Everyone’s sex life is going to have lulls. Stress, exhaustion, relationship issues, and a million other things can put “having sex” towards the bottom of your to do list. But if you’re going through the menopause transition, it can fall off the list completely — something that has a lot to do with your hormones. Menopause significantly reduces your body’s levels of estrogen and progesterone as well as androgens (male hormones) — all of which are linked to libido. Here, learn what’s going on, how to know if your loss of libido is an issue, and what you can do to get yourself back in action.
What is libido?
Libido is defined as sexual interest, appetite, or desire. It’s the feeling you may get when reading an extra spicy romance novel or looking at your partner and thinking how attractive they are. It may seem like your libido is all in your head, but it’s actually regulated by certain hormones. Estrogen and testosterone increase sexual desire, while progesterone can suppress it. It’s why you might have noticed in the past that you’re in the mood more often during certain times of the month.
How common is menopause-related loss of sex drive?
Noticing you’re less into sex is extremely common for women in midlife. A systematic review looking at over 80,000 women found that up to three out of four reported sexual dysfunction at some point during menopause. “Sexual difficulties can range from a lack of interest in sex to trouble having an orgasm,” says Dr. Aimee Eyvazzadeh, M.D., an OB-GYN and reproductive endocrinologist based in San Ramon, California. It can be an issue with desire or arousal — anything that gets in the way of you having a pleasurable, satisfying sex life.
What causes decreased libido during menopause?
This is not a case where a single thing is to blame, according to Dr. Stephanie Faubion, M.D., the director for the Center for Women's Health at the Mayo Clinic, medical director for The Menopause Society, and member of the WeightWatchers scientific advisory board. But what kicks it off tends to be the fluctuating hormone levels, with lower estrogen and progesterone having a domino effect that ends with less libido. Here’s what’s going on:
Reduced blood flow
Lower estrogen levels reduce blood flow to the clitoris and vaginal area, which decreases the ability to be aroused. With less blood pumping and flowing well in the vaginal area, things may not feel as “awake” or sensitive down there, which can make it much harder to get in the mood or enjoy sex like you did pre-menopause.
Vaginal dryness
Estrogen is a hormone that helps your vagina stay lubricated — it’s why you may have noticed extra discharge at certain points in your cycle — so when it drops, it can affect how you feel. As your body starts producing less estrogen, the result is less moisture down there. “Vaginal dryness can lead to discomfort or even pain with sexual activity,” says Faubion.
Less energy
Menopause can leave you feeling tired for several reasons, taking a toll on libido. For one, dipping progesterone levels can cause flat-out fatigue. Plus, says Evyazzadeh, “hormonal changes can lead to sleep disruption,” leaving you even more drained. If you’re exhausted from night sweats-induced insomnia, the only thing you may be in the mood for is more rest.
Brain changes
The hormonal shifts in menopause can also increase the risk of depression and anxiety, which then can decrease libido. Other mental health-related factors, such as feeling worse about your body due to menopausal weight gain and aging, can bring down your self-confidence and make you less likely to want to get naked with your partner.
Symptoms of decreased libido
The exact way a lower libido presents itself can vary from person to person, but symptoms generally include:
- having less or no interest in sex
- not having sexual thoughts or fantasies
- being depressed or concerned about a lack of sexual activity
While many women may write these symptoms off as “normal” or simply a part of menopause, Faubion encourages women not to just accept things as they are. “I don’t reassure women about these symptoms,” she explains. “I try to help women identify the factors that could be contributing to low sexual desire so that we can address them.”
Treatment for decreased sex drive
There are various treatments, including medication and therapies, that can help you feel more desire and interest in sex.
Lifestyle changes
Lifestyle changes are often the first line of defense against low libido. Eating a balanced diet, being physically active, managing stress, and getting good sleep can all help. This can feel overwhelming, especially with menopause making stress high and sleep difficult, so focus on making small changes in your daily habits. For example, making sure you eat enough protein and drinking enough water can increase your energy, which may make you more motivated and excited in the bedroom. And going on evening walks can improve your mood, increase blood flow in the body (including your sex organs), and help you to feel more confident about your body overall.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT), sometimes known as menopause hormone therapy (MHT), is commonly prescribed to treat menopausal symptoms, including loss of sex drive, mood swings, sleep issues, vaginal dryness, hot flashes, night sweats, and more. These medications come in tablets, skin patches, gels, or vaginal creams, and typically provide a mixture of estrogen and progesterone. Faubion notes that low dose vaginal estrogen (the creams, tablets, rings, and inserts applied directly into the vagina) is most likely to improve low libido. “Systemic estrogen therapy is not known to help with low sexual desire beyond the impact on vaginal dryness,” she explains. Consult a medical professional to determine if HRT is appropriate for you.
Lubricants and moisturizers
If vaginal dryness is impacting your sex drive, common over-the-counter lubricants, made with an oil, silicone, or water base, can provide immediate, short-term relief during sex. For more of a long-term solution, over-the-counter vaginal moisturizers can improve comfort and tissue elasticity. Talk with your healthcare provider to determine which product is best for your needs and when to use it.
Other medications
There are several non-hormonal medications that may be able to increase your sex drive. Buspirone, an anti-anxiety medication, is sometimes used to improve libido by modulating serotonin and dopamine levels. Wellbutrin, a popular antidepressant, increases dopamine and norepinephrine, which may result in boosted libido as a side effect. Be wary of supplements that claim to boost your libido, like maca and ginseng, as they lack supporting evidence and may interact with other medications.
Pelvic floor exercises
You’ve likely heard of kegels — the move where you contract your pelvic floor muscles and hold them — as being helpful for incontinence, but they can also help with sex. That’s because when the pelvic floor is strong, sex will feel better. After 12 weeks of pelvic floor exercises, postmenopausal women reported improved sexual function, including more arousal, orgasm, and satisfaction. While pelvic floor exercises don’t directly affect libido, they can help you to build stronger, more engaged muscles, improve blood flow and sensation, decrease discomfort, and boost confidence.
Therapy and counseling
There are likely some psychological components to having a decreased sex drive, including changes in self-esteem related to menopause and a shifting dynamic with your partner. That’s where therapy might be able to help. “Counseling can help women and their partners address all the contributing factors to low sexual desire, either directly or indirectly,” says Faubion. Consulting with a psychologist, social worker, or certified sex therapist may improve communication and, as a result, sexual desire.
The bottom line
If you’re going through menopause and experiencing lower than usual sexual desire, or no interest in sex at all, you’re not alone. Low libido is extremely common during menopause due to the natural decline of two key hormones: estrogen and progesterone. The drop in those hormones sets off a domino effect of bodily changes that may result in painful, uncomfortable sex, like vaginal dryness, as well as depressed mood, anxiety, fatigue, and frustration. Thankfully, there are multiple treatments, including HRT, and lifestyle changes you can incorporate to help you get back in the groove, and make sex feel good again.
FAQs
Yes, your libido can come back. “Libido can and often does return after menopause,” says Eyvazzadeh. “Many women adjust to the 'new normal' hormone levels and experience their libidos returning.” To help the process, talk with your provider about your symptoms and work with your partner to keep communication open.
Research suggests that low libido during menopause can last for years, although the duration and significance vary depending on the person. For most people, the loss of libido is not permanent, and will improve over time.
Yes, menopause can make sex uncomfortable. Dropping estrogen levels can lead to vaginal dryness and thinning of vaginal tissues, which can make it painful to have intercourse. Fortunately, there are treatments that can help to improve pain related to vaginal dryness, such as lubricants and moisturizers. Talk with your healthcare provider to find out what might work best for you.
This content is for informational purposes only and does not constitute medical advice, diagnosis or treatment. It should not be regarded as a substitute for guidance from your healthcare provider.