Menopause and Sex Drive: Why Is My Libido So Low?

It’s been 12 months since your last men­stru­al peri­od, and you’ve offi­cial­ly hit menopause. For the past few years lead­ing up to this, you’ve expe­ri­enced all of the hall­mark symp­toms that you expect­ed – the hot flash­es, the night sweats, the irreg­u­lar periods. 

But late­ly, you’ve real­ized some­thing else. Your sex dri­ve has tak­en a nose­dive. Could that be linked to menopause?

The sex­u­al response cycle is divid­ed into four phas­es: libido (desire), excite­ment (arousal), orgasm, and res­o­lu­tion. These phas­es may vary in sequence, over­lap, repeat, or be absent dur­ing some or all sex­u­al encoun­ters. Many women may lack desire until feel­ing phys­i­cal arousal. 

Low sex dri­ve, or low libido, is actu­al­ly quite com­mon for women who have reached menopause or are in per­i­menopause (the tran­si­tion peri­od that hap­pens before menopause). Per­i­menopause can begin 8 – 10 years pri­or to your final men­stru­al peri­od. In the U.S., the aver­age age women start menopause is 51, but as ear­ly as age 45 is con­sid­ered normal. 

Also read: 7 Myths About Menopause — And The Truth Behind Them

The Link Between Menopause and Sex Drive

There are sev­er­al rea­sons why menopause can make you less inter­est­ed in hav­ing sex. Libido, or desire, starts in the brain and can be affect­ed by declin­ing hor­mone lev­els, med­ica­tion side effects, poor body image, increased stress, rela­tion­ship issues, and poor sleep. 

Low­er Hor­mone Levels

Dur­ing the menopausal tran­si­tion – includ­ing per­i­menopause and menopause – your ovaries don’t pro­duce as much of the hor­mones estro­gen and prog­es­terone as they used to. 

One big rea­son this effects sex dri­ve is that low estro­gen can make sex less com­fort­able or enjoy­able, and even down­right painful. Decreased lev­els of estro­gen reduce nat­ur­al lubri­ca­tion in your vagi­na, and your vagi­nal tis­sue can become dry and thin (called vagi­nal atro­phy). All of this can cause pain that puts a damper on your sex drive. 

There are oth­er rea­sons why low estro­gen lev­els can trans­late to low libido. For example:

• It can be more dif­fi­cult to become aroused.
• As you get old­er, blood doesn’t flow to your gen­i­tals dur­ing arousal as quick­ly as it did in your younger years. This means you might not have the same sen­si­tiv­i­ty dur­ing sex, which can make it less pleasurable. 
• Reduced estro­gen can cause night sweats, which can keep you up at night and leave you feel­ing tired, which can make you less inter­est­ed in sex.
• Social changes (such as rela­tion­ship changes like dat­ing or divorce), chil­dren leav­ing home, adult chil­dren liv­ing at home, or the car­ing for aging or ill par­ents often take place at this time of life.

Changes in Men­tal Health and Self-Esteem

Between hor­mone fluc­tu­a­tions, frus­trat­ing symp­toms, and the every­day pres­sures of life, it’s nor­mal for men­tal health to shift dur­ing per­i­menopause. On top of that, notic­ing menopause- or age-relat­ed changes like weight gain or grey hair can affect your body image and self-esteem. 

These emo­tion­al changes can make it hard­er to get in the mood, and chal­lenges with body image may lead to avoid­ing intimacy

Med­ica­tions to Treat Menopause Symptoms

One of the more uncom­fort­able parts of menopause is hot flash­es, which lead many women to seek med­ical treat­ment. Addi­tion­al­ly, the risk of devel­op­ing depres­sion can increase dur­ing perimenopause.

The most effec­tive treat­ment for hot flash­es, night sweats, sleep dis­tur­bances, and many oth­er menopausal symp­toms is hor­mone replace­ment ther­a­py (HRT). 

A com­mon non­hor­mon­al treat­ment for both hot flash­es and depres­sion is a type of anti­de­pres­sant called a selec­tive sero­tonin reup­take inhibitor (SSRI). SSRIs are a great non­hor­mon­al option for eas­ing hot flash­es and symp­toms of depres­sion. How­ev­er, one of the side effects they are known to cause is low sex dri­ve. They can reduce your over­all inter­est in sex, as well as make it dif­fi­cult to become or stay aroused and to reach orgasm. While these effects can be present in any­one tak­ing SSRIs, they tend to get worse with age. This does not hap­pen to every­one, but it is a pos­si­ble side effect to be aware of.

Also read: Guid­ing You from Puber­ty to Menopause

Increas­ing Libido Dur­ing Menopause

First things first – if you’re okay with hav­ing a low sex dri­ve, there’s no need to treat it. Accept­ing low libido doesn’t mean there’s any­thing wrong with you. 

That said, there are plen­ty of meth­ods to increase your sex dri­ve if you want to do so, such as:

• Start­ing local vagi­nal estro­gen, which has many ben­e­fits for women expe­ri­enc­ing painful inter­course. This is a dif­fer­ent treat­ment than hor­mone replace­ment ther­a­py (HRT). 
• Using over-the-counter prod­ucts like lubri­cants to reduce pain dur­ing intercourse
• Mak­ing lifestyle changes, like increas­ing phys­i­cal activ­i­ty, quit­ting smok­ing, or avoid­ing alcohol
• Start­ing hor­mone replace­ment ther­a­py (med­ica­tion that con­tains estrogen) 
  • In some cas­es, your provider may rec­om­mend tak­ing trans­der­mal testos­terone. Women’s ovaries pro­duce testos­terone, as well as estro­gen, and this can decrease in per­i­menopause and menopause. 
• Work­ing with a men­tal health provider (i.e. indi­vid­ual, cou­ples, or sex therapy)
• Prac­tic­ing pelvic floor exer­cis­es or pelvic floor phys­i­cal ther­a­py that strength­en your mus­cles involved in orgasm and improve blood flow to your vagina 
• Tak­ing a pre­scrip­tion med­ica­tion or sup­ple­ments to increase libido
• Hav­ing a dis­cus­sion with your provider about Switch­ing to a dif­fer­ent med­ica­tion if you’re tak­ing one that’s caus­ing low libido*

Talk to your provider to see which method is right for you, and to learn how they can best help you nav­i­gate this time. Have ques­tions or con­cerns about menopause? Duly Health and Care is here for you. Sched­ule an appoint­ment with a Duly provider today. 

*If you believe that a med­ica­tion you’re cur­rent­ly tak­ing is low­er­ing your sex dri­ve, do not stop tak­ing it with­out talk­ing to your provider first. 

Also read: 3 Rea­sons to Strength­en Your Pelvic Floor Muscles

It can be frus­trat­ing when your sex dri­ve is not at the lev­el you want it to be at. It’s impor­tant to note that it’s very com­mon and there are sev­er­al ways to man­age it. Menopause and aging don’t need to stand in the way of a sat­is­fy­ing and ful­fill­ing sex life.