Managing low libido during menopause: Causes, tips & treatment options
A change in sexual desire can be an unexpected part of perimenopause and menopause. You may notice that you think about sex less often, take longer to become aroused, or simply don't feel the same level of interest you once did.
For some women, this is a minor change. For others, low libido can affect confidence, relationships and overall wellbeing.
The important thing to know is that low libido during menopause is common, but you don't simply have to accept it as something you can't change. There are often several contributing factors, and many can be addressed.
Why does libido change during menopause?
Hormonal changes can play a role. Falling oestrogen can contribute to vaginal dryness, thinning of vaginal tissue and discomfort during sex. When sex becomes uncomfortable or painful, it's understandable that your desire for it may decrease.
But hormones are only one piece of the puzzle.
Low libido can also be influenced by:
- Stress and feeling mentally overloaded
- Poor sleep and fatigue
- Changes in body image and confidence
- Relationship difficulties
- Anxiety or low mood
- Certain medications, including some antidepressants
- Other health conditions
- Vaginal dryness or pain
- Simply having less time and energy for intimacy
The Australasian Menopause Society emphasises that sexual wellbeing is complex and usually involves a combination of physical, psychological and relationship factors.
Start by addressing discomfort
If sex has become uncomfortable, this is an important place to start.
Lower oestrogen during menopause can cause vaginal dryness and make vaginal tissue thinner and less elastic. This can result in irritation, discomfort or painful sex, which can understandably affect sexual desire.
A vaginal lubricant can help reduce friction during sexual activity, while regular vaginal moisturisers may help with ongoing dryness.
For women experiencing persistent vaginal symptoms, vaginal oestrogen is another treatment option to discuss with a doctor. The Australian Government's current menopause guidance recognises vaginal oestrogen as an option for local symptoms such as vaginal dryness and irritation.
Pain during sex shouldn't simply be accepted as part of getting older. Speak with your GP if this is happening regularly.
Take the pressure off
One common misconception is that sexual desire always needs to appear spontaneously.
For some women, desire can become more responsive rather than spontaneous. In other words, you may not initially feel interested in sex, but desire can develop after affection, connection, touch or arousal begins.
This doesn't mean you should ever feel pressured to have sex. Instead, it can be helpful to take the expectation of “I should feel in the mood” away and allow intimacy to develop naturally when you feel comfortable.
Prioritise sleep and energy
It's difficult to feel interested in intimacy when you're exhausted.
Hot flushes, night sweats, anxiety and disrupted sleep can leave you feeling depleted during the day. If you're constantly tired, libido may understandably move down your priority list.
Rather than viewing low libido as an isolated problem, consider the bigger picture:
How well am I sleeping?
How stressed am I?
Am I getting enough time for myself?
Am I feeling connected to my partner?
Am I experiencing other menopause symptoms?
Addressing these areas may help improve your overall sexual wellbeing. Sleep disruption, stress and relationship factors are recognised contributors to changes in sexual desire.
Make time for intimacy
Life in midlife can be incredibly busy. Work, children, ageing parents, household responsibilities and everyday stress can leave very little time or mental space for intimacy.
Rather than waiting for the perfect spontaneous moment, some couples find it helpful to intentionally make time for connection.
This doesn't have to mean scheduling sex. It could simply mean:
Going to bed together without your phones.
Having a conversation without distractions.
Going on a date.
Having a cuddle.
Giving each other a massage.
Making time for affection.
Intimacy doesn't have to begin or end with sex.
Talk openly with your partner
Changes in libido can sometimes lead to misunderstandings.
A partner may interpret a reduction in sexual desire as rejection, while the woman experiencing it may feel guilty, frustrated or worried that something is wrong with her.
An honest conversation can help.
Explain what you're experiencing and, importantly, what you do want — whether that's more affection, less pressure, more time together or simply understanding while you work out what is happening.
If communication has become difficult, relationship counselling or a qualified sex therapist may be helpful.
Look after your body and confidence
Menopause can bring changes in body composition, skin, weight, energy and physical comfort. These changes can affect how you feel about yourself.
Regular physical activity can support strength, energy, mood and overall health, while nourishing your body and getting adequate sleep can help you feel more like yourself.
The goal isn't to change your body so that you're “good enough” for intimacy. It's about feeling comfortable and connected to your body.
What about testosterone?
Testosterone is sometimes discussed as a treatment for low libido after menopause.
Current Australian guidance says testosterone may be considered for some women with low libido, but it isn't a standard part of menopausal hormone therapy. Evidence suggests testosterone can improve sexual desire and aspects of sexual function in appropriately selected postmenopausal women experiencing clinically significant low sexual desire.
Importantly, testosterone treatment should be assessed and prescribed by an appropriately qualified healthcare professional. It isn't something to self-prescribe based on a testosterone blood test or an online supplement.
What about MHT?
Menopausal hormone therapy (MHT) may help some women whose sexual difficulties are related to other menopausal symptoms, particularly vaginal or genitourinary symptoms. Vaginal oestrogen can specifically target vaginal dryness and irritation.
MHT isn't a universal treatment for low libido, however. Your doctor can help determine whether it is appropriate for you based on your symptoms, medical history and individual risk factors.
When should you talk to your doctor?
You don't need to wait until low libido becomes a major problem.
Consider speaking with your GP if:
- Your libido has changed significantly and it's bothering you
- Sex has become painful
- You're experiencing persistent vaginal dryness
- You have other troublesome menopause symptoms
- You suspect medication may be affecting your sexual function
- Low desire is affecting your relationship or wellbeing
- You'd like to explore treatment options
Your doctor can look at the whole picture, rather than assuming that hormones are automatically responsible.
Low libido during menopause is common, but it isn't something you need to be embarrassed about or simply put up with.
Hormonal changes can contribute, but so can sleep, stress, vaginal discomfort, medications, relationships, body image and many other aspects of life.
Start by addressing anything that's making intimacy uncomfortable, take pressure off yourself, prioritise connection and speak with a healthcare professional if the change is persistent or troubling you.
Most importantly, there is no “normal” level of sexual desire you have to achieve. What matters is how you feel about your own sexual wellbeing and whether you feel happy, comfortable and supported.
This article is for general education and isn't a substitute for personalised medical advice. If you're experiencing persistent or distressing changes in libido, speak with your GP or a healthcare professional experienced in menopause care.
You can join the Zing Wellbeing app here for menopause support, recipes and meal plans all focused on supporting various menopause symptoms.
