Let’s Talk Sex: Menopause and ACT Therapy
When we talk about menopause, we usually talk about hot flushes, poor sleep and hormones. Sex gets mentioned too, often because it has become uncomfortable or desire has changed. But what about feeling less attractive? Or pulling away from a partner because you don’t know how to explain what is happening?
Discomfort during sex, reduced desire and mood changes can all be part of menopause.[1] Physical symptoms need medical attention but I believe the emotional impact deserves more attention too.
Someone might miss wanting sex, or feel embarrassed about something they used to enjoy. Another person might be quite happy having less sex, but worry that their partner isn’t. These are different experiences, and treating the physical symptoms may not address everything that is troubling them.
A review of 18 qualitative studies found that body image, changes in desire and concerns about a partner’s satisfaction shaped women’s experiences of intimacy during menopause.[2] It also described difficulties talking about sex, both with partners and with healthcare providers. Embarrassment and cultural expectations could get in the way.
In therapy, I would want to understand what the person finds difficult to say. Are they worried about hurting their partner? Do they feel they should still want sex? How do they feel about their body?
Acceptance and Commitment Therapy, or ACT, is a therapy that helps people develop psychological flexibility. This means being able to notice difficult thoughts and feelings and respond to them in ways guided by what matters to them.[3]
For someone going through menopause, a thought such as “I’m not attractive anymore” might make them avoid being touched. ACT offers a way to explore the effect of that thought and what they would like to do when it shows up.
That also means asking what kind of intimacy they actually want. It could be more sex or a different kind of sex. It could be affection, feeling wanted, or being able to cuddle without worrying that it has to lead somewhere.
Finding a way to explain that to a partner may be an important part of the work.
As a woman in midlife and a psychotherapist in training, this subject matters to me personally and professionally. My own experience, though, won’t tell me what someone else is going through.
Menopause can affect trans men and nonbinary people too.[4] Knowing a person’s gender, sexuality or relationship status doesn’t tell me what intimacy means to them, or whether changes in their sex life are even a concern.
For LGBTQ+ clients, I would want to understand what intimacy means in their lives and relationships, using their own language and leaving room for whatever they want to explore.
In therapy progress may look different for different people. It might mean an honest conversation that has been avoided for months. Asking for something different. Feeling less ashamed. Or deciding that intimacy can change without the relationship having failed.
What matters is whether the change makes sense to the person living it.
References
NHS. (2026). Symptoms of menopause and perimenopause.
Bulut, H., Hinchliff, S., Ali, P., & Piercy, H. (2025). Women’s experiences of intimate and sexual relationships during menopause: A qualitative synthesis. Journal of Clinical Nursing, 34(5), 1543–1554. https://doi.org/10.1111/jocn.17436.
Macri, J. A., & Rogge, R. D. (2024). Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review. Clinical Psychology Review, 110, Article 102432. https://doi.org/10.1016/j.cpr.2024.102432
NHS England. (2022). Supporting our NHS people through menopause: guidance for line managers and colleagues.
