Couple-pause is a relatively recent (and slightly controversial) concept that refers to when both partners in a relationship (generally in their 40s and 50s) are experiencing significant hormonal shifts at the same time. It's pretty obvious that same-sex female couples could face challenges as they both hit perimenopause and menopause together, but did you realise it could also affect male-female relationships too? The challenges of going through menopause and andropause (often referred to as the male menopause) concurrently can create a shift in relationship dynamic.
While the concept of a ‘male menopause’ remains relatively new1,2, and it certainly doesn’t manifest itself in the same way as female menopause, increasing research suggests there are hormonal changes going on for men at around the same age that women are going through the perimenopause and menopause. These can equally cause unsettling physical and psychological changes in men as they do for many menopausal women.
Coined in 2018 by two Italian professors – one in Endocronology and Sexual Medicine and another in Obstetrics & Gynaecology3 - couple-pause is defined simply as, ‘a new paradigm that considers the needs of the ageing couple as a whole4.’ In a study published in 2024 the professors point out that the hormonal shifts experienced during mid life generally happen in the context of a relationship and so should involve both parties addressing any issues together. Clearly, any stress, discomfort or frustration that may be felt by one partner due to hormonal changes is clearly going to impact on the other and vice versa. As the professors say, the couple-pause ‘effectively addresses the sexual health needs of ageing couples as a unit, considering physical, psychological, cultural, social and dyadic-related [involving interactions between two people] factors5 ‘ Significantly, it also diverts attention from seeing one partner in the relationship as ‘the problem’ and frames any challenges as a dilemma to be faced by both people involved. It can also be a time to pause, reflect, take stock and think about what you both might be going through physically and psychologically at this mid-life point. So what should you be looking out for and how can you manage the couple-pause effectively together?
Understanding menopause and andropause
The natural transitions of menopause and andropause are marked by fluctuating and declining oestrogen levels in women (along with a a steady loss of testosterone) and a slow, steady and gradual drop in testosterone levels (men will lose between 30-50% of their testosterone by the time they hit 50)6 for men. These can potentially lead to a range of physical and psychological changes for both that are likely to impact on your relationship. Of course, hormones are not the only factors to cause physical and/or psychological problems or worries within a relationship during your 40s and 50s but being informed about them can help you to build up a more rounded picture of what might be happening to either, or both, of you. The point is living with a partner going through the menopause or andropause can affect the general health, psychological well-being and sex life for the two of you, so it can be helpful to know how to read the signs.
- Menopause, as most of us are aware, is a completely natural phase in a woman’s life when her periods stop and signals the end of her reproductive years. It typically starts with perimenopause in a woman's mid 40s, and then turns to menopause as periods stop in her late 40s/early 50s. (the average age a woman goes through it in the UK is 51)7 . This transitional time involves an often rapid decline in oestrogen production which can lead to symptoms such as insomnia, brain fog, anxiety, irritability, low self-esteem, changes in body shape, vaginal dryness, low libido, hot flushes and night sweats.
- Andropause, sometimes referred to as the ‘male menopause’, is becoming an area of mounting research and refers to the steady decline in testosterone levels in men from the age of the 30s onwards. As this decline is slow and gradual and tends to happen over several decades symptoms or changes might go completely unnoticed or be attributed to lifestyle factors (like drinking or eating too much, stress, exercising less or lack of sleep). While the andropause doesn't mark the end of fertility like menopause, or have a noticeable physiological ‘end’ like with women when their periods stop, low testosterone levels can potentially lead to symptoms in some men such as low energy, depression, decreased libido, erectile dysfunction, difficulty sleeping, fatigue, an increase in body fat, loss of muscle mass, mood changes, irritability, lack of focus and dips in confidence and motivation.8
The impact on relationships
Given the symptoms outlined above, unsurprisingly, navigating couple-pause can pose a challenge for relationships. Both partners may be dealing with disconcerting changes to their body, (meno-belly and breast changes for women and a bigger belly and ‘man boobs’ in men, for example), concerning mood swings (irritability and depression are common symptoms for both women and men at this life stage), plus changes in libido – all potentially happening at the same time. You can quite see why this can put a strain on communication, intimacy and make your life together potentially harder. For example, if neither of you are sleeping well, you are both feeling irritable and maybe self-conscious about your ageing body misunderstandings or misinterpretations can quickly build into tension or conflict. On top of this, one or possibly both partners might not even realise these challenges are hormonal.
Managing couple-pause together
1. Talk. As far as possible try to be honest and open with each other about how you are feeling. Consciously or not (and changes in your mood and body shape might also be chalked up to getting older, lack of exercise, drinking more or other factors like financial worries etc) be aware that if you are in your 40s and 50s you are almost certainly experiencing some hormonal changes. Sharing these feelings, concerns, and symptoms should lead to greater understanding and empathy between you and your partner. Relationship experts from Relate have put together useful advice for women on how to manage stress, anxiety and anger and keep your relationship strong during menopause but much of the advice can be equally applicable to men going through the andropause. They also explain about loss of libido during perimenopause and menopause and working through it with your partner. Try reading these articles together.
2. Empathise and be supportive. It might be easier said than done when neither of you are feeling on top form and may be wandering around feeling tired, grumpy and like you don’t quite know who you are any more but try to be empathetic and supportive of each other's struggles. Validate each other's experiences and aim to offer emotional support during difficult moments.
3. Be curious. Take time to educate yourselves about menopause and andropause, and the associated symptoms. Understand what physiological and psychological changes can occur and how to reduce common misconceptions (for example, he/she doesn’t fancy me anymore when it could be that one, or both, of you is too tired or is self-conscious about your changing body shape to initiate, or want, sex) should lead to greater empathy.
4. Get professional help. If symptoms are significantly impacting your quality of life or relationship, look to get help from a healthcare professional. Counselling can be effective for many and this can be done in tandem with using Hormone Replacement Therapy or Testosterone Replacement Therapy if this has been prescribed for either of you.9
5. Look after yourselves. Often making simple lifestyle changes can offer all the relief you need during these transitional times. So try to encourage each other to do things which should lead to improved physical and emotional well-being as well as helping to balance your hormones. Ideally, do them together. These can include regular exercise (losing weight and exercising can often increase testosterone levels naturally and has also been shown to reduce typical menopause symptoms like hot flushes and mood swings)10,11; eating a healthy diet, (ultra-processed foods has been shown to negatively impact on testosterone levels12 and exacerbate hot flushes, insomnia, memory and concentration during menopause)13; taking supplements to support hormonal regulation practising relaxation techniques and finding ways to effectively manage stress
Couple-pause as a shared journey
While the couple-pause phase may present challenges for both of you, being aware of its existence can offer an opportunity for you and your partner to support each other through it. It should also help to foster greater empathy, understanding, and communication between the two of you so you can navigate your way more seamlessly through these times of hormonal transition. Best of all, by embracing the couple-pause as a shared journey and supporting each other through its highs and lows, you should emerge stronger together.
References
- https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070997/
- https://academic.oup.com/smr/article-abstract/6/3/384/6830833
- https://pubmed.ncbi.nlm.nih.gov/38515320/
- https://academic.oup.com/smr/advance-article-abstract/doi/10.1093/sxmrev/qeae016/7633161
- https://www.nhs.uk/conditions/male-menopause/#:~:text=Although%20testosterone%20levels%20fall%20as,cause%20any%20problems%20in%20itself.
- https://thebms.org.uk/wp-content/uploads/2023/08/17-BMS-TfC-What-is-the-menopause-AUGUST2023-A.pdf
- https://www.medicalnewstoday.com/articles/322647#naturally-boosting-testosterone
- https://www.medicalnewstoday.com/articles/testosterone-replacement-therapy-trt
- https://www.urologyhealth.org/urology-a-z/l/low-testosterone
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722698/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291266/
- https://pubmed.ncbi.nlm.nih.gov/35033227/
