It’s likely been a while since you had a “sex talk,” right? Has anyone sat you down to talk about the birds and the bees in your 40s? While you probably don’t need a primer for the basics anymore, sex can still be a somewhat taboo subject and women are often left in the dark about their reproductive health, especially when it comes to the menopause transition (sometimes not-so-fondly compared to a second puberty!). Along with the physical, hormonal, and emotional changes that can kick off during perimenopause, your sex drive, aka libido, can start to change as well—so let’s talk about it.
Does perimenopause affect libido?
It certainly can and often does! Up to 87% of women experience “diminished sexual desire” or loss of libido as they age, and many will notice those changes starting during the menopause transition.
But libido is highly unique from person to person and there’s not really a baseline threshold of desire everyone should be meeting, so keep in mind that “low libido” to one person could mean something wildly different to someone else. It’s normal for your interest in sex, physical levels of arousal, and satisfaction from sexual experiences to fluctuate throughout different times in your life for all kinds of reasons, but if you feel like you’ve noticed drastic changes to your sex drive in your late 30s, 40s, or 50s, it could very well be related to perimenopause.
What factors affect sex drive in midlife?
- Hormones
- Physical conditions and symptoms
- Medications you’re taking
- Stress levels and mental health
- Body image
- Lifestyle behaviors
- The state of your relationship
- How you feel about sex in general lately—is it enjoyable? Do you orgasm? Or has it become boring or even painful?
Low libido tips and solutions
Should I be worried about low sex drive in perimenopause?
We’d never tell you to worry without cause; we’re here to educate, not scare you. If you’re not currently worried about your sex drive, there’s no need to start now. It is unlikely that low libido on its own would be the sole symptom of a more serious medical condition, especially during perimenopause, when libido changes are incredibly common thanks to fluctuating hormones. Sometimes medical conditions like PCOS (polycystic ovary syndrome), endometriosis, and thyroid disorders, to name a few, can be accompanied by low libido, but you would probably notice other symptoms in addition to low sex drive or painful sex. If that’s going on, it’s worth keeping track of your symptoms so you can bring them up with your doctor to find the root cause.
That said, it’s okay to feel bothered if you’re not as interested in sex during perimenopause, even if nothing else is wrong. Sex is an important part of intimacy for most people, may influence your body image and self-esteem, and can be great for your mood, your pelvic floor, even your immune system. If you’re used to your libido behaving a certain way, changes can be unwelcome, annoying, even upsetting.
What about FSIAD? Could I have that?
Prolonged distress over a lack of interest in sex or difficulty reaching or maintaining arousal actually has a name: Female Sexual Interest/Arousal Disorder, or FSIAD. This term encompasses two common sexual dysfunction disorders in women: Hypoactive Sexual Desire Disorder, and Female Sexual Arousal Disorder.
Crucially, your feelings are an important part of diagnosis; if you used to enjoy sex but disinterest in sexual activities, lack of sexual thoughts, and problems with physical arousal have caused you distress for six months or longer, you may meet the criteria for FSIAD, which is treatable and should be diagnosed by a physician. Depending on what’s behind your symptoms, your doctor may recommend medication adjustments, hormone therapy, and/or counseling alone or with your partner.
Should I take testosterone to boost my sex drive during menopause?
Testosterone therapy during menopause is a hot topic. It’s not uncommon to hear some say that it’s the key to helping perimenopausal women feel better, lose weight faster, build more muscle, and yes, boost libido, but supplemental testosterone comes with some major drawbacks.
A quick testosterone primer: Testosterone isn’t just a hallmark of ultra-manly men. It’s an important hormone for women, too, though it’s present at lower levels than in men. Unlike estrogen and progesterone, testosterone levels don’t wildly dip as we age—in fact, testosterone decline during perimenopause tends to be a steady, gradual process, not a steep plummet, so it’s not the primary culprit for much of the hormonal chaos of midlife. Additionally the data for testosterone, when dosed safely, shows only modest benefit, and only for some women.
Gennev’s Chief Medical Officer, Dr. Rebecca Dunsmoor-Su, cautions against thinking of testosterone as an easy fix for a few reasons:
There are no FDA-approved testosterone doses for women, so physicians must engineer proper dosage for their female patients based on products designed and dosed for men. This can be a tricky process and requires regular blood work to make sure that women really are getting physiologically suitable and safe doses of testosterone.
Because it’s an anabolic steroid, testosterone isn’t a one-and-done solution. It’s effective for a while, but you will continue to need greater doses to maintain those effects as your body adjusts to higher levels of the hormone. Those higher doses of testosterone can make women vulnerable to heart problems, which is not ideal during menopause, when women are already at increased risk of cardiovascular disease.
Too much testosterone supplementation in women comes with other side effects, too. Acne, facial hair growth (yeah, those short wiry chin hairs? They’re coming back faster and bringing friends), hair loss, voice deepening, and clitoral growth are common side effects of high testosterone use in women. Some of these changes are not reversible, even after stopping testosterone.
Finally, Dr. Dunsmoor-Su never recommends testosterone in compounded or pellet form. These unregulated formats often contain very high levels of testosterone, cause significant side effects, and have not been shown to be safe or effective with long-term use.
Wait—if testosterone is that problematic, why does anyone take it for libido at all?
There are studies showing that low doses of testosterone, carefully prescribed and monitored, can benefit postmenopausal women struggling with libido and improve sexual function, leading to a few more “sexually satisfying encounters” per month. When used and prescribed appropriately, testosterone therapy can be an effective part of a libido-management plan, but Gennev physicians feel strongly that it must be overseen by an in-person provider with menopause experience.
How do I get my libido back?
Take it one step at a time and recognize that even though your libido in your 40s, 50s, and beyond might not feel like it did when you were younger, your sex drive and sexuality can still evolve in satisfying ways.
- Figure out physical blockers first: If you’re struggling with sheet-drenching hot flashes, serious fatigue, or vaginal dryness or atrophy that’s making sex painful, doing the deed won’t be any fun no matter what you try. So put your body first. Treating and managing perimenopause symptoms and medical conditions, as well as getting regular exercise, quality sleep, and plenty of complex carbs, fiber, protein, and healthy fats in your diet may not be the first things you think of when you think about boosting your sex drive, but they can make a big difference for how you feel during menopause, and feeling good can make sex much more appealing. When it comes to having more comfortable sex in the moment, a good lube goes a long way.
- Address the emotional elements: Stress, relationship issues, and mental health concerns can absolutely interfere with your desire for sex, and midlife comes with plenty of challenges on those fronts. Counseling, sex therapy, and medications for anxiety or depression, if needed, can all help ease the psychological and emotional reasons behind midlife libido loss, so don’t be afraid to bring this up with a doctor or therapist if it’s been a blocker to intimacy lately.
- Get your mind in the mood: If you’re waiting for the sudden urge for sex to strike out of nowhere before getting down to business, you could be waiting a long time. Spontaneous desire is just that—feeling turned on first, then seeking sex—but plenty of people experience responsive desire instead (and this tends to be the more prominent type of desire for women), where their arousal and desire for sex arrives and increases once the action has already begun. Both desire types are normal and healthy, but if you “want to want sex more” and it just doesn’t seem to happen, there are cheeky ways to kickstart your interest: Devote some time to fantasizing, send a sexy text, prioritize non-sexual touch like massage or cuddling first—you may find that these small gestures help you look forward to sex when it’s otherwise not top of mind.
- Remember—or discover—what you really like: If sex has become rote, orgasms have been absent, or intimacy hasn’t been enjoyable for a long time, it’s never too late to explore what turns you on to bring some new energy into the bedroom. Solo or partnered, consider trying something that’s always intrigued you, whether that’s toys, new positions, new locations, or role-playing a fantasy you’ve always wanted to try. These days, you can also find plenty of sex-positive, ethically produced content to read or listen to; there’s a wealth of apps, websites, and books for steamy storytelling and erotic audio created for women that you might find very worth your while.
- Make it your most fun habit: Scheduled sex sounds pretty ho-hum if you think about it as one more thing on the calendar, but sex therapists recommend it for a reason—it works! Laurie Minz, Ph.D. and the author of A Tired Woman’s Guide to Passionate Sex calls these sex dates “trysts” to make them sound a little sexier, but you can call yours whatever you want (rendezvous sounds kind of hot, right?). The point is, making regular sex a priority can help restart your libido; it’s something to look forward to, creates frequent occasions for connection and intimacy, and gives you more chances to enjoy all the physical and emotional benefits of a healthy sex life.
- Consider medication: There are FDA-approved medications, like Addyi and Vyleesi, designed to help increase desire in women with low libido who haven’t fully reached menopause. They work differently and have different application methods (Addyi is a pill while Vyleesi is an injection taken about 45 minutes before you want to have sex), so you’ll want to talk to your doctor about the pros and cons of each one. If you’re concerned about low sexual desire and haven’t had success with other approaches, a Gennev OBGYN can help you decide if one of these medications would be suitable for you.
Increased libido during perimenopause
My sex drive is higher in my 40s. That’s not what I was expecting at all; is this for real?
In Miranda July’s 2024 novel All Fours, the 45-year-old narrator is perplexed to hear that she’s in perimenopause and can expect “reduced libido”; this never comes. Instead, she finds herself, body and mind, overtaken with lust as she navigates a series of midlife epiphanies about marriage, her body, and aging.
Yes, it’s fiction, and the very idea of a sky-high libido in perimenopause might make you snort “Yeah right!” but the truth is, no two sex drives are the same. Some women do report a surprising spike in libido during perimenopause, especially if they had a high sex drive before. Even those who didn’t have a particularly high sex drive earlier in life can experience more frequent desire and more intense arousal during perimenopause. It’s not quite as common as decreased libido and usually doesn’t last throughout the entire menopause transition, but rest assured, it does happen.
What causes increased libido in perimenopause?
Physiologically, this “midlife sex surge” could come from how some women react to hormonal changes. As estrogen dips and testosterone levels stay more stable, testosterone’s effects may feel more pronounced, effectively revving up the signals that contribute to the desire for sex. Some women report a libido boost after starting hormone therapy for menopause symptoms, though this experience varies widely.
But most of the time, high libido during and after perimenopause is likely being driven by situational factors, like:
- Reduced fear of pregnancy: Many postmenopausal women describe enjoying sex more after the possibility of an unintended pregnancy is off the table. Keep in mind that if you’re perimenopausal, sexually active, and still having periods, there’s always a chance that without protection, you could still get pregnant as your body’s reproductive functions try to have their last hurrah.
- Less demanding family obligations: Sometimes a higher libido in midlife coincides with women having more chances to connect with their partners. As children get older and more independent, the burden of parenting changes, giving couples more time, energy, and privacy to enjoy sex and intimacy again.
- More self-confidence: By the time perimenopause rolls around, many women describe feeling more confidence, fewer inhibitions, and a better sense of what they enjoy when it comes to sex.
- Better communication: With all that midlife confidence often comes improved communication about sex; women can talk about what they want from sexual experiences in ways they might not have in decades past.
- New relationships: While midlife relationship changes like divorce are usually cited as a source of stress, some people find a silver lining to being back on the dating scene: the excitement of sex with new partners and the chance to explore their sexuality in new ways. “New relationship energy” —dating, flirting, enjoying the novelty of discovering romantic and sexual compatibility again—can have a reinvigorating effect on a libido gone quiet. It’s a great reminder that your brain can play a powerful role in how your sex drive works.
Should I do anything about my high libido?
Not unless you want to! Just like with decreased libido, feeling like your sex drive is working overtime in perimenopause probably isn’t something to worry about unless it’s causing you distress. If your renewed interest in sex is fun, feels good, and brings you closer to your partner, great! But if it becomes a source of stress, distraction, or relationship friction, know two things: the intensity will likely mellow over time, and it’s okay to bring this up with a counselor or your doctor if you’re really concerned about a high sex drive affecting your day-to-day life.
Sex and libido after menopause
What should I expect from my libido after menopause?
It’s hard to say, since experiences vary and sex drive isn’t a static thing even before menopause. While your desire may continue to decline or stay lower than before, even after the hormonal swings of perimenopause have eased, having good sex is absolutely still possible.
If pelvic floor dysfunction or vaginal dryness after menopause prevent you from having comfortable sex, a menopause specialist physician or pelvic floor physical therapist can help you find relief (and don’t forget the lube!); if mental health or relationship challenges are affecting your libido, therapy (for individuals, couples, or specifically for sex and intimacy) can be worth a try. Even if you’re not interested in partnered or penetrative sex after menopause, pleasure’s still very much within reach: toys, masturbation, and even physical touch that doesn’t lead to intercourse can be great for your body, mind, and mood.
Struggling with painful sex or low libido in perimenopause? Gennev’s menopause specialists can help you get to the bottom of it and feel better fast. Book an appointment with one of our board-certified OBGYNs today.