This has led to more widely available information and discussion about the changes women may expect during the menopause. It has also helped to inform women about intervention options such as Hormone Replacement Therapy (HRT), which can help alleviate some of the changes women experience.

However, my work with (mainly opposite-sex) couples over the past ten years has revealed that the menopause can not only lead to additional challenges for women but also for their partner and the couple relationship.

Couples who seek help are often at crisis point in their relationship. Common presenting problems that couples bring include dealing with the fall out of an affair, intimacy issues (physical and emotional), communication problems, bereavement, infertility, unresolved feelings of anger and/or resentment from one partner towards the other. The work to rebuild their relationship based on a more solid foundation of mutual trust, respect, empathy and kindness is hard and often painful.

Further difficulties can arise when this coincides with other key events in the couple’s life, such as children going through puberty, children leaving home, and the illness and/or death of parents. As stated earlier, the experience of menopause – a key life event for women - may also pose challenges for the couple. Let’s look at why and how this might happen.

Women and menopause

One thing that has become clear is that all women experience menopause differently. The hormonal fluctuations associated with the transition from perimenopause (the period before menopause where the ovaries gradually make less oestrogen) through menopause and post-menopause can lead to physiological and psychological changes, which can vary in both frequency and severity and include: 

  • hot flushes
  • urticaria (hives)
  • fatigue
  • osteoporosis (weakening of the bones due to reduced levels of oestrogen)
  • difficulty concentrating and making decisions
  • memory loss
  • sleep problems
  • loss of sexual desire and arousal
  • vaginal dryness
  • anxiety
  • panic attacks
  • depression

Onset of these changes can be sudden or occur gradually over a period of months or years. Some women seem to pass through perimenopause and menopause with relatively little disruption to their daily life. For other women, however, the experience of menopause can be quite debilitating.

The impact of the menopause on the couple relationship

So what are the implications for these women and their couple relationship? Drawing on my work, a number of common themes have emerged:

1) Lack of information and awareness

First and, perhaps most importantly, the general lack of information and discussion about the menopause, awareness of the changes to expect and intervention options seems to have led some women to feel even more anxious and confused as they struggle to make sense of the changes that they are experiencing.

Unable to understand or articulate their experiences to their partner, who is often also confused at the changes he is seeing, can add to existing communication problems between the couple, making them feel even more disconnected from each other. Helping both partners to be aware of what is happening can help to alleviate shared feelings of anxiety and confusion and also creates the chance for each partner to understand how the other is feeling, which can help to build trust

2) Identity and loss

The onset of menopause can also evoke more deep-seated feelings related to a woman’s sense of identity as a woman. For those women for whom being a mother is core to their sense of identity, the experience of menopause and end to their fertility can evoke strong feelings of loss, akin to bereavement. Often, the experience of menopause also coincides with one or more children leaving home, which can further compound the feelings of loss.

For other women who may or may not have had children, there may be a sense of loss or regret for the child or children that they never had. This may be the case even if the decision to be childfree has been a conscious one. In this situation, it appears to be the loss of choice and/or loss of control of their body and fertility that can be difficult for some women to work through.

Helping these women to think and talk about the feelings of loss and/or regret with their partner can foster feelings of trust and understanding between the couple. Indeed, it has been the case with a number of couples I have worked with, that the male partner may also be feeling a sense of loss at children leaving home and/ or regret at not having had children.

3) Changes in sexual desire and arousal

For many women, the outcome of the psychological and physiological changes associated with menopause is often the loss of sexual desire and arousal, self-confidence and attractiveness.

This is exacerbated by the rise in social media, which has led to increasing value placed on youth and beauty for both women and men. As a result, the menopause can leave some women feeling unattractive and invisible. This, together with other menopausal changes such as depression, anxiety, and issues relating to identity may all contribute to a woman’s loss of self-confidence and sexual desire.

In addition, a reduction in oestrogen during menopause can lead to vaginal dryness, which can affect both sexual desire and arousal. Consequently, not only may women feel that they don’t want to have sex as often with their partner, when it does happen, sex can be painful.

This element of the menopause experience can be especially difficult for the couple to navigate. Women may feel confused, anxious and unable to make sense of their reduced interest in and/or pain during sex so may choose to avoid it altogether. This leaves their partner feeling hurt and rejected, which can lead to their own loss of sexual desire and arousal. Moreover, if the couple has not found sex an easy topic to talk about in the past, or have sought help specifically to address a psychosexual / infidelity issue, this may further compound the problem, potentially leaving both partners feeling more misunderstood, disconnected and isolated from each other.

Interventions such as Hormone Replacement Therapy (HRT) can help to rebalance hormone levels and alleviate problems with sexual desire and arousal and as well as other physiological and some psychological changes. Alongside HRT, psychosexual therapy can be really helpful for these couples, but only once the broader relationship issues and the impact of other menopausal changes on the woman (and the couple), have been addressed.

As relationship therapists we need to be mindful of the role the menopause may play in our work with particular couples (i.e., those in mid-life) and the impact on both women and the couple relationship. We also need to be aware of intervention options, like HRT, which are available from the GP or menopause clinics.

This, and the wider media coverage of the menopause, can help women to navigate this significant life event more smoothly, with increased confidence and with their partner’s understanding, support and comfort. As one client said after starting HRT whilst undergoing couple therapy, “I feel beautiful again Clare.”

Dr Clare Murray is a verified welldoing.org therapist in SW7, London

Further reading

7 ways to make your menopause work for you

Can hypnotherapy relieve the symptoms of the menopause?

How biodynamic therapy supported me through the menopause

How therapy helped me through middle age

Middle-aged women: ignored or liberated?


Gannon, L. and Stevens, J. (1998). Portraits of menopause in the mass media. Womens Health, 27 (3), 1-15