Menopausal symptoms, sexual function, and psychological well-being in women across the menopausal transition

Sexual health is an important yet often underrecognized aspect of menopausal health. Previous findings on female sexual dysfunction across menopausal stages remain heterogeneous. This study investigated female sexual function across premenopausal, perimenopausal, and postmenopausal stages and examined its associations with menopause-related symptoms and psychological well-being.

A cross-sectional online study included 539 women aged ≥35 years. Menopausal stages were classified using self-reported menstrual characteristics based on principal STRAW+10 criteria. Menopausal symptoms, sexual function, and psychological well-being were assessed using the Menopause Rating Scale (MRS), Female Sexual Function Index (FSFI), and WHO-5 Well-Being Index, respectively. Stage differences were examined using ANOVAs and chi-square tests. Multivariate associations with FSFI domains were assessed using a general linear model including age, menopausal symptoms, and psychological well-being.

Mean FSFI total scores were below the screening cut-off of 26.55 across all menopausal stages. Overall, 63.4% of participants scored at or below this threshold, indicating possible sexual dysfunction. Perimenopausal women reported the highest overall menopausal symptom burden and lowest psychological well-being. Postmenopausal women reported significantly lower sexual desire and lubrication than premenopausal women, while FSFI total scores did not differ significantly across stages. Urogenital symptom burden showed the strongest multivariate association with sexual functioning across FSFI domains.

Reduced sexual functioning was common across all menopausal stages, but stage-specific differences in individual sexual-function domains should be interpreted cautiously. Perimenopause appeared particularly vulnerable due to elevated symptom burden and reduced well-being. Sexual health and potentially menopausal symptoms should be addressed proactively within holistic menopause-related healthcare.