Summary: A new Wake Forest Baptist Medical Center study finds that many women experience a measurable decline in sexual function beginning about 20 months before their final menstrual period and continuing through the first year after that last period, with further, slower declines over the next five years.

Source: Wake Forest Baptist Medical Center

Menopause Linked to a Significant Decline in Women’s Sexual Function

Key finding: Sexual function in many women declines sharply beginning roughly 20 months before the final menstrual period and through the first year after that final period. That decline continues for up to five years after the last cycle, although at a slower rate.

Researchers led by Nancy Avis, Ph.D., a professor of public health sciences at Wake Forest School of Medicine, analyzed long-term data from the Study of Women’s Health Across the Nation (SWAN) to isolate changes in sexual functioning around the time of menopause. Their analysis shows that menopause itself is an important contributor to the decline in sexual health for many women, even after accounting for other commonly co-occurring physical, psychological, or social factors.

“Sexual functioning in women declines with age, and there has been much debate about how much this is due to menopause, aging or other physical, psychological or social factors,” said Avis. “Our findings support that menopause has a negative effect on sexual functioning in many women.”

Study design and participants

The research team examined questionnaire responses from 1,390 participants in the federally funded SWAN cohort, which began in 1996. Women were between the ages of 42 and 52 when they enrolled and all had a known date for their final menstrual period during the study. Participants completed self-assessments covering aspects of sexual function including desire, arousal, satisfaction, and pain; each woman completed between one and seven assessments over the follow-up period.

In total the investigators analyzed 5,798 self-assessments: 4,932 assessments from 1,164 women who experienced a natural menopause and 866 assessments from 226 women who underwent hysterectomy before the onset of menopause. The team tracked changes in sexual-function scores relative to each woman’s final menstrual period (for natural menopause) or relative to the date of hysterectomy.

Differences by hysterectomy status and race/ethnicity

Women who had a hysterectomy before menopausal onset did not show a pronounced decline in sexual function immediately before their procedure, but they did show declines following hysterectomy that persisted for as long as five years. This pattern contrasts with the natural menopause group, where a clear decline was observed beginning about 20 months before the final menstrual period.

Among women experiencing natural menopause, the study also identified meaningful differences by race and ethnicity. African-American women showed a significantly smaller decline in sexual function than white women, while women of Japanese descent experienced a greater decline compared with white women. These patterns indicate that cultural, biological, or social factors associated with race and ethnicity may influence how menopause affects sexual functioning.

Clinical and personal implications

Sexual functioning is an important element of quality of life for many women. In the SWAN cohort, more than three-quarters of middle-aged participants reported that sex was moderately to extremely important to them at the study’s start. The study authors emphasize that better awareness of how sexual function changes around menopause can help women and their health care providers address concerns more effectively.

Understanding the timing and magnitude of changes—particularly the pronounced decline starting roughly 20 months before the final menstrual period—can inform counseling, screening, and potential interventions. The study suggests that while aging and other health factors play a role, the menopausal transition itself is a primary driver of declines in sexual function for a substantial number of women.

Funding: The SWAN project received support from the National Institutes of Health, including the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office on Women’s Health through multiple grant awards.

Co-authors: Alicia Colvin, Ph.D.; Maria Brooks, Ph.D.; Ping D. Tepper, Ph.D.; Arun S. Karlamangla, M.D., Ph.D.; Gail A. Greendale, M.D.; Sybil Crawford, Ph.D.; Rachel Hess, M.D.; and L. Elaine Waetjen, all contributed to the analysis and reporting.

Original research publication: The study is published in Menopause: The Journal of the North American Menopause Society.

Press contact: Wake Forest Baptist Medical Center communications

Image credit: Image used in the original release was credited to Michael Mack at the University of Toronto.