Low libido

Understanding Changes in Libido During Menopause

Changes in sexual desire during perimenopause and menopause are incredibly common, though not often openly discussed. For many women, a previously consistent sense of sexual interest or intimacy may shift, sometimes gradually and sometimes suddenly. These changes can be influenced by hormonal fluctuations, sleep disturbance, stress, physical symptoms like vaginal dryness, and emotional or psychological factors.(1)

It is also important to note that changes in libido are common throughout a woman’s life, not just during menopause. Sexual desire naturally varies across different life stages and circumstances. A lower libido is not automatically a problem that needs to be ‘fixed’.

What matters most is how it affects you. If low libido causes distress, creates tension in a relationship, or affects your overall quality of life, then support and treatment options are available.

These changes are real, and there are compassionate, evidence-based ways to explore what you need, whether that is reassurance, support, or treatment.

The Hormonal Landscape: Why It Happens

As oestrogen levels decline during menopause, several physical and neurological changes can affect libido. Oestrogen plays a role not only in maintaining vaginal tissue and lubrication, but also in supporting the brain’s regulation of mood and desire [3].

Testosterone, though often overlooked in women, also contributes to libido, arousal, and overall sexual satisfaction. Levels of testosterone decline steadily from a woman’s 30s onward and may drop further during menopause [4].

Other symptoms of menopause such as vaginal dryness or atrophy, hot flushes, night sweats, sleep disruption, and mood changes can all reduce interest in sex, or make intimacy feel like another burden rather than a source of connection [5, 6].

Beyond Hormones: Emotional and Relational Factors

Libido is not just hormonal. It’s relational, emotional, psychological and deeply personal.

Factors that can contribute to low libido during midlife include:

• Chronic stress of being pulled in many directions including caring for elderly parents, juggling work, children, social life.
• Poor body image or changes in self-esteem or personal and societal attitudes to ageing
• Relationship difficulties
• Loss of emotional intimacy or communication breakdown
• History of trauma or negative sexual experiences [7, 8]

All of these are valid. And all deserve attention in the context of whole-person menopause care.

What Can Support Libido in Midlife?

There is no one-size-fits-all solution, but there are effective, evidence-based options. Often, it starts with a conversation.

• Hormonal Therapies:
  • Systemic HRT (oestrogen with or without progesterone) may improve libido indirectly by improving sleep, mood, and reducing other symptoms.
  • Testosterone replacement can be considered for postmenopausal women with persistent low libido not explained by other causes. This is recommended in some clinical guidelines when prescribed by a specialist [9, 10].
  • Vaginal oestrogen (creams, tablets, rings) can reduce dryness, irritation, and discomfort during sex which significantly improves sexual confidence and comfort [11].
• Therapeutic Support:
  • Cognitive behavioural therapy (CBT) and sex therapy can be helpful in addressing psychological or relational barriers.
  • Couples therapy may support communication and connection, particularly if sex has become a source of tension.
• Lifestyle Interventions:
  • Regular physical activity can boost mood and body confidence.
  • Prioritising stress reduction, rest, and non-sexual touch can rebuild intimacy gently.

When to seek help and what to expect

If low libido is affecting your wellbeing or your relationships, it is worth speaking to a menopause-aware clinician. These conversations can feel awkward at first but they are important.

A good clinician will explore your symptoms, health history, and life context. They may recommend blood tests (e.g. to assess testosterone levels), offer guidance on HRT options, or suggest referral to a specialist in sexual health [12].

Low libido during menopause is common. But that doesn’t mean it should be ignored. With the right support, sexual wellbeing can be reclaimed and redefined in a way that feels right for you.

References

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1. NHS Inform. Sexual wellbeing, intimacy and menopause. https://www.nhsinform.scot/healthy-living/womens-health/later-years-around-50-years-and-over/menopause-and-post-menopause-health/sexual-wellbeing-intimacy-and-menopause/

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1. North American Menopause Society. Sexual health and menopause. https://www.menopause.org/patient-education/menopause-topics/sexual-health

^³

1. Davis SR et al. Global consensus position statement on the use of testosterone therapy for women. J Clin Endocrinol Metab. 2019;104(10):4660–4666.

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1. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970-978.

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1. Johns Hopkins Medicine. How sex changes after menopause. https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-sex-changes-after-menopause

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1. NHS. Loss of libido. https://www.nhs.uk/symptoms/loss-of-libido/

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1. Kingsberg SA. Hypoactive sexual desire disorder in women: pathophysiology and treatment. Obstet Gynecol Clin North Am. 2006;33(4):625-636.

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1. Mayo Clinic. Low sex drive in women: diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/diagnosis-treatment/drc-20374561

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1. Wierman ME, Arlt W, Basson R, et al. Androgen therapy in women: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2014;99(10):3489–3510.

^¹⁰

1. Simon JA et al. Local effects of vaginal estrogen therapy. Menopause. 2013;20(10):1043-1049.

^¹¹

1. Parish SJ, Clayton AH. Sexual medicine for the menopausal woman. Best Pract Res Clin Obstet Gynaecol. 2015;29(5):691-702.