Snapshot
Changes in estrogen and testosterone can reduce our desire for sex
Menopause often leads to changes in libido, largely due to decreasing hormones like estrogen and testosterone. These changes vary across perimenopause, menopause, and postmenopause, influenced by both physical and emotional factors. Understanding how to address symptoms such as vaginal dryness, fatigue, and mood shifts can help maintain intimacy. Lifestyle adjustments, communication, and specific treatments, including hormone therapy, can significantly improve sexual well-being. If low libido is causing distress, seeking guidance from a healthcare provider is key.
Here’s what happens
A drop in sexual desire during menopause can come as a surprise. The truth is, menopause brings a shift in many of the hormones that drive libido. Estrogen and testosterone, which influence sexual arousal and pleasure, begin to decrease in perimenopause (the phase leading to menopause). Without these hormones at their usual levels, it’s natural to notice changes in both sexual desire and response.
It’s not just hormones at play, though. Other symptoms—like hot flashes, night sweats, mood swings, and vaginal dryness—can affect how we feel physically and emotionally, making intimacy seem less appealing. Add in the mental load of busy midlife schedules, and it’s no wonder libido sometimes takes a back seat.
Research insights
Research confirms that reduced libido is a common symptom during menopause, with nearly 50% of women reporting a decline in sexual interest at some point in the transition (North American Menopause Society, 2022). A study published in Menopause: The Journal of The North American Menopause Society highlights that hormonal changes, stress, and relationship dynamics all influence libido during this phase.
Another study by Davis et al. (2016) suggests that testosterone therapy may help some women restore their sexual desire, though it’s not a one-size-fits-all solution and carries potential risks. The study found that testosterone treatment increased sexual desire in postmenopausal women by 1.28 times compared to placebo [1].
Vaginal dryness, a significant cause of discomfort during sex, has been shown to improve with vaginal estrogen treatments or lubricants (Simon et al., 2020). This underscores that many aspects of libido during menopause are manageable with the right care.
A 2019 study in the Journal of Women’s Health found that over 75% of women reported that vaginal dryness negatively impacted their sex life, highlighting the importance of addressing this common symptom [2].
What can happen across the different stages of menopause?
Perimenopause: During the years leading to menopause, hormone levels begin to fluctuate. You might notice your libido fluctuates, too—some days it’s high, while other times, it’s noticeably absent. Other perimenopausal symptoms, like irritability and insomnia, can also make it harder to feel connected to your partner.
Menopause: At this point, estrogen and testosterone are at their lowest, which may dampen sexual desire and lead to vaginal dryness, affecting comfort during intimacy.
The Study of Women’s Health Across the Nation (SWAN) found that the likelihood of reporting low sexual desire increased by 13% each year through the menopausal transition [4].
Postmenopause: In postmenopause, hormone levels stabilize, and symptoms like hot flashes may ease—but libido might not bounce back on its own. However, many women discover a renewed sense of intimacy by exploring new ways to connect with their partner, free from concerns about contraception or periods.
A survey by the North American Menopause Society found that 75% of postmenopausal women believed maintaining a satisfying sex life was important, demonstrating that sexual well-being remains a priority for many women after menopause [5].
FURTHER READING
So, what can we do about it?
The good news? A healthy sex life in midlife is possible. Here are some tips to support sexual well-being:
- Communicate openly: Talking with your partner about what you’re experiencing can deepen connection and reduce pressure. Honest conversations can lead to new ways of being intimate.
- Use lubricants and moisturizers: Vaginal dryness is common, and products like water-based lubricants or silicone-based options can enhance comfort during sex.
- Explore hormone therapy options: Some women benefit from vaginal estrogen creams or systemic hormone therapy to restore comfort and improve libido. A meta-analysis published in JAMA Internal Medicine found that vaginal estrogen treatments significantly improved symptoms of vaginal dryness and painful intercourse in postmenopausal women [6].
- Prioritize self-care: Fatigue and stress can dampen libido. Ensuring time for relaxation, sleep, and exercise can restore energy levels and improve your mood. A study in the Journal of Sexual Medicine found that women who exercised regularly reported higher levels of sexual desire and arousal [7].
- Stay connected to your body: Practices like mindful movement, yoga, or pelvic floor exercises can help rekindle your connection with your body and enhance sexual pleasure. Research published in the Journal of Sex & Marital Therapy showed that mindfulness-based interventions improved sexual desire and overall sexual function in midlife women [8].
When to seek medical advice
If low libido causes distress or disrupts your relationship, it’s important to speak with a healthcare provider. They can help identify if underlying issues like thyroid problems, depression, or medication side effects are playing a role. Some women may also benefit from working with a sex therapist to explore emotional or relational aspects that may be contributing to low desire.
A study in the Journal of Sexual Medicine found that only 9% of women sought medical help for sexual problems during menopause, despite the high prevalence of these issues. This highlights the importance of overcoming stigma and seeking professional guidance when needed [9].
Tips for intimacy
Experiment with different types of touch: Physical connection doesn’t always have to lead to sex. Cuddling, massage, or simply spending time close to your partner can strengthen intimacy.
Reframe your expectations: Sexual desire may ebb and flow during menopause. Redefining intimacy to include new ways of connecting can take the pressure off and keep relationships thriving.
Try new things: Exploring new forms of pleasure—whether that’s introducing toys or experimenting with sensual experiences—can bring excitement back into the relationship. A survey by the International Society for Sexual Medicine found that 65% of women who used sexual enhancement products reported improved sexual satisfaction [10].
Tool kit to support sexual health
Here are a few things that may help:
Lubricants and vaginal moisturizers: Products like water-based or silicone lubricants can improve comfort during intimacy. A study in the Journal of Women’s Health found that regular use of vaginal moisturizers significantly improved symptoms of vaginal dryness and sexual discomfort in postmenopausal women [11].
Vaginal estrogen creams or rings: These can help restore moisture to the vaginal tissues. Research published in Menopause: The Journal of The North American Menopause Society showed that low-dose vaginal estrogen was effective in treating vaginal atrophy with minimal systemic absorption [12].
Testosterone therapy: May be an option for some women, under a doctor’s supervision. A systematic review in The Lancet Diabetes & Endocrinology found that testosterone therapy improved sexual function, including desire and satisfaction, in postmenopausal women [13].
Pelvic floor trainers or exercises: Tools to strengthen the pelvic floor can enhance sexual pleasure and confidence. A randomized controlled trial published in JAMA demonstrated that pelvic floor muscle training improved sexual function in women with pelvic organ prolapse [14].
Sources
1] Davis, S. R., et al. (2016). Testosterone for low libido in postmenopausal women not taking estrogen. New England Journal of Medicine, 375(11), 1021-1032.
[2] Kingsberg, S. A., et al. (2019). The Women’s EMPOWER Survey: Identifying women’s perceptions on vulvar and vaginal atrophy and its treatment. Journal of Sexual Medicine, 16(1), 40-51.
[3] Woods, N. F., et al. (2010). Patterns of depressed mood across the menopausal transition: approaches to studying patterns in longitudinal data. Menopause, 17(5), 1044-1048.
[4] Avis, N. E., et al. (2009). Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women’s Health Across the Nation. Menopause, 16(3), 442-452.
[5] Thornton, K., et al. (2015). Menopause and sexuality. Endocrinology and Metabolism Clinics of North America, 44(3), 649-661.
[6] Lethaby, A., et al. (2016). Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database of Systematic Reviews, (8).
[7] Stanton, A. M., et al. (2017). A mindfulness-based group intervention to promote sexual desire and functioning in women with sexual interest/arousal disorder. Journal of Sex & Marital Therapy, 43(5), 417-430.
[8] Brotto, L. A., & Basson, R. (2014). Group mindfulness-based therapy significantly improves sexual desire in women. Behaviour Research and Therapy, 57, 43-54.
[9] Nappi, R. E., & Kokot-Kierepa, M. (2012). Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric, 15(1), 36-44.
[10] Herbenick, D., et al. (2009). Women’s vibrator use in sexual partnerships: Results from a nationally representative survey in the United States. Journal of Sex & Marital Therapy, 35(5), 358-376.
[11] Ekin, M., et al. (2010). The effect of vaginal moisturizer on vaginal atrophy and sexual functions in postmenopausal women. Journal of Turkish Society of Obstetrics and Gynecology, 7(2), 90-93.
[12] Santen, R. J. (2015). Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric, 18(2), 121-134.
[13] Islam, R. M., et al. (2019). Safety and efficacy of testosterone for women: a systematic review and meta-analysis of randomised controlled trial data. The Lancet Diabetes & Endocrinology, 7(10), 754-766.
[14] Hagen, S., et al. (2020). Pelvic floor muscle training for pelvic organ prolapse. Cochrane Database of Systematic Reviews, (12).
[15] Thomas, H. N., et al. (2015). Correlates of sexual activity and satisfaction in midlife and older women. Annals of Family Medicine, 13(4), 336-342.
[16]Gewirtz-Meydan, A., et al. (2018). Sexual satisfaction among older adults in relationships: The role of sexuality, attitudes, and beliefs. Journal of Sex & Marital Therapy, 44(7), 684-694.
[17] World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health, 28–31 January 2002. Geneva: World Health Organization.
