How do perimenopause and menopause affect my sex drive?

The reasons why they can impact your libido, plus tips on boosting it

Sex drive, or libido, is an aspect of perimenopause and menopause that often remains taboo. You may feel comfortable talking about your brain fog or flushes with friends but there’s not nearly the same openness around levels of desire or pleasure from sexual experiences.

Lots of things can affect your libido, including:

• Hormones
• Medication
• Relationship with a partner
• Vaginal dryness and discomfort during sex
• Stress
• Body confidence
• Sleep

Which hormones affect libido?

Two hormones are often important for your libido: oestradiol (a type of oestrogen) and testosterone. The amount of these hormones produced by your body declines during perimenopause and menopause, which can reduce your sex drive and lead to irritability and mood changes that can impact on your relationship.

Lack of hormones can also cause vaginal dryness and soreness, which can make sexual intimacy painful. Taking replacement hormones in the form of HRT and/or vaginal hormones can help to tackle these symptoms and improve your libido. Some women also benefit from testosterone to help their libido [1]. Testosterone can significantly improve sexual wellbeing for women, including sexual desire, function and pleasure. Other benefits can include improved energy, stamina, concentration and sleep, which can in turn increase wellbeing.

RELATED: The importance of testosterone for women

Does medication affect libido?

Medications can affect your libido in various ways. Some affect the chemical messengers in the brain that are involved in sexual arousal, others can worsen vaginal dryness, which can make sex uncomfortable, while some can impact on your ability to orgasm.

Types of medication that may reduce libido include:

• Medications for high blood pressure
• Medications for anxiety and depression such as antidepressants like citalopram, sertraline and fluoxetine
• Medications to treat psychosis
• Medications for allergy, such as antihistamines
• Chemotherapy
• Aromatase inhibitors

However, it is really important that you do not stop taking your medications without speaking to your GP or specialist first. They may be able to offer an alternative that is less likely to affect your libido.

I’m too tired for sex – what can I do?

Research has shown that poor sleep can reduce your sex drive [2]. It can also exacerbate problems such as depression and anxiety that can reduce libido further.

Lots of symptoms that occur during your perimenopause or menopause can affect the quality of your sleep. These include night sweats, needing to go to the loo lots, hot flushes, anxiety, restlessness and itchy skin. Additionally, the hormone melatonin that helps your body to regulate sleep is affected by the decline in oestrogen and testosterone, which can lead to a bad night’s sleep.

RELATED: Sleep and hormones factsheet

Replacing the missing hormones by taking HRT can improve sleep and some women benefit by taking testosterone as well as oestrogen. Many women take progesterone tablets as part of their HRT, and micronised progesterone (the type used in Utrogestan) is a natural sedative so it can help to get you to sleep. It is usually taken at night for this reason.

Other things you can do to help improve your sleep include:

• Sticking to a strict bedtime routine by going to bed at the same time each evening and getting up at the same time each morning
• Avoiding caffeine in drinks or foods (including chocolate) in the afternoon
• Switching off screens – the blue light from phones, TVs and laptop screens reduces your production of melatonin so try to avoid looking at these for at least an hour before bed
• Keeping your room as dark as possible by using blackout blinds or wearing an eye mask
• Avoiding alcohol before bed, as it can act as a stimulant and keep you awake at night
• Taking a magnesium supplement with Vitamin B to improve your sleep
• Doing an activity before bed to clear your mind and relax, such as meditation.

RELATED: Can you exercise your way to better sleep?

I don’t want sex – it hurts too much!

Sex can become painful during perimenopause and beyond, which understandably may reduce your desire for sex. You may feel dry or tight or notice soreness and burning in and around your vagina during or after sex.

These symptoms can happen due to low hormones, which causes thinning of the tissues of the vagina and reduced natural lubrication, leading to dryness, itching, inflammation and infections such as thrush or urinary tract infections. Lack of hormones also makes the vagina less stretchy, which can cause pain during sex.

RELATED: UTIs and menopause: what’s the link?

HRT can help to relieve vaginal dryness and soreness, which can help to reduce the amount of pain during sex. You may also need topical vaginal hormones alongside HRT to improve symptoms. Topical oestrogen and prasterone is applied directly on the affected area in the form of a pessary, gel, ring or cream. It can be used safely for ever alongside your HRT or own its own with no associated risks.

As well ashormone treatments, you can use moisturisers and lubricants that do not contain hormones but help to hydrate the vaginal tissues and make them feel less sore. These can be brought over the counter.

How lubricants can help

Lubricants are for using just before sex. Recommended brands of lubricants that do not contain irritants are YES OB (oil-based) or WB (water-based), Sylk and Sutil Luxe. It can sometimes be helpful for one partner to use a water-based lubricant and one partner to use an oil-based lubricant. This creates a ‘double-glide’ effect that makes sex more comfortable – however, oil-based lubricants can make condoms less effective.

The ingredients in some lubricants, such as glycerin, glycols or parabens, can worsen vaginal irritation but the recommended brands above do not contain these common irritants. Alongside lubricants, remember to use foreplay, which helps increase natural lubrication, and experiment with different sexual positions to help you find what is most comfortable for you.

Vaginal moisturisers help with general dryness and are long-lasting so may only need to be used every two to three days. Both Sylk and Sutil Luxe can be used as a lubricant and a vaginal moisturiser.

YES also makes a vaginal moisturiser that is low irritant but is different to its lubricant products.

If using the above treatments regularly does not improve your symptoms after three months, then it is important to let your doctor know as sometimes these symptoms can be due to other conditions.

RELATED: Sex, hormones and the menopause: Dr Kelly Casperson

I’m too stressed for sex – help!

Often perimenopause and menopause come at a very busy time in your life when you may be juggling work, relationships and perhaps caring responsibilities, so being intimate after a stressful day may be the last thing you feel like doing! Stress and poor mental health can also reduce your libido.

There are lots of things you can do to try to keep your stress in check:

• Make time for yourself: find something that lifts your mood and brings you joy such as a meal with a friend or going for a walk
• Prioritise sleep using the strategies above
• Keep physically active by doing a mixture of exercise such as swimming, walking or yoga at least three times a week. Exercise releases endorphins in the brain, which reduce stress and help you feel good
• Eat well: try to keep processed foods and sugary foods to a minimum and focus on a balanced diet
• Reduce or cut out alcohol. Alcohol can change the balance of chemical messengers in your brain, leading to more negative feelings such as anxiety, anger or depression. It can also worsen your menopause symptoms [3].
• Stop smoking – research has shown that smoking can actually increase anxiety and tension after the initial immediate feeling of relaxation [4]
• Download the balance app to keep track of your symptoms, nutrition, sleep, stress levels and medication. It also has a handy feature that you can use to time your meditation too

How can I improve my relationship and sex life?

Has sex become boring? If you have a partner, do you feel less attracted to them, or feel less attractive yourself? Busy and stressful lives often mean you don’t make time to connect with your partner, and that in turn can affect your libido.

Communication with your partner about how you feel is really important. Connecting without the pressure of sex can reboot your relationship – you can be intimate in other ways such as by cuddling, kissing, massage, spending time together as a couple and talking.

Sometimes relationship counselling can help you identify any issues in your relationship and address them together.

RELATED: Perimenopause and menopause: a guide for partners

There are many ways you can improve your sexual arousal. Foreplay is important and can boost your natural lubrication to make sex more comfortable. For some women, erotic literature can help with libido. You might want to explore books by Nancy Friday such as Women on Top, Men in Love or My Secret Garden.

Sexual mindfulness has been shown to help people feel aroused more quickly and may help to make orgasms more intense [5]. It helps you to focus on what is happening in your mind and body during sexual activity rather than thinking about the sensations and experiences as being bad or good.

If you have been with the same partner for a long time, sex may have become boring and you may want to spice up your sex life – experiment with lubricants and sex toys, talk to your partner about your sexual fantasies or even try them out. Try experimenting with different sexual positions or changing up the scenery by booking a hotel room. However, sex is about more than just penetration. Many couples can enjoy a satisfying sex life in other ways such as mutual masturbation, genital touching, oral sex and using sex toys.

Psychosexual therapy

Sometimes psychosexual therapy or sex therapy can be helpful. Sex therapists can provide counselling for individuals or couples – they talk to you about the problems you are having to decide if they are psychological, physical or both.

You may be given tasks to do by yourself or with your partner. Some of the problems that they can help with include lack of libido, difficulty achieving orgasm and pain during sex.

Your GP may be able to refer you to a sex therapist, or you can find a therapist privately by visiting the Institute of Psychosexual Medicine website.

RELATED: Emotionally supporting each other through the menopause

Can exercise help my libido?

Regular exercise has been shown to improve levels of desire, arousal, lubrication and quality of orgasm as it increases blood flow and sensitivity of the vagina. Exercise also helps to boost your endorphins – the hormones that make you feel good. This helps to reduce stress, which is often a big factor in low libido. Try to find an activity that you enjoy – any activity is beneficial!

RELATED: The importance of exercise

Strengthening your pelvic floor muscles can improve the quality of your orgasm as well as helping with symptoms of urinary incontinence and vaginal prolapse.  You can do this through pelvic floor exercises, plus swimming is also a good form of exercise for naturally strengthening your pelvic floor as you have to use these muscles to help you balance in the water.

Can supplements help my libido?

There is no magic pill to help increase libido – a holistic approach is required.

RELATED: Hypoactive sexual desire disorder: what you need to know

References

1. NICE guideline [NG23]: Menopause: identification and management
2. Kalmbach D. A., Arnedt J. T., Pillai V., & Ciesla J. A. (2015), ‘The impact of sleep on female sexual response and behavior: A pilot study.’ The Journal of Sexual Medicine, 12(5), pp.1221–1232. https://pubmed.ncbi.nlm.nih.gov/25772315/
3. Shihab S., Islam N., Kanani D., Marks L., Vegunta S. (2024), ‘Alcohol use at midlife and in menopause: a narrative review’, Maturitas, 189. https://doi.org/10.1016/j.maturitas.2024.108092.
4. NHS: Stopping smoking for your mental health
5. Leavitt, C.E., Maurer, T.F., Clyde, T.L. et al. Linking Sexual Mindfulness to Mixed-Sex Couples’ Relational Flourishing, Sexual Harmony, and Orgasm. Arch Sex Behav 50, 2589–2602 (2021). https://doi.org/10.1007/s10508-021-02054-0