How does menopause affect my sex drive?

The science behind why menopause impacts your libido, plus tips on boosting it

Sex drive. It’s an aspect of the perimenopause and menopause that all too often remains taboo.

Here we look at the reasons why your sex drive can plummet during the perimenopause and menopause, plus strategies and treatments that can help get things back on track in the bedroom.

What is libido?

Libido refers to your sex drive. It includes how often you feel like being sexually intimate, your level of desire and how much pleasure you get from sexual experiences.

There are lots of things that can affect your libido, including:

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

Which hormones affect my libido?

Two hormones are important for your libido: estrogen and testosterone. The amount of these hormones produced by your body declines during the perimenopause and menopause which can reduce your sex drive and lead to irritability and mood changes that can impact on your relationship. Lack of estrogen can also cause vaginal dryness and soreness which can make sexual intimacy painful. Taking replacement estrogen in the form of HRT can help to tackle these symptoms and improve your libido too. Some women may also need to take testosterone replacement to help their libido if HRT alone is not effective [1].

Is my medication causing this?

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 makes 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 estrogen 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 people benefit by taking testosterone as well as estrogen. Many people take progesterone tablets as part of their HRT, one type in particular – micronized progesterone – is a natural sedative so 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.

I don’t want sex – it hurts too much!

Sex can become painful during the 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 estrogen 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 estrogen also makes the vagina less stretchy which can cause pain during sex.

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 estrogen (also known as local estrogen) alongside HRT to manage symptoms. Topical estrogen is applied directly on the affected area in the form of a pessary, gel, ring or cream. Local estrogen can be taken safely for a long time alongside your HRT with no associated risks. To find out more information read the Vaginal Dryness Factsheet available here.

As well as estrogen 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 which makes sex more comfortable – however remember that oil-based lubricants can make condoms less effective.

The ingredients in some lubricants can worsen vaginal irritation such as glycerin, glycols or parabens 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 make a vaginal moisturiser that is low irritant but is different to their 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.

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, 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 and 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 at least three times a week such as swimming, walking or yoga – this 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. We know 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.
Stop smoking – research has shown that smoking can actually increase anxiety and tension after the initial immediate feeling of relaxation [3]
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 our 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 with your partner 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.

There are many ways you can improve your sexual arousal – foreplay is important and can also boost your natural lubrication to make sex more comfortable.

For some women, erotic literature in the form of books or audiobooks can help with your libido and arousal. 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 [3]. 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.

Sex can become boring if you have been with the same partner for a long time. There are lots of ways 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.

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.

RELATED: the importance of exercise

In addition, exercise helps to boost your endorphins which are 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!

Strengthening your pelvic floor muscles can improve the quality of your orgasm as well as helping with symptoms of urinary incontinence and vaginal prolapse. This factsheet contains a step by step guide to pelvic floor exercises, while 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.

References

National Institute for Health and Care Excellence (2015), ‘Menopause: diagnosis and management’, www.nice.org.uk/guidance/ng23
Leavitt, C.E. et al. (2021), ‘Linking sexual mindfulness to mixed-sex couples’ relational flourishing, sexual harmony, and orgasm’, Archives of Sexual Behavior, 50,6: 2589-602. doi:10.1007/s10508-021-02054-0
NHS.uk (2021), ‘Stopping smoking for your mental health’, www.nhs.uk/live-well/quit-smoking/stopping-smoking-mental-health-benefits

Further information

Institute of Psychosexual Medicine