Whilst women tend to be the ones typically described as ‘hormonal’, both men and women in their 40s and 50s are almost certainly likely to be going through some hormonal upheavals and these can trigger unwanted, sometimes even debilitating, symptoms and/or out of character behaviour. This is in essence what the concept of the couple-pause refers to: a time when both partners are experiencing hormonal shifts at roughly the same time and the impact it can have on their relationship.
His and hers hormones
The couple-pause is a relatively recent concept coined by two Italian professors attempting to address how partners can work through the symptoms of the female menopause and the andropause together. However, whilst symptoms of the perimenopause (the lead up to the female menopause) and menopause are now pretty well-documented and increasingly discussed, those of the so-called ‘male menopause’ or to give it its correct name – the andropause - are not. In fact, the whole concept of the ‘male menopause’ remains controversial and misleading – not least because it doesn’t manifest itself in the same way as the female menopause at all. This is why: The female menopause (which happens to women on average, aged 51 in the UK), involves often rapid fluctuations and decline in oestrogen which can lead to symptoms such as insomnia, brain fog. anxiety, irritability, low self-esteem, lack of confidence, changes in body shape and fat distribution, vaginal dryness, low libido, hot flushes and night sweats. The andropause, on the other hand, involves a slow and steady decline in testosterone levels in men from their late 30s onwards. Research suggests that total testosterone levels fall at an average of 1.6% per year whilst free and bioavailable levels fall by 2%–3% per year.1,2,3 Which means men can lose up to 50% of their bioavailable testosterone by their 50s (compared to their 20s).
Lifestyle factors, genetics, and overall general health can all influence the onset and progression of andropause symptoms. A study has shown men with healthier lifestyles tend to maintain more stable testosterone levels as they age.4 Smoking, obesity and depression, however, have all been linked to lower testosterone levels.5 Andropause also doesn't mark the end of fertility like female menopause, or have a noticeable physiological ‘end’ as with women when their periods stop, but testosterone deficiency 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.6
How could couple-pause affect your relationship?
Given the symptoms outlined you can see why these can potentially cause unsettling physical and psychological changes and any frustrations or stress that may be felt by one partner is clearly going to impact on the other and vice versa. One of the scientists involved in coining the couple-pause concept Professor Emmanuele Jannini from the Tor Vergata University of Rome says, ’Physical, psychological and relationship changes faced at middle-age and beyond can affect the sexual health of both members of a couple7. He suggests, for example, that a woman might not seek treatment for painful sex if her lover doesn’t get help for his erectile dysfunction. Similarly, it might be that both of you need more time and need to take things slower in order to become fully aroused and orgasm and this can be different to when you initially got together. Don’t automatically assume that the spark has gone out of your relationship or you love each other any less but consider whether this could be the result of physical and physiological changes triggered by the menopause or andropause.
Managing the couple-pause together
‘The issues a midlife couple may be facing can be complex’, says GP and Health & Him medical adviser Dr Hannah Allen. ‘At this time of life you are likely to have children, may be caring for ageing and/or ill parents, possibly experiencing financial concerns or you could just be re-appraising your life generally – all of which can lead to potential frictions. Try to look at your situation holistically and not assume how you are feeling, or coping, is entirely down to your hormones.’ The point is that acknowledging the idea of the couple-pause can help you to stand back, take stock and look at how hormones may be one, possibly crucial, part of the picture of what may be happening to you both at this life stage. So, what else can you do to help each other and lead to greater understanding in your relationship?
1. Share what you’re going through
Changes in your mood and body shape might also be the result of exercising less, drinking more or cost of living worries, say, but it can help to be aware that if you are in your 40s and 50s you are almost certainly experiencing some hormonal changes. Sharing your concerns could lead to greater understanding between the two of you.
2. Empathise
It might be easier said than done when both of may be wandering around feeling tired, grumpy and like you don’t quite recognise yourselves anymore but try to be empathetic and supportive of each other's struggles.
3. Be curious
Take time to educate yourselves about menopause and andropause and the associated symptoms. Understand what physical and psychological changes can occur and how to reduce common misconceptions (for example, thinking she just doesn’t fancy me anymore when it could be that one, or both, of you is too tired, stressed or self-conscious about your changing body shape to want, or enjoy, sex). The relationship experts at Relate offer helpful advice here on how to work through loss of libido in perimenopause and menopause with a partner.
4. Get professional help if needed
If symptoms are significantly impacting your quality of life or relationship, get help from a healthcare or relationship professional. As Dr Allen says, ‘I would ask a patient presenting with emotional concerns, “When were you last happy?”; “What do you want out of life?”; “What is your core reason for coming in to see me?”’ It could be that lifestyle adjustments might be enough, they might possibly be helped by antidepressants, hormone replacement therapy or I might suggest a talking therapy or, if appropriate, couples counselling.’
5. Look after yourselves and each other
Often making simple lifestyle changes can offer all the relief you need so encourage each other to do things which should lead to improved physical and emotional well-being generally as well as potentially 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 evidence shows it can reduce typical menopause symptoms like hot flushes and mood swings); eating a healthy balanced, phytoestrogen-rich diet such as a Mediterranean one or foods known to boost testosterone; taking hormone-regulating supplements; practising relaxation techniques like meditation and finding ways to effectively manage stress.
References
- https://www.researchgate.net/publication/322622006_Couplepause_A_New_Paradigm_in_Treating_Sexual_Dysfunction_During_Menopause_and_Andropause
- https://www.nhs.uk/conditions/male-menopause/#:~:text=Although%20testosterone%20levels%20fall%20as,cause%20any%20problems%20in%20itself.
- https://www.tandfonline.com/doi/full/10.2147/cia.s190#d1e151
- https://onlinelibrary.wiley.com/doi/10.1111/cen.14648
- https://www.sciencedaily.com/releases/2012/06/120623144944.htm
- https://www.baus.org.uk/patients/conditions/7/male_menopause_androgen_deficiency_in_the_ageing_male/
- https://www.researchgate.net/publication/322622006_Couplepause_A_New_Paradigm_in_Treating_Sexual_Dysfunction_During_Menopause_and_Andropause
