Sexual Dysfunction in Perimenopause May Be Rooted in Psychosocial Stressors

An active senior couple in love playing with balloons in front of a white background
Sexual dysfunction during perimenopause among women prescribed hormone replacement therapy may have more to do with psychosocial factors, not menopausal symptoms.

Among women in menopausal transition, the use of menopausal hormone therapy was not associated with a change in sexual function, and psychosexual education and consultation should be offered to women during this time period. This is according to research results published in Menopause.  

The findings are based on a cross-sectional, observational study that evaluated factors associated with sexual function during perimenopause, including the role of menopausal hormone therapy in perimenopausal women.

While most research shows that menopause is associated with an increased risk for sexual dysfunction (by as much as 10 times, according to one study), this study finds that neither the presence of menopausal symptoms, nor the use of hormonal therapy is directly associated with sexual function.

The study, which was conducted by Krzysztof Nowosielski, MD, and Marcin Sidorowicz, MD, PhD, both of the University of Opole in Poland, included 210 women between 45 and 55 years of age. They were recruited between January 2019 and January 2020 from 4 gynecology outpatient clinics in Poland. Participants received a questionnaire and completed an interview focused on sexual function and behaviors.

The treatment group included 107 women (mean age 49.6 years) taking menopausal hormone therapy; and, 103 women assigned to the control group. Comorbidities included well-controlled hypertension (22%), well-controlled type 2 diabetes (3%), and mild heart failure (1%). Those in the treatment group had lower body mass index, better relationship quality, more romantic relationships, more positive attitudes towards sex, a better quality of sexual life, more sexual activities per month, more satisfying sex, higher body esteem during sexual activities, and better sexual function in all domains except desire/interest, higher sexual satisfaction, and better quality of relationship.

Within the total group, 19.5% (n=41) of participants were using nonhormonal contraceptives: 15.9% (n=17) in the treatment group and 23.3% (n=24) in the control group.

For those taking menopausal hormone therapy, mean duration of treatment was 16.4 months (range, 1-48 months), with 7.5% (n=8) using oral estrogen-only therapy, 40.2% (n=43) using oral combined continuous estrogen-progesterone therapy, 18.7% (n=20) using oral combined sequential estrogen-progesterone therapy, 4.7% transdermal estrogen only therapy, 25.2% (n=27) transdermal combined sequential estrogen-progesterone therapy,  and 3.7% (n=4) transdermal combined continuous estrogen-progesterone therapy.

Among those in the treatment group, 4 different groups of factors were identified that correlated with menopausal hormone therapy use: socioeconomic factors, psychosexual factors, sexual behaviors, and relational factors. No correlation with severity of menopausal symptoms was noted, and a logistic regression model showed that only the importance of sex to the respondent and the level of similarity with a relationship partner played a statistically significant role in menopausal hormone therapy use. Women who viewed sex as important were also more likely to use menopausal hormone therapy (odds ratio, 1.85; 95% CI, 1.2-28; P <.001).

Investigators also created a model to describe sexual function in this population of perimenopausal women. Nine factors were found to enhance sexual function, including positive attitudes toward sex (total effect=2.54) and lower severity of menopausal symptoms (total effect=9.77), among others; the use of menopausal hormone therapy, however, did not have any influence. Women in the treatment group also had a lower prevalence of all sexual dysfunctions based on DSM-5 diagnostic criteria, and a lower frequency of reported sexual problems. 

Study limitations include the retrospective nature and cross-sectional design, a lack of hormonal analysis, and the possibility that some statistically significant findings occurred by chance.

The results of this study provide some important clinical implications, namely the importance of including routine psychosexual consultation and education on psychological and sexual changes in menopause in treatment modalities.

“The authors of this study believe that knowing possible modifying factors might help implement long and short-term medical interventions that focus not only on ‘fixing’ or treating declines in sex hormones, but more on psychosexual behaviors and attitudes related to building sexual self-worth and consciousness, of both women and their partners, as women enter menopausal transition,” study authors wrote.


Nowosielski K, Sidorowicz M. Sexual behaviors and function during menopausal transition—does menopausal hormone therapy play a role? Published online December 21, 2020. Menopause. Doi: 10.1097/GME.0000000000001693