It is ten years since my life imploded in my mid-40s. I wish I’d known back then what I know now: that a midlife crisis is not only a good thing, but essential for all women.
Historically, the midlife crisis has been the preserve of men. A bit of a joke, characterised by a few silly blokes in red convertibles.
Women haven’t had a look-in. Well, now it’s our turn. Our turn to understand and own this turning point and ensure it is a transition into a bigger, better, more magnificent future.
The need to change and adapt seems to start somewhere between late-30s and 60s. For some there can be two, or even three, midlife crises. For others it is more of a transition: bumps to overcome on the road to somewhere calmer, more creative and fulfilling. There’s a lot to look forward to, but it’s tough out there and we need to be fully equipped. Divorce, anxiety and depression all peak in midlife.
When life is full and we are running on empty, the fallout can be catastrophic.
I managed to cover a fair few of the fallout possibilities in my own midlife crisis. Within a couple of years I left my home and marriage, had an affair with a married man, got divorced, lost my memory, lost my job and lost my mother to Alzheimer’s. Also, the dog died after a tick bite. There were profound losses, but there was also healing.
Everyone’s midlife moment is unique – the partner, house, job and dog might stay exactly the same, but how you relate to them might feel completely different.
Then there’s The Rage. When the loving, protective hormonal padding of oestrogen and progesterone disappears around perimenopause, a roar of long-suppressed anger can emerge.
When I talk to women in their 30s, 40s, 50s and 60s, often their main emotions around midlife are the three Fs: frazzlement, frustration and fear, writes Muir, pictured
As women, we have subsumed so much of ourselves in work and household duties that we no longer remember who we really are. When we have time at last to think, we are confronted with this fact and that can bring a lot of (justified) anger.
I deeply regret the emotional damage I caused to those I love during my own crisis. I had discovered I just couldn’t hold a family, a full-time job and all those demands and expectations on my shoulders any more. I couldn’t turn the supertanker, so I jumped off.
When I talk to women in their 30s, 40s, 50s and 60s, often their main emotions around midlife are the three Fs: frazzlement, frustration and fear. They see perimenopause, menopause, then the long years stretching out afterwards as the beginning of decrepitude.
That’s rubbish. I know, because I’ve been there and come out the other side. So let’s lean in to recalibrating the next stage of our lives. Reframing life stages is exhilarating for women and men.
What if I am going to work until I am 80? What if I go back to university or art school at 90? What if I have a second career? Or a third husband?
Frankly, what’s not to like? Let’s start with a look at sex.
‘Everyone talks about needs and anxiety in midlife, but no one talks about the elephant in the room, which is the sex and the libido part,’ says Emma Sayle, founder of Killing Kittens, a sex-positive community where women take the lead.
‘Sex just gets ignored and it’s huge,’ she says. ‘You’re not talking about it. You know you don’t want the sex your partner wants. Or maybe you’re not having it at all and it’s just like right, you know what, I’ll get it somewhere else.
A lack of mutual communication around our desires and expectations stands in the way of pleasure, especially among Boomers and Gen X-ers who grew up in a different era
‘What if men and women actually had conversations about sex with each other? Spoke about it, went through it together?’
A lack of mutual communication around our desires and expectations stands in the way of pleasure, especially among Boomers and Gen X-ers who grew up in a different era. So it’s rather refreshing to get a relaxed take on it all from Emma, who is 46 and married with three children.
Killing Kittens is both a giant chatroom where you can talk safely about sex and a portal to real-life parties every month, leading to casual sex in a safe, contained way, or just some kissing, touching, talking or flirting.
Only women can join the parties, but they can bring a man as a partner or a guest and everyone needs official ID. The name comes from an old-fashioned warning about the dire consequences of self-pleasuring: ‘Every time you masturbate… God kills a kitten’. Thereafter ‘killing kittens’ became a codename for this activity.
Emma decided to reclaim the phrase. Two-thirds of the partygoers are female and everyone wears masks until the ‘playspaces’ open later in the evening. There’s no pressure to use them, Emma tells me. ‘You can just have a drink and hang out.’ There’s also a strict policy of ‘hugs not drugs’; consent is mandatory and there are trained staff with red LED armbands if anyone needs help.
Obviously, Killing Kittens is not for everyone, but it opens the door to a deeply liberating way of thinking and talking about sex. We may not all need adventures and affairs, but even the happiest of relationships probably needs a midlife MoT in bed.
Sexy parties are the lighter side of some fairly dark times around intimate relationships in midlife, when affairs, break-ups and perhaps just a constant low hum of dissatisfaction bring painful confrontation within ourselves and with others.
‘We learned about sex behind the bike sheds, from Jackie magazine, from Alison at school, who was the first to get a bra and was the font of all knowledge’, says Dr Claire Macaulay, creator of a coaching programme to help people improve their sex lives.
Emma Sayle is the founder of Killing Kittens, a sex-positive community where women take the lead
‘Very little of what we learned was even true or useful. As a consequence, we may have been living our whole sexual lives with some wonky beliefs and ideas and not really getting what we want – or knowing how to ask for it.’
Dr Macaulay, who started her career as an NHS oncologist, is a brilliant combination of sex-positive and medically informed. Many of her breast cancer patients were facing early chemical menopause due to treatment. As a result, they often found their sex lives were hugely impacted.
Aside from feeling awful after chemotherapy or radiation, it’s often afterwards in recovery that patients experience menopausal symptoms such as dry vaginas, caused by the anti-oestrogenic cancer drugs. Dr Macaulay suggests her post-cancer patients in menopause can still safely use incredibly low-dose vaginal oestrogen, available from GPs. A study of almost 50,000 women published in the Journal of the American Medical Association showed that this treatment did not increase the risk of death after breast cancer; in fact, topical oestrogen users were healthier – but only 5 per cent were using it.
It’s not just cancer patients that need vaginal oestrogen, either – pretty much every single menopausal woman does, eventually. But we’re not told that.
Many midlife women stop having penetrative sex – or grin and bear it – because their vaginas are painful. They may also give up riding a bike, or wearing tight jeans, due to itching and discomfort.
Dr Rachel Rubin is one of America’s top urologists and sexual health specialists. ‘This is not just vaginal dryness. This is Genitourinary Syndrome of Menopause, a very serious condition caused by lack of hormones,’ she says.
It’s scary talking to Dr Rubin about what happens in your 50s or 60s or later if you don’t use vaginal oestrogen. She estimates that around 80 per cent of women could do with vaginal oestrogen but only 7 per cent actually use it.
Topping up our hot female hormone testosterone helps libido too. Testosterone makes women feel sexier and improves orgasms for most of us. But gender bias in medicine has buried that good news for far too long.
As a woman in the UK, you can ask your GP for body-identical testosterone gel for ‘low sexual desire’ – but there are huge barriers in place to accessing this.
You have to be diagnosed with what’s officially – and perhaps sexistly – known as Hypoactive Sexual Desire Disorder, and usually have to be settled on oestrogen and progesterone HRT first. Not to mention the fact that getting an appointment at an NHS menopause clinic for a testosterone prescription can take months or even years.
There’s a huge disconnect in the treatment of men and women sharing the same bed. Men can get testosterone from their GPs after a blood test and prescriptions for erectile dysfunction (ED) drugs are given immediately, or they can take ‘little blue pills’ such as Viagra (sildenafil) over the counter in a few minutes. They don’t have to answer probing questions to prove that they, too, have Hypoactive Sexual Desire Disorder.
In 2023, more than 4.5 million drugs for ED were prescribed, costing the NHS £15.5 million, and more than half of men say they experience this condition at some point. They also get testosterone topped up for general health if levels are extremely low, while women have to prove that we’re on our knees and failing our partners when it comes to having sex.
As the American urologist Dr Kelly Casperson told me: ‘When a man comes in with low libido and erectile dysfunction, we don’t tell him “this is just how it is now”, the way doctors dismiss women in menopause. We don’t ask him if he’d like an antidepressant.’
We’re fixing men, but not women. Dr Casperson believes women’s sex lives are being neglected because we define menopause as the end of periods and fertility, rather than a low hormone issue. ‘Our definition is wrong and closed-minded,’ she says. ‘Because when a person comes into my office and they haven’t had sex in seven years, and their last periods were ten years ago, they can’t fathom that this is a hormone issue.’
Sex is often a point where the physical and the psychological intertwine. Psychotherapist Dr Kalanit Ben-Ari, who specialises in couples therapy, says previous trauma can re-erupt in midlife, percolating into the bedroom and making everything more complex. ‘Traumatic events, stress and emotional upheaval can influence your sexual wellbeing and your relationship, and that can affect desire, trust, and connection,’ she says.
‘I try to help couples find pathways to healing and there are practical things you can do around communication, mutual understanding, and asking for emotional support.’
Women and men on antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline or escitalopram, can find it harder to reach orgasm. There are so many other layers here, too, wrapped up in religion, or a very rigid upbringing and the past.
We need life-changing help for changing lives. Yet Dr Macaulay finds women are often still playing the same roles in relationships and in bed they grew used to years ago, when they have grown up into very different people.
‘Midlife is throwing up questions, added to the anxiety, irritability, intolerance and even depression caused by hormonal changes,’ she says. ‘The impact on mental health can be profound, draining and isolating. It’s a very vulnerable time.’
She has clients coming in hoping their partner will change, but find it’s up to them instead. ‘The world is full of, “if only they would…” but what if they don’t? What if they never do?
‘We don’t know how to communicate our own needs, repair after a fight, prioritise intimacy and connection or help each other grow,’ adds Dr Macaulay. ‘We are not taught how to create a healthy partnership.’
Not communicating properly helps to keep the orgasm gap going strong; studies show that 95 per cent of heterosexual men usually or always orgasm during sexual intimacy, compared with only 65 per cent of heterosexual women. Women think they’re broken because they can’t orgasm from normal penetrative intercourse, when surveys show less than 25 per cent can.
Further studies have estimated that between 53 and 85 per cent of women admit to faking orgasms, mostly during intercourse. We’ve all done it, although perhaps not as well as Meg Ryan in her classic When Harry Met Sally scene.
We also need to reduce shame and embarrassment around sex and advocate for what we want; vibrators and other sex toys often help to loosen up conversations and inhibitions.
What’s hilarious is how mainstream all this now is. I was seeking vacuum cleaner reviews on the Good Housekeeping website when I found: ‘The best vibrators to buy now, tested by 130 women. From rabbits to bullets, the Good Housekeeping Institute tried a range of sex toys to find our winners.’
There’s added pleasure to be had by maintaining muscle strength in the pelvic floor and there’s not enough emphasis on that in the UK and US. After I’d had a baby in Paris, I was sent by the French state to a few weeks of free and uplifting pelvic floor exercises in a class which was very much about putting the mother first.
It doesn’t happen for most mothers here – but for sexual pleasure and preventing future womb prolapses, playing with your pelvic floor muscles, doing kegels or other exercises, is really important.
At the other end of the scale, there are those who find perimenopause turns out to be a wild peak in their sexual life, like nothing ever before.
This is known as the perimenopausal sex surge and some millennials, the oldest of whom reach the age of 44 in 2025, may well be heading there.
Not every woman gets the surge – most experience a diminution of desire – but those who have very high peaks of oestrogen as their body fights waning fertility towards 50 can find they just want to have sex all the time.
There are threads on Mumsnet with confessions about the surge lasting for years, as well as its effect on vibrator batteries and long-term relationships.
As one noted last year: ‘Trouble is, the middle-aged men can’t keep up! My sex drive is higher now than when I was married, although it did increase around 40, after divorce.
‘Now 50, and my boyfriend only wants it once or twice a month. I’d have it every day, so we compromise about once a week.’
She had also started taking HRT and testosterone, adding to the hormonal hothouse.
However it affects us individually, it’s powerful to think of this time of midlife as an odyssey, with menopause at the centre of it. Not as a negative, but as a lightbulb moment for change.
For me, discovering that testosterone was a female hormone was like discovering a new planet. Frankly, I thought the London menopause specialist offering me it was a bit weird. But then I started taking testosterone, in a tiny quantity, as part of my hormone replacement therapy… and the rest is history.
Quite simply, a daily pea-sized blob of testosterone gel gave me my intellectual and libidinal oomph back in midlife. I started investigating why, listened to other women’s experiences, spoke to pioneering doctors, read the latest science papers and wondered how profoundly female health and longevity might be affected in the future by The Big T.
Research is already pointing to the amazing effects of reclaiming this hormone and topping it up in later life. Understanding that testosterone is not a male hormone but a people’s hormone throws a spanner into decades of cultural and medical assumptions.
Despite what we were all wrongly taught at school, testosterone is produced in significant quantities in the female body. Neuroscience has opened a window into women’s brain scans – we can now see all the testosterone receptors there – and we have discovered there are more all over our bodies, including our breasts, eyes and muscles.
There’s an animated conversation around testosterone among women on social and traditional media, and I always find when I’m giving talks on hormones and the menopause that the atmosphere in the room gets electric as we discuss it. It’s a sexy topic.
Testosterone doesn’t work for everyone. A minority of people find it makes them irritable or angry, or gives them acne or a bit more body or facial hair.
It’s also not going to magically rescue your libido and relationship if other things, such as exhaustion, boredom or an impending divorce, are standing in the way.
However, a survey of more than 900 UK women showed that in almost half, the addition of testosterone to HRT ‘significantly improves mood-related symptoms such as anxiety and irritability, as well as concentration and memory’.
A deeper look into cutting-edge research indicates that testosterone might help protect us against dementia, cardiovascular disease, osteoporosis and possibly even breast cancer. A small 2013 study by Professor Susan Davis of Monash University in Australia revealed that testosterone can also improve memory. This is what many women report anecdotally when using testosterone as part of HRT, as brain fog disappears and intellectual clarity returns.
Davis worked with 92 healthy postmenopausal women, who were not receiving oestrogen therapy, and assigned them to either testosterone gel or a placebo for 26 weeks. After treatment, the testosterone group ‘had a statistically significant and clinically meaningful improvement in verbal learning and memory’.
Testosterone also improves most people’s spatial abilities.
There is plenty of anecdotal evidence regarding testosterone supplementation, but even though women are reporting positive effects far beyond libido, these results are largely ignored by the medical establishment. Even the British Menopause Society wrote last year: ‘There is no evidence to support claims that testosterone will help with symptoms associated with menopause or prevent bone disease or dementia.’
‘Medical sexism is real,’ says urologist and menopause specialist Dr Maria Uloko, who works in California. ‘Men and women are not getting the same level of care, access to care or even scientific integrity in their care. It is so deeply ingrained in our system that we don’t even notice it.’
Fear of its very ‘maleness’ has made us tremble before testosterone, when in fact it is an integral part of women’s lives and in particular their health in later years.
Natural testosterone loss reaches a nadir at about the age of 62 on average – and one study shows that, surprisingly, testosterone takes a turn for the better for a small number of women as they head towards 70.
Adapted from How To Have A Magnificent Midlife Crisis by Kate Muir (Gallery UK, £16.99), to be published June 5. © Kate Muir 2025. Follow Kate Muir on Instagram @menoscandal
