Menstruation & Women’s Sexual Health

Menstruation & Women’s Sexual Health

Menstruation is the body’s way of preparing for a possible pregnancy and is a normal part of a women’s sexual health cycle, but a woman’s sexual response and levels of sexual desire can be affected by hormonal changes related to menstruation or monthly periods.

Hormones like testosterone, estrogen, and prostaglandins have an impact on women’s sexual health, impacting on sex drive, mood and also on physical processes related to menstruation. (Prostaglandins make the smooth muscle lining of the uterus contract causing the monthly bleed – and high levels of this hormone-like substance may result in period pain.)

Many aspects of the menstrual cycle affect how a woman feels about herself, her body and her sexual health, with key areas including:

  • Contraceptive choices – eg., contraceptive pill
  • Pregnancy and child birth
  • Pre-menstrual tension (PMS or PMT)
  • Period pain – cramps or migraines


Hormones control your menstrual cycle, the monthly cycle where the body:

  • prepares for pregnancy by releasing an egg
  • preparing the uterus for fertilisation of that egg
  • and then shedding the lining when conception does not occur

Physical changes that can cause discomfort and reduce sexual desire in women as a result of hormonal changes during menstruation include:

  • Menstrual cramps
  • Tenderness in the breasts or abdomen
  • Emotional stress – tiredness or irritability, moodiness
  • Headaches or migraines

What Causes Menstrual Cramps?

Menstrual cramps occur as the uterus is contracting to shed the lining which is no longer required because pregnancy did not occur. Women with higher levels of prostaglandins experience more severe pain, because they experience stronger contractions and the nerve endings become sensitive.

See our Treatments page for a range of treatment options for managing menstrual cramps.

Oral Contraceptives and Sexual Health

Some contraceptive pills are acknowledged “passion destroyers”, killing sexual desire and reducing sexual arousal.

To stop ovulation, the Pill uses artificial hormones related to the sex hormones oestrogen and progesterone that prevent ovulation. Researchers believe it may also reduce testosterone – the hormone responsible for sex drive.

By contrast, researchers found that condoms and other barrier methods boosted users’ levels of arousal more than those who used no contraception at all – perhaps, the scientists speculated, because of the comforting knowledge that they are protected from getting pregnant.

Sex During Pregnancy and Child-birth

Pregnancy and child birth affects women differently, with some women finding their desire fades during pregnancy and others finding they feel more desirable and connected.

For some, desire fades during pregnancy. Other women feel more deeply connected to their sexuality and more aroused when they’re pregnant.

Web MD recommends that you adjust sex positions from the fourth month of pregnancy. Substitute lying sideways for the missionary flat on back position which may place stress on the baby’s blood supply. Or try positioning the woman upright or sitting on top.

Child birth is a traumatic experience for a woman’s body, with delicate vaginal tissue inevitably bruised or torn in the experience which will take at least a few weeks to heal so it’s important that men in particular do not expect “everything to return to normal” immediately after birth.

Although its “standard advice” to wait six weeks until after the post natal check up for penetrative sex, there is no real scientific evidence to support this and many woman say they feel sexy within two to three weeks of giving birth. Everyone is different. And because of hormonal changes you may also notice some changes in sexual response, and may need additional lubrication to start with.

Fore play and non-penetrative sex are fine right from the start, but oral sex – cunnilingus – where the man goes down on the woman – is off limits for the first few months after child birth for serious reasons: it may cause infection or even death through an air embolism being introduced into the vagina.

Pre Menstrual Tension (PMT or PMS)

Pre Menstrual Syndrome is quite common, affecting four out of 10 women with recurring symptoms like:

  • Depression
  • Angry outbursts
  • Irritability
  • Anxiety
  • Confusion
  • Withdrawal from people
  • Breast tenderness
  • Bloating
  • Headache
  • Swelling of extremities (fingers, hands, feet)

To be diagnosed as suffering from PMS, the symptoms must occur during the premenstrual phase of her cycle for at least three consecutive cycles and be severe enough to interfere with daily life.

PMS can be managed with a number of treatment options.

What Causes Menstrual Migraines?

Some women experience migraines when they start menstruation during their teen years, with the highest incidence occurring around the age of 40, but fortunately with aging and menopause the migraine rate seems to drop off.

There is strong scientific evidence that there is a connection between migraines and fluctuations in estrogen levels, and although these headaches are a nuisance, the hormone fluctuations which trigger them are considered normal.

According to About Womens Health migraines and PMS-related headaches are different.

While ‘menstrual migraines occur only during the period of 2 days before and 2 days after the onset of menstruation – most frequently on the first period day, premenstrual syndrome (PMS) related headaches usually end with the onset of menstruation.”

The Pill and Migraine Risk

Oral contraceptives may either trigger migraines are alleviate them, and even if you stop taking the Pill because of migraines, it sometimes can take up to 12 months before any improvement.

Another risk should be considered if you are on the Pill and suffer migraines; the risk of stroke seems to be higher in migraine patients who take oral contraceptives, or have high blood pressure, or smoke.

Jenny Wheeler