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Menopause and Low Sex Drive

Woman looking out of window demonstrating low mood associated with loss of libido during menopause in women

I get so many women talk to me about loss of libido. This can be due to many factors, but I feel the reasons women don’t want to have sex can apply throughout our life phases from pre-conception, childbearing, and menopause. In this post I am referring to menopause and loss of sex drive, but I think most women can relate to this post. 

Loss of sex drive is extremely common, but not widely talked about. It is often linked to vaginal symptoms like dryness and irritation, mood changes and lower testosterone levels.

What is menopause related loss of sex drive?

If you’ve noticed that your sex drive isn’t what it was, please don’t worry, as you’re not alone – it’s something I hear a lot. The truth is that most women have less desire to have sex as they get older.

Sexual desire, also known as sex drive or libido, is controlled by the brain. It’s the biological, driving force that makes us think about sex and behave in a sexually active way. When we talk about sexual arousal, we refer to the physical changes that happen when we experience desire from the anticipation of sex. These include:

  • Increased blood flow to the vagina
  • Increased vaginal lubrication
  • Swelling of the external genitalia or ‘vulva’ (including the opening of the vagina, the fleshy lips surrounding this and the clitoris)
  • Expanding of the top of the vagina inside the body
  • Increased heart rate, breathing and blood pressure

Remember, desire and arousal aren’t the same thing. You might find that your levels of desire decrease, but your arousal and response don’t change. However, when sexual intercourse is pleasurable, desire can increase. If sex is painful or unsatisfactory, you can, unsurprisingly, also experience a loss of arousal and desire. It’s no surprise that menopause can affect all the different aspects of your libido.

Why does loss of sex drive, or libido, happen?

Feeling busy, stressed, or tired can make you feel less sensual. Whether it’s a never-ending to-do list or broken sleep, it’s easy to feel a bit run down. You might also feel less attractive, due to (the entirely natural) changes to your body. All these different things can make you feel less like having sex.

You may be surprised to learn that testosterone is found in women as well as men and can play a part in our sex drive. Testosterone levels fall gradually during our adult life, which is important for some women.

Oestrogen levels play a big role in female sex drive. The natural loss of oestrogen during menopause affects mood and energy levels and our libido too. The physical effects of falling oestrogen levels, like hot flushes and night sweats, and vaginal dryness, can also have an adverse effect on your sex life.

Changes to the vagina and vulva from loss of oestrogen can lead to vaginal dryness, soreness, and irritation. Loss of elasticity of the entrance to the vagina affects some women, making penetrative sex painful or difficult. The tissue here can become very delicate and easy to split, which causes considerable pain. Changes in the blood supply to the vulva can mean that orgasm is more difficult, takes longer or is less intense.

Don’t forget, it’s not just about what’s happening in your body. Your surroundings and relationships make a big difference too. If you have relationship issues that you aren’t happy about, they can have a real impact on how you feel about sex.

You may feel that there are issues within your long-term relationship – these may include boredom, infidelity, lack of communication or a combination of anger, frustration, or resentment for whatever reason. You may be dating and facing the challenges of meeting new partners while dealing with confidence issues. Whatever your personal situation, the good news is that there’s plenty that you can do about a lack of sex drive.

How many women typically experience loss of libido?

A loss of sex drive is a common issue for women. Surveys have found that up to 40-50% of women going through the perimenopause and menopause experience loss of sex drive and can occur at any stage of the menopause transition – so from early in the perimenopause to postmenopausal life.

How can loss of sex drive be treated?

Sex in the menopause is a complex topic and there’s no one list that covers off how everyone feels and experiences it. If sex drive is an issue for you, we recommend speaking to a sex and relationship therapist. Talk to your partner, your doctor, or a therapist. You might want to try either relationship therapy or psychosexual therapy, depending on the root of the loss of sex drive.

Lack of desire can stop you letting your partner know you’d like to have sex. Partners sometimes feel that they are the problem and if you don’t talk about how you feel, relationship issues can develop.

Explaining that it’s the menopause and hormones – not your partner – can be helpful. Maintaining physical contact with your partner helps to keep you close and connected. Communication is key.

Vaginal oestrogens can be brilliant for helping vaginal symptoms and are prescribed by doctors. When you put oestrogen directly into your vagina, your body only absorbs a tiny amount, but it can have a positive effect on vaginal symptoms of the menopause.

Make time and space to relax in whichever way is helpful, whether it’s yoga, meditation, exercise, going for a walk or having a bath. Exercise can also help by improving your sense of wellbeing, releasing testosterone and aiding weight loss. It doesn’t have to be marathon running, just something to get the blood pumping!

Make sex more pleasurable

If you’re wondering how to increase sex drive, there are some other things you can try:

Lubricants and vaginal moisturisers – non-scented, water-based lubricants are best. Lubricants for menopause can be oil-, water- or silicone-based. The oil-based ones can be better, as they last longer, but watch out if you use condoms for contraception as the oil can make them less effective.

Vibrators – they can work wonders and can be ordered from the privacy of home. The extra sensation can help orgasm, either with your partner or by yourself.

Masturbation – don’t put pressure on yourself (any kind of pressure is a killer to sex drive), but a little self-pleasure can make you feel good and help you relax.

Hormone Replacement Therapy (HRT) – Hormonal Replacement Therapy isn’t just good for hot flushes, it can help improve your sex drive too. HRT can help with many menopause symptoms, so it’s worth reading about.

Pelvic floor exercises – Having a strong pelvic floor can help with arousal. On the flip side, pelvic floor relaxation may be helpful if muscle tension is an issue for you and causes painful sex.

Testosterone – There is evidence that it helps some women with desire and arousal. Unfortunately, there is no licensed testosterone preparation for women in the UK, but tiny amounts of male testosterone can be prescribed.

I hope this helps you to understand more about yourself and your body and know that you are not alone. It may be helpful to share with your partner, to help open an adult conversation about your sex life together.


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