Where Did My Libido Go? Navigating Sex Drive During Menopause

It’s a well-studied topic, and there’s no shame in talking about it: menopause can affect your sex life. If you’re feeling a dip in your sex drive during the menopause transition, you’re not imagining it.

Let’s discuss the complicated relationship between menopause and intercourse: we’ll cover the mental and physical changes, hormonal causes of sexual problems, and the treatment options that can help.

More than just low sex drive: What is female sexual dysfunction?

An estimated 22-43% of women worldwide deal with sexual problems. These problems can show up in several ways, but most fall under the umbrella term of female sexual dysfunction (FSD).

FSD is most common among menopausal people: 14% of 45-64 year-olds report experiencing one or more distressing sexual issues. For FSD, distress is the defining factor: a sexual health change isn’t necessarily a dysfunction if it doesn’t bother you!

Kinds of female sexual dysfunction (FSD)

Aligning sex drive, arousal, and pleasure can be complicated, even at the simplest of times. FSD can complicate one or all of these elements and make satisfaction even more elusive. These conditions can affect any kind of sexual activity, including penetration, digital, anal, and oral sex.

FSDs are conditions that cause problems with one or more of the following:

Sexual desire, aka libido
Sexual arousal, or the physical response to sexual stimuli
Ability to orgasm or experience pleasure
Pain from sex or penetration

Sex isn’t always straightforward, and neither is sexual dysfunction. FSDs can overlap, start suddenly, and change over time.

As we talk about FSDs, keep in mind: the problem often goes beyond the physical body. Mental, emotional, and relational factors can greatly affect the physical side of sexual functioning.

To support your sex life during menopause, recognizing the complexity of sexual desire is a good first step.

The elements of sexual response

Libido

Hormonal changes during perimenopause and menopause certainly can affect your natural sex drive. However, a sudden, libido-driven urge to get busy isn’t always the first step in sexual activity.

A popular model of female sexual response offers an alternative: for people born with ovaries, emotional intimacy often comes first. Feeling emotionally close to your partner can motivate you to initiate sex or make you more receptive to your partner’s advances.

Physical arousal

The genitourinary syndrome of menopause (GSM) can impact your body’s response to sexual stimuli. Specifically, GSM can cause vaginal dryness, thinning of the vaginal walls, and decreased vaginal lubrication, all of which can make sex—particularly penetration—less appealing.

Pleasure

As people with vaginas get older, it can become more difficult to achieve sexual pleasure and orgasm. It may take longer and need more stimulation to achieve the same amount of pleasure, and sensations may be more muted overall. Keep in mind: pleasure patterns may change, but with some modifications, you can continue to enjoy sex!

Discomfort

Painful sex is a common symptom of GSM, and pain from penetration affects anywhere from 13-84% of postmenopausal women. Discomfort may come from several sources, including thinning vaginal tissues or pelvic conditions. Some people experience pain during sex, while others only notice it after the fact.

The current research focuses primarily on pain from penetration. However, some people experience discomfort from external stimulation. Those with vulvodynia, or chronic vulvar pain, may feel a sharp pain or burning sensation from touch alone.

Sex drive and menopause: A complicated relationship

If you’re perimenopausal, it’s natural to wonder when you might experience a change in your sex drive, and what causes it.

When to watch out for a dip in drive

A large national study, called SWAN (Study of Women’s Health Across the Nation), investigated how sexual functioning changes around the time of a woman’s final menstrual period (FMP). They followed 1,390 women aged 42-52 and discovered the following:

20 months before the FMP: sexual function started to decline
20 months before the FMP to 12 months after the FMP: sexual function declined most rapidly
1-5 years after the FMP: decline in sexual function continued, but more slowly
The biggest reported changes: increased pain and decreased sexual interest

It’s impossible to know exactly when you’ll stop menstruating, or when you’ll notice a change in sexual functioning—if you even do. But knowing what might happen can help you prepare and explore your treatment options.

Possible causes

Sexual function may continue to worsen the longer you progress through menopause. While hormones contribute, there’s plenty still within your control.

Contributing factors to consider include:

Hormonal changes: Lower estrogen levels, combined with an age-related drop in androgen hormones, can contribute to FSDs. Specifically, you may notice low sex drive, decreased arousal, increased pain from sex, difficulty reaching orgasm, and lower satisfaction.
Mental health: Mood disorders and self-criticism can greatly affect your relationship with sex and intimacy. Stress, anxiety, and depression are all correlated with lower sexual function.
Vaginal dryness: Some studies suggest that dryness plays a key role in sexual decline, while others disagree. Either way, there are treatments that can help alleviate this symptom.
Physical health: Studies suggest that maintaining good physical health often correlates with better sexual function as people age.
Relationships: Having a partner may help maintain sexual function, but declines in relationship quality can have a negative impact.

The emotional side of desire

Shifts in sex drive and satisfaction happen to everyone over time. What distinguishes FSD is whether it causes you emotional suffering or affects your relationships.

The (surprising!) mental burden

One study of over 31,000 women, from the ages of 18 to 102, found that sexual problems did increase with age. But here’s some good news: distress related to those problems didn’t. This pattern held true for women in other countries with distinct cultures and norms.

The takeaway: Lower sex drive and other issues become more likely as you age, but dealing with those issues might not create a major mental toll.

Satisfaction vs. function

Menopause and aging may impact how your body responds to sex. However, sexual function is not the same as sexual satisfaction.

An analysis of 1,345 women found that menopausal status alone wasn’t the main determinant of their sexual satisfaction. Other factors were more strongly linked to satisfaction levels, including how important participants felt sex was, how well they communicated with their partners, and their overall relationship satisfaction.

Sex might not look or feel the same, but your sex life can still be satisfying during the menopause transition and beyond.

How to increase sexual desire

Navigating sex and menopause can be tricky, but certain treatments can help. The first step in accessing treatment is speaking with your healthcare provider.

There’s no reason for embarrassment here: doctors have heard it all. Being open and honest about your sexual history, symptoms, and desired outcomes is essential.

Your provider may recommend a physical examination, which includes a pelvic exam, and discuss any medications you’re currently taking.

These assessments help inform your possible treatment options.

Non-hormonal treatment

Menopause can cause some big changes in your sex life, but simple treatments can make a world of difference. Consider some—or all!—of the following:

Vaginal moisturizers: The Menopause Society (formerly the North American Menopause Society) recommends vaginal moisturizers as a first-line treatment for GSM symptoms. These topical creams help treat vaginal dryness and increase moisture. Ideally, you should use them regularly: their benefits often last several days.
Vaginal lubricants: Used during sex to add additional moisture, lubricants are also a first-line therapy for dryness and painful intercourse.
Vitamin E: Using vitamin E suppositories may help relieve symptoms like vaginal thinning and dryness. They might be a possible alternative if you’re unable to use vaginal estrogen.
Pelvic physical therapy: Physical therapists can help you both strengthen and relax your pelvic floor muscles, helping to improve sexual functioning. Pelvic PT can be especially helpful if you also have other pelvic floor symptoms such as bladder leaks or constipation.
Sexual health and intimacy counseling: Sex is as much a mental game as it is a physical one. Cognitive behavioral therapy, mindfulness, and mental health understanding can all help improve your desire. Therapists who specialize in sex counseling can be a huge help for people struggling with sexual dysfunctions.

Topical hormonal treatment

Hormone therapy can help treat menopausal symptoms that negatively affect your sex life. The following options are topical treatments, meaning you apply them directly to the inside of your vagina.

Vaginal estrogen: This common treatment for GSM symptoms is available in a cream, suppository tablet, or vaginal ring. Estrogen can help reduce pain with sex and vaginal dryness. It may also have a positive impact on sexual interest and overall sexual function.
Vaginal progesterone (DHEA): DHEA can help with GSM symptoms and improve sexual functioning. Like vaginal estrogen, DHEA may positively affect your sex drive and functioning.
Vaginal testosterone: This option isn’t FDA-approved for treating GSM symptoms, but some providers prescribe it off-label. Some studies show that it may offer effects similar to vaginal estrogen.

Systemic treatment

There are also several options for systemic treatment, such as a patch, a pill, or a combination of both. These treatments administer medication through your circulatory system and affect your whole body.

Estrogen or combination hormone therapy: Menopause hormone therapy (MHT) can help with vaginal dryness and painful intercourse, but it’s often not enough to completely solve GSM symptoms. Doctors often advise combining this option with vaginal estrogen.
Ospemifene: An oral pill specifically approved to treat GSM symptoms, studies have shown that Ospemifene improves painful sex and vaginal dryness.
Flibanserin: This medication received FDA approval to treat sexual desire and arousal issues in premenopausal women. Filbanserin isn’t approved for postmenopausal people. However, the available safety and efficacy data support its off-label use. Speak with your provider to see if it’s safe for you.
Bremelanotide (Vyleesi): This medication is the second to receive FDA approval to treat low sexual desire in premenopausal people.
Transdermal testosterone: Though it’s not currently FDA approved, systemic transdermal (through the skin) testosterone is a common off-label treatment that may increase sexual desire for postmenopausal women.

Vibrators and other options

Caring for your sexual health in menopause demands a holistic approach. Enjoying erotic podcasts or books, connecting emotionally with your partner, getting enough sleep, and maintaining a healthy weight can all help you stay sexually active.

A study of 79 women aged 18-80 found that using a vibrator helped participants improve their sexual function in several ways. After three months, participants reported increased desire and arousal, improved rates of orgasm, and better overall sexual satisfaction.

Results from this study also showed that vibrators helped participants maintain pelvic floor health and even decreased their rates of depression! With these potential benefits, a vibrator is a worthy addition to your sexual health toolkit.

Tracking your sex drive during menopause

Whether it’s a decrease in desire or an increase in discomfort, understanding your GSM symptoms is essential to treating them. Tracking helps you stay in the know and in control.

Vaginal dryness is an excellent example because it doesn’t go away on its own. Noticing changes, speaking with your provider, and getting treatment is often the best path forward.

Sex drive may feel difficult to quantify, but it’s still important to note how it changes over time. Remember that changes in sex drive are common and well worth your attention.

If you’re not sure how to start the discussion with your provider, tracking can help! You can make the conversation more comfortable by having clear data on your symptoms: when they started, how they’re progressing, and how they’re making you feel.

Questions to ask your provider

Talking with your provider about FSD and GSM symptoms is well worth the effort. Here are a few questions you can ask to get the conversation started:

I’ve been noticing a drop in my sex drive recently, and it’s really bothering me. Do you think (peri)menopause could be causing it?
Sex has been uncomfortable and even painful lately. Can you walk me through any potential treatment options and help me find the right one for me?
I’d like to talk about some alternatives to hormone therapy for my symptoms. Can you offer some suggestions or refer me to a pelvic physical therapist if indicated?

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.