A guy’s guide to supporting your partner through menopause and perimenopause

Dear guys:

As an ob-gyn, women open up to me every day about their transition into menopause. I hear how their partners help, and how they make it worse. So, I thought it might help them — and you — to share what I hear from women and what can ease this transition.

First, know that you’re already doing something right by educating yourself about what your partner is experiencing. Here are three other things you should know.

1. Your partner’s body and mind are acting weird (even to her).

Perimenopause is the transitional phase between fertility and being “in” menopause. It usually starts in her 40s or even late 30s, can last up to a decade, and can be a very tumultuous time.

Her body doesn't mind that she’s in her 40s; it’s still trying to support a possible pregnancy. Her ovaries can work so hard to do their job that they overshoot, causing a big surge of estrogen and then a big drop in estrogen.

This can cause her periods to get closer together, make them heavier or make them more painful. When she has these big spikes in estrogen, her breasts can get tender and she can feel more emotional. Then you have these big drops in estrogen, which can cause more irritability and even depression.

Her hormonal changes used to happen predictably, on the same pattern each month. During perimenopause, they happen erratically — which means that within one month, she could both have “too much” estrogen and “not enough” estrogen.

These fluctuations can also cause night sweats, trouble sleeping, joint pain, brain fog, memory problems, mood swings and feelings of being overwhelmed. About 80% of women experience hot flashes, and it’s normal for women to gain weight around their midsection that they can’t lose even with diet and exercise changes.

The feeling of not being in control of her emotions or body can be scary, frustrating and embarrassing. And lack of sleep makes work and every social interaction harder.

A woman is “in” menopause when she hasn’t had a period for 12 months, but even then, she may experience hot flashes, be at a higher weight than she was before and have sleep difficulties.

What you can do: Some of these symptoms — like mood swings — are somewhat out of her control. Try not to take them personally, even when it’s hard. But also: If your partner is complaining about specific symptoms or problems, encourage her to explore them with her doctor. Successfully treating even one symptom could improve her day-to-day life.

2. These changes make everything else harder to manage.

Remember puberty, when your voice cracked, your body changed rapidly, and embarrassing things began happening? A woman’s transition through perimenopause and into menopause is often compared to going through puberty — just in reverse.

In adolescence, she transitioned from childhood into her reproductive years; now, her body is moving towards no longer being able to conceive. It’s driven by hormones, just like puberty was.

Those confusing feelings you had in puberty where “everything’s changing all at once,” and “what’s happening to my body?!” are all occurring again — this time, while she manages a whole lot of extra responsibilities.

In midlife, most women are sandwiched between caring for lots of people — children, teens, aging parents, partners. They’re working on specific career goals. They’re torn between playing roles in their life and trying to manage everything. It’s like puberty with a lot more pressure, and no room for error.

What you can do: Take stock of all your partner’s roles. How could you support her in one of those roles this week? If you don’t know, ask her.

3. Connection and sex may look different — and that's normal.

Your love life may change as she moves through this transition, and that’s normal.

As women go through perimenopause, their testosterone levels slowly decrease, leading to decreased interest in sex. And some of the treatments for perimenopause symptoms — like birth control used to regulate periods and medication to treat mood symptoms — can also lower interest in sex.

In the later stages of perimenopause and into menopause, low estrogen can lead to dryness in the vaginal and vulvar tissues and cause painful sex and decreased sensation. The things that used to bring them to orgasm may no longer work. Women tell me, “Sex doesn't work anymore,” despite efforts from both partners.

All of this can create a frustrating cycle for women: Intimacy feels like something she “should” do rather than something she wants to do. She pushes through anyway, but the discomfort increases, her body tenses, and the experience becomes even less enjoyable — making it harder to look forward to it the next time.

Some women aren’t bothered by lower libido — but then their partner complains, it causes problems in their relationship, or they feel guilty. There’s also a big subset of women that used to love sex and orgasm easily, and these changes are disappointing and upsetting to them.

Understand that there are things going on hormonally that have nothing to do with you. I hear all the time from patients: “I love my partner and I want to feel like I want to have sex with him because I love him so much, but I just don’t." They’re bothered by it and they’re trying to fix it.

What you can do: Have ongoing, open conversations as you work through this transition. There is no “silver bullet” that will fix everything; you may both need to adjust a few things.

To address physical changes:

• Vaginal estrogen (a prescription cream applied inside the vagina or to surrounding tissues) and hormonal treatments can improve painful sex. So can the right lubricant. I recommend trying a silicone-based lubricant first, then a water-based lubricant if that doesn’t work well for you. A natural oil like coconut oil can also help. I don’t recommend scented or warming lubricants, which can be irritating.
• If vaginal estrogen is not helping and sex is still painful, I refer women to specialized physical therapy for the pelvic floor muscles called pelvic floor therapy. It has helped many of my patients enjoy sex again — including patients in their 70s.
• If lowered sexual drive is bothering her, there are two FDA-approved prescription medications she may want to explore: Addyi and Vyleesi. Additionally, some providers are comfortable prescribing testosterone off-label which can increase her libido.
• Help your partner make time and space for exercise. Exercise can improve her self-confidence, lower her stress, and increase blood flow to the vaginal tissues, which can reduce vaginal dryness.

To address emotional changes:

• Female libido is often tied to emotions. One of the first things I ask patients with low libido is, “How are things going with your partner?” I can report back that when partners don't share household chores, don’t help with the kids, or are being mean about her aging parents, many women feel less emotionally connected, which can affect desire.
• Be sensitive that her body often doesn’t look like it did or feel like it did even just a few years ago. Help her realize that you still find her attractive and beautiful, even though she feels frustrated by a new “spare tire” that she can't seem to get rid of.
• Be open to trying new things. You may not be able to make sex as pleasurable for her as it used to be because of her decreased sensation — not because your skill has declined or because she doesn’t find you attractive. Be open to new sexual experiences that may work better for her changing body.
• Your own body may also be changing, and you may start having some sexual challenges of your own. Explain what’s going on to your partner; she’ll probably understand. If you are considering taking a medication like Viagra, know that it is not necessarily pleasant for sex to last longer if it was already painful for her.

Ideally, every couple could talk honestly about these topics without getting upset with one another. If this is difficult, I highly recommend couple's therapy.

Finally, reach out for help as needed. Ob-gyns hear about these topics all day, every day, and these conversations aren't awkward for us. You can join her for the visit if she’s comfortable with it.

One tip: I encourage women to make a separate appointment to talk about perimenopause or menopause instead of trying to address it in their annual well visit — then we can spend more time going through exactly what’s bothering her and how we might fix it.

Your partner might be changing, but so are you. Instead of clinging to “what was,” this can be an opportunity to explore new ways of finding intimacy and satisfaction in this new chapter together.

*As told to Sarah Bonnema