There are many reasons why the thought of sex may fill you with dread rather than desire during menopause. Low sex drive is a common symptom and some people are content with little or no sex. If you want to boost your libido, read our guide on how menopause can affect your sex drive and whether hormone therapy (HT) can make a difference.
What is libido?
Libido is another word for sex drive and refers to how much you feel sexual desire.
This is different for everyone and it can fluctuate over the years. Libido can be affected by illness, mental health, and hormonal changes – and of course that includes menopause.
Low libido is a common and sometimes upsetting issue during menopause. When low sexual desire becomes distressing and disrupts your life, it is called hypoactive sexual desire disorder (HSDD).
What happens to your libido during menopause?
How much sex you have or don’t have is personal to you. It may help to know that 15% of married individuals had not been intimate for a year – and 13.5% for five years – according to a study of 18,000 US adults.
Research shows that sex drive often decreases at this time of life. Women who go through spontaneous menopause are 50% more likely to report low desire compared to premenopausal women.
Those who have been through surgical menopause are 30% more likely than premenopausal women to report this symptom. They also have double the risk of developing hypoactive sexual desire disorder (HSDD) compared to premenopausal women.
Why does menopause lead to low sex drive?
It is impossible to pinpoint a single cause of low sex drive for most people, but there are some common culprits. Here are the three main ways menopause may be getting in the way of enjoyable sex:
Troublesome symptoms
Let’s face it, some menopause symptoms can be distressing and uncomfortable and sex is likely the last thing you want to do when you are sleep-deprived, plagued by hot flushes, or lacking energy.
Your mental health may also hold you back in the bedroom. Menopause can cause anxiety, depression, and mood swings, all of which can contribute to a low libido or strain your relationship in other ways.
Vaginal and urinary issues
Low estrogen levels also directly affect the tissues of the genital area. The vagina, vulva, clitoris, and perineum can all suffer as hormonal changes lead to dryness, pain, tightness, and shrinking. Urinary tract infections (UTIs) also become more common.
Together, these changes are known as vaginal atrophy or atrophic vaginitis.
As you might expect, these symptoms get in the way of sex for many people. If sex is painful, your libido is bound to take a nosedive. It is important not to force sex when it is uncomfortable.
GSM affects over 50% of women of menopausal age, but it can be treated effectively with low-risk vaginal HT.
Read more about painful sex in menopause.
Less satisfying sex
Low estrogen levels can also mean that sex feels less pleasurable than it used to. Blood flow to your vagina decreases during this time and it can be more difficult to feel aroused or to achieve orgasm. Sex can quickly lose some of its old appeal.
Does hormone therapy (HT) improve libido?
HT may improve your libido, but it depends on what’s causing it.
Estrogen HT is an effective treatment for most menopause symptoms. This includes hot flashes, disrupted sleep, and mood swings as well as vaginal symptoms. If these are the cause of your low libido, you may well see an improvement after a few months on HT.
If standard HT hasn’t helped, testosterone may be an option for you, although it isn’t right for everyone. Doctors may advise a trial of this alongside estrogen HT if you haven’t seen an improvement in your libido after about three months.
Speak to your healthcare provider if you would like to discuss your HT options.
Which HT is best for libido?
Most types of HT can help with libido. You might feel overwhelmed by all the different kinds of HT available – your doctor can help you weigh up the options. The best option for you depends on your symptoms and the cause of your low libido. Let’s look at what’s available…
Systemic HT
Systemic HT supplies estrogen to tissues throughout your whole body and you take it:
- Orally – as a tablet
- Transdermally – as a patch, gel or spray absorbed through your skin
It is an effective treatment for most symptoms of menopause including hot flashes, poor sleep, and mood swings. It can also help improve menopause symptoms in your vagina and surrounding tissues.
While systemic HT is safe and effective for most people, it isn’t suitable for everyone. Your healthcare provider will be able to advise on the best choice for you.
Vaginal HT
Vaginal HT may help symptoms affecting your vagina, vulva, and genital area. Giving estrogen directly to these tissues through vaginal HT can be more effective in this area than systemic HT and helps make sex more pleasurable again.
Positive effects of this type of HT include:
- Less burning, tightness, itching, and bleeding
- More moisture and lubrication
- Improved arousal and enjoyment of sex
Vaginal HT is the safest form of hormonal treatment as very little estrogen is absorbed into the bloodstream. This means that it is suitable for most people.
Testosterone
Testosterone is prescribed if you have noticed no improvement in your libido even after taking HT for three months. It has been proven to help with low libido during menopause and is an increasingly popular treatment.
Testosterone is supplied as a cream or gel, which is rubbed into the skin of your arms, stomach, or thighs.
What else can improve libido?
HT isn’t the only solution to low sex drive, and may not solve the problem alone.
Lifestyle change
If you suspect that general menopause symptoms such as fatigue and poor mental health are part of the problem, you may find that a few lifestyle changes make a big difference, such as cutting down on alcohol and caffeine, improving your diet, and moving more. Try to:
- Get enough rest. Aim for 6-8 hours of sleep per night as a guide
- Manage stress
- Eat a healthy diet
- Consider how much alcohol, caffeine, and/or nicotine you are having. Tracking these things could help you spot patterns in your symptoms or sex drive
Rethinking your sex life
Menopause is a time of change, and sex is no exception. It is common to find that your body works differently at this time.
If you don’t feel sexual desire as often as you would like anymore, it may be time to take stock.
If you are in a relationship, how are things with your partner? Try talking to them or writing a letter about your experience and symptoms to help them understand what you are going through.
Would it help to work on intimacy or building your relationship outside the bedroom? Or do you need to spice things up and try something different? You could experiment in the bedroom and discover which menopause-friendly sex toys might work for you.
The same applies if you aren’t in a relationship. Do you need to think about different approaches to self-pleasure? Perhaps different things will turn you on during this time of change.
Menopause does not have to mean the end of sex if you still want it in your life, but it may well be the start of something new. Read more about how to have great sex in midlife.
A medical check-in
Speak to your healthcare provider if your symptoms are ongoing or severe. They may want to investigate your symptoms further or review your existing medications, as some can cause low libido. This includes certain blood pressure medications, anti-seizure medicines, and antidepressants.
Final word
Low libido is a common problem but it is not always easy to solve. HT (sometimes including testosterone) can help, as can simple changes like addressing stress.
Anuradha’s story of how treatment helped
Many women don’t talk about menopause because so many symptoms are linked to shame, much like periods and many other parts of a woman’s life. Symptoms creep up on you and it’s so hard to nail down until you are completely depleted. Before you know it, they have taken over and are destroying relationships and your professional life. I want to share what worked for me.
We need to talk about it
I was 39 when symptoms began and I have been dealing with fatigue, excess weight gain, brain fog, lack of energy, and low libido over the last five years.
I have no idea if my early perimenopause was linked to genetics as my family never talks about these things. It is very debilitating and stressful not knowing what is happening to your body and mind during menopause. I have a 10-year-old daughter and when she’s in her 20s, I will make sure I tell her to watch out for it!
A struggle to find solutions
Every woman goes through menopause and it is a natural aging process, but it felt like my healthcare provider was untrained to recognize any of the symptoms. I couldn’t cope and was struggling to have a successful career, but it was hard to get answers from my PCP in the 10-minute slot given.
Fortunately, my husband’s workplace had generous healthcare benefits. Even this wasn’t straightforward. I saw one healthcare professional who told me “This is part of life and you just have to learn to live with it.”
The next healthcare professional I saw said: “You need HT. You will be fine.” His attitude and help made a big difference to my life.
Treatment that worked
He prescribed estrogen patches and I had a testosterone implant under my rib for a couple of years, put in under local anesthetic. Now I have testosterone in a gel form that goes on my thigh, as it’s much easier.
Both treatments work in tandem to help me concentrate more and I’ve lost the indecisiveness that comes with brain fog. When I use testosterone regularly, I have proper energy and can get things done. If I miss it for a few days, my energy levels really plummet.
The impact on my libido
Testosterone also improved my low libido. When men go to their healthcare provider about libido, they get Viagra. When women go, there is no female Viagra. It’s like no one understands the impact and importance of not wanting sex for three years and trying to explain to your partner that they still need to have a good relationship with you. You feel you are letting them down and worry they think you are bloody bonkers – they might be right!
Read our guide on menopause and testosterone.
Women are worthy of having a sex life and we need it to be seen as a normal human body function. After all, you would go to your healthcare provider if you had a sudden loss of appetite as it indicates an underlying problem.
I’m a different person now. I will take whatever medication I need to get my life in order and have a personal trainer three times a week. I have tried acupuncture and it works for me. These practices are now essential for my survival!
It’s time to stop undermining myself
I am fifteen years behind in my career in terms of growth because of childcare and not being able to operate at my best. My daughter was young when I started having menopause symptoms and it was a horrible time. I lost jobs, couldn’t keep jobs, and felt pulled between home and work while symptoms meant I was operating at just 40% capacity.
We lose our self-esteem through the whole process of menopause and need to stop undermining ourselves, as everyone else is doing a good enough job of that. No more underselling and compromising on ambition, as I’d rather have my ambition than anything else!
I am not going to let other people decide how far I can go! Running a triathlon and getting promoted to C-level is not the only definition of success or being a hero. A hero is someone who can deal with their own life and still continue to put each foot in front of the other every day. That’s a real hero.
Find out more about menopause on our blog or in our symptoms library.
- Simon, JA 2011, ‘Identifying and Treating Sexual Dysfunction in Postmenopausal Women: The Role of Estrogen’, Journal of Women’s Health, vol. 20, no. 10, pp. 1453-1465
- Stella, Testosterone and menopause
- Stella, Our guide to different types of HT for menopause
- Stella, Non-penetrative sex options during menopause
- Stella, The best sex toys for sex during menopause
- Stella, Menopause and contraception
- West SL, D’Aloisio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM 2008. ‘Prevalence of Low Sexual Desire and Hypoactive Sexual Desire Disorder in a Nationally Representative Sample of US Women’, Arch Intern Med., vol. 168, no. 13, pp. 1441–1449
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