The menopause can lead to changes in your sex life, but there are ways of boosting a flagging libido says Dr Lesley Hickin

As you reach the years leading up to the menopause, you may find your attitudes to sex and relationships changing. This may be for a variety of reasons:

• Your children may be growing up and leaving home, so the enormous demands they have placed on your time and energy are less
• You will have more spare time and might find your career taking off or even think about changing your job
• You may be widowed or divorced and be entering new relationships just at the time when your menopause occurs, and this can lead to anxieties about feeling attractive and worries about sex

These life changes can have effects on your mental well-being and it is important to seek help if you feel things are getting too much. Depression and anxiety are common at this time of a woman's life and are not caused by hormone changes alone. You may need counselling or anti-depressant medication, so talk to your GP or a good friend if you feel low.

When do I stop worrying about contraception?
You will be reaching the time when you no longer have to worry about contraception. However you need to wait a full 12 months after your last period before discarding contraception altogether if you are over 50, and two years if you are under 50.

With the decreased fertility that comes with the perimenopause you may like to talk to a family planning expert about suitable forms of contraception for you. 'Change of life' babies are usually born to women who thought they could not become pregnant again! Remember that HRT does not act as a contraceptive and that it is difficult to know whether you have reached the menopause if you are taking HRT, as it gives you a monthly bleed.

Will I still want to have sex after the menopause?
A menopausal woman's desire to have sex and her ability to participate in it are both affected by hormone changes. Although oestrogen plays some part, the hormone most involved with sexual desire is testosterone. This is, like oestrogen, produced by the ovaries, fatty tissue and the adrenal glands that sit on top of your kidneys. Testosterone, unlike oestrogen, continues to be produced after the menopause.

Sexual desire (libido) may be diminished during the perimenopause but often returns when the symptoms subside. Many women (and men) believe that women's libido disappears at the menopause - this is far from true. Up to a third of women experience a reduction in sex drive after the menopause but many more find their sex lives are greatly improved by no longer worrying about pregnancy. With the children gone you have much more time for spending with your partner and rediscovering each other.

Physical problems
Lack of oestrogen can cause thinning of the vaginal wall and reduced lubrication. This can cause intercourse to be uncomfortable or even painful. Water-soluble lubricating gels can help with this problem.

Also helpful are Kegel, or pelvic floor, exercises that can firm up the vaginal wall, control urine flow and enhance orgasm. These exercises involve tightening and relaxing the muscles used to control urine flow. They are also recommended for post-natal exercises.

Does HRT help?
The good news is that taking HRT can in almost all cases restore your sex drive and get rid of the physical discomfort. This can take several weeks to happen. Some women, especially those who have had their ovaries removed surgically, will need treatment with testosterone as well as oestrogen.

What else can I do to help myself?
It is important to realise that what you are experiencing is a natural life event. Share your thoughts and anxieties with your partner, a good friend or a health professional. Improve your self-confidence by taking the time to pamper yourself. Don't underestimate the rejuvenating effects of a good haircut, change of hair colour or a relaxing facial. Make sure your diet is healthy and take regular exercise - you will reap the benefits.