Why Did You Lose Your Libido, and How to Get It Back? Understanding the changes and finding solutions for low sex drive in menopause

By Dovile Kalvinskaite
OBGYN | Menopause Specialist | Lifestyle Medicine Doctor | High-Performance Coach

Sexual health is an essential part of our lives. And menopause should not be the end of it.

With the gradual increase in our lifespan, women now spend, on average, a third of their lives in the post-menopause stage. Half, if you include the perimenopause transition years, which can start in our 40s or even earlier.

For many, menopause is a time of significant change. While it marks the end of the reproductive years, it also brings about a myriad of physical and emotional shifts.

One of the most common and yet least discussed is the decline in sexual desire or libido.

There is no day in the Menopause clinic without a patient telling me how menopause affected their relationships, sometimes even leading to a breakdown.

One study showed that 84% of women in perimenopause and menopause think that an active sex life is important. This study and various others suggest that 40 to 80% of women experience a significant decrease in libido and quality of intimate life.

This isn’t just a number. It’s a reflection of relationships strained, self-esteem affected, and quality of life diminished.

So why, for some, does the desire disappear?

What Is Normal Desire?

The health benefits of sex are widely known.

It improves and stabilises our mood, and it’s a perfect stress relief tool. It improves sleep, strengthens the immune system, and relieves pain. It’s a great physical exercise for the cardiovascular system and pelvic floor.

However, sexual desire is a complex interplay of emotional, physical, and psychological factors. It varies from person to person and can change over time.

There are two main types of sexual desire — spontaneous and responsive.

Spontaneous desire often looks like an automatic sexual urge that arises seemingly out of nowhere. It’s the kind of desire often seen in movies and literature, striking quickly and with intensity. It’s more common for men, and for a long time, we thought it was the primary way that our desire worked.

On the other hand, responsive desire is more like a reaction. It builds as a response to stimulation or intimacy. It may not be present initially but emerges due to a sensual, emotional, or physical connection with a partner or self.

Most women are not running with spontaneous desire. Emotional intimacy and stimulus are crucial to our passion light to switch on.

While spontaneous desire is often expected in cultural narratives about sex, responsive desire is just as normal and common, especially among women. It becomes more prevalent as people age or navigate changes in their sexual health, such as during menopause.

So when should I worry?

The type of desire can change with age and with different relationships. Only you can tell what is normal to you. And if your desire changed or completely disappeared AND it’s causing you distress, then it’s not normal.

The most common desire disorder (aka low libido) is Hypoactive Sexual Desire Disorder (HSDD), a persistent or recurrent lack of sexual fantasies and desire for any sexual activity.

How do you know if you have HSDD? Simply put, you previously had normal desire and now have no interest in any sexual activity, no sexual thoughts or fantasies, and no response to being stimulated (including self-pleasure); it lasts more than 6 months and affects your quality of life.

Of course, having only desire is not enough for great sex. Two other vital components are arousal and orgasm. And they also can change with menopause.

But before we dive deep into how to fix it, let’s make another important distinction.

Sex is not just intercourse. It’s whatever gives you erotic sensual pleasure, with or without a partner, with or without an orgasm.

What’s “normal” for one might not be for another. Remember, it’s not about reaching a certain “number” of intimate encounters but about feeling satisfied and connected in your intimate life.

So Why Did Your Sex Drive Disappear?

Our sex drive is complex, and if it’s low, there are often a few key players.

1. Menopause is all about the hormones, or lack of them

If your desire completely disappears with menopause, most likely, it’s because of hormonal changes.

Sex hormones, estrogen, progesterone, and testosterone, are all crucial for modulating sexual desire in women. And they drop significantly during menopause.

The decline of estrogen and progesterone can directly dampen libido by affecting your brain and blood flow in your pelvis. Hormones influence sexual behaviour, mood, and cognitive functions, all important for normal desire.

Testosterone is also crucial for libido, arousal, and overall well-being, affecting energy, mood, and our brain function.

And it’s not just about the hormones directly.

Menopause can come with hot flashes, sweats, mood swings, joint pains, palpitations, and headaches, which can make sex the last thing on your mind. Lack of sleep and energy can leave you too exhausted for anything, let alone intimacy.

2. The dry and sore vagina

During menopause, a staggering 80% of women experience Genitourinary Syndrome of Menopause (GSM) or Vulvovaginal Atrophy (VVA), which are mainly caused by a lack of estrogen in your genital area.

This often causes physical discomforts, which include decreased vaginal elasticity, dryness, oversensitivity, and even fissures or ‘cuts’ at the vaginal entrance.

In one study, about 70% of women reported a tendency to avoid intimacy, engaged in sexual activity less frequently, and found sex to be less satisfying or completely impossible. Almost a third of them felt uncomfortable sharing it with their partners.

With all these changes, our sensitivity and even the size of the clitoris changes, which prolongs the time it takes to reach arousal and orgasm.

The decline in estrogen also affects your bladder and can worsen urinary incontinence, which can be particularly unpleasant during orgasm. And you are more likely to have a burning sensation when peeing after sex, none of which is particularly arousing.

3. Medical problems and medications

Medical conditions like hypertension, diabetes, thyroid problems, arthritis and medications to treat them can significantly affect our sex drive.

For example, antidepressants cause loss of sex drive and difficulties reaching orgasm. Gabapentin, pregabalin and clonidine, medications sometimes used to treat menopausal symptoms as an alternative to HRT, can reduce sensitivity in pelvic areas.

4. Moods and emotional health

Psychological factors always play a pivotal role in shaping sexual function, not only during the (peri)menopause transition.

Women often tell me how they lost confidence because of how their bodies have changed. Difficulties with weight control or signs of ageing affect our self-image and make us more self-conscious.

Fluctuating hormones can also trigger mood swings, anxiety, and depression, which in turn can dampen sexual desire and satisfaction even more.

5. And how is your relationship?

Relationship dynamics are integral to our sexual function, menopause or not. But additional hormonal changes, stress and mood swings can really put relationships to the test.

My patient once said, ‘I would have sex if he was nicer to me’.

Often, stress and relationship tension spill over into our sex lives, and it’s important to recognise and address this first. A lack of emotional closeness or communication about it can lead to building walls that prevent us from intimacy.

On the other hand, a crucial part of women’s desire response is novelty, and sexual boredom can come from a routine that lacks variety or excitement.

Different expectations, preferences, or levels of interest in sex can create tension in our relationships even more. And often, it’s not the easiest conversation to have.

Getting Your Desire Back 101

It’s normal to go through phases when you have less interest in sex. But it’s important to recognise when it’s just a phase and when it’s a permanent state of being that needs attention.

Getting your sex drive back can be tricky, and it often means trying out a few different things.

Simple changes like regular exercise, balanced nutrition, relaxing activities, and setting aside time for intimacy can make a big difference.

But let’s look into other most effective ways of switching your light back on.

1. Talk About It

Opening up about sex and desire can feel challenging, but it’s a crucial first step in getting back on track.

Share openly with your partner about what you want, what’s changed, and what you’re going through. It’s also about exploring what you both like and trying new things together. Having an honest conversation can bring you both closer and spark that connection again.

Sometimes, though, talking with your partner isn’t enough, or it’s hard to start the conversation. That’s when bringing in a professional can make a big difference. Healthcare providers, sex therapists, and relationship counsellors are there to guide you.

And talk to your friends or other people going through similar challenges. Listening to the experiences of those who have successfully improved their sex lives during menopause can give inspiration and hope.

But most importantly, having support can make navigating any new changes easier.

2. Balance Your Hormones

Hormone Replacement Therapy (HRT) is the most effective treatment for low libido that starts during menopause.

By restoring hormonal balance, HRT improves blood flow to the pelvis, relieves dryness and discomfort in the vagina, and changes how the brain responds to your partner.

Plus, it’s about the bigger picture — better mood, more energy, and fewer menopausal symptoms like sweating and hot flashes, all of which can give your libido a much-needed lift.

It’s not a one-size-fits-all or a quick fix, but it’s always a first step to treating low libido and other symptoms of menopause.

If HRT fixed most of your symptoms, but your desire is still non-existent, testosterone is often the missing piece.

For many of my patients, even though the HRT fixed hot flashes, and restored their ‘shrunken vagina’, they still had no interest in sex or were not able to orgasm until they got additional testosterone.

I often hear stories of how it changed their lives and brought back not only the desire and sensations, but they found their husbands a lot more attractive and felt safe with them again.

However, HRT and testosterone might not be suitable for all, so please discuss it with your healthcare provider first.

And if you find that low libido is still holding you back, don’t hesitate to reach out to a professional for a personalised approach to your situation.

3. Fix painful sex

Restoring vulval and vaginal health is a crucial aspect of improving libido and comfort during sex.

There is nothing better for this than a vaginal estrogen.

Available as gels, creams, tablets, or rings, this targeted therapy is generally safe and can be used long-term. The hormone levels reaching the bloodstream are minimal, and research suggests that using vaginal estrogen doesn’t increase the risk of breast cancer, which is reassuring for many.

Patience is key, as it may take 3–6 months to experience the full benefits. However, improvements can often be felt within the first few weeks.

Starting treatment early and continuing it long-term is my usual approach.

However, if vulval dryness, burning or itching sensations persist, or if there are changes like white patches on the skin, please see a doctor. Skin conditions like lichen sclerosus require specific treatments and regular monitoring due to increased long-term risks.

Beyond hormonal treatments, increasing blood flow and elasticity through pelvic floor exercises, moisturising creams, massage, and vibration can all improve vaginal health.

And make it slippery!

Lubricants can significantly improve comfort during sex; just choose the right one.

Skip lubes with glycerin, alcohol, perfumes, and cooling or warming ingredients, as they can irritate sensitive vaginal tissue. Water-based lubricants are user-friendly, condom-compatible, and easy to clean up. Silicone-based lubes are long-lasting and need only a tiny amount, but avoid using them with silicone toys. For a longer-lasting effect, oil-based lubes or coconut oil work nicely, but don’t use it with condoms.

If you don’t need a condom, I usually advise mixing oil-based lube on you and water-based on your partner. This creates a double-glide effect and less friction that lasts longer. It can be messy, but great sex usually is.

Why am I talking about condoms if you can’t get pregnant? Sexually transmitted infections are not only for young people. Be safe.

4. Rediscover Your Pleasure

Menopause presents a unique chance to rediscover what brings you pleasure, potentially enhancing your sex life in unexpected ways.

With the concerns of pregnancy behind you and more time to yourself, it’s an ideal phase to experiment with and savour new sexual experiences.

One excellent way to do so is via self-pleasure practices. This isn’t just about immediate gratification — it’s a journey of self-discovery.

By experimenting with toys, various techniques, and different forms of touch, you can reconnect with your body’s desires and learn how to communicate these to a partner.

Such practices not only boost libido and overall mood but also promote better blood flow to the pelvic region, which can heighten pleasure in the long run.

It’s like exercise for the muscles; the more you use it, the stronger it gets.

You also learn to know your body better and can later guide and teach your partner what works for you.

And get creative. Introducing variety in your relationship — like experimenting with new locations, gentle caresses, or even non-penetrative forms of intimacy — can enrich your sexual experiences.

Exploring alternative methods of pleasure, such as tantra, can open up entirely new avenues of intimacy and enjoyment.

This time in your life is also perfect for introspection about your sexual identity. What kind of touch resonates with you? What fantasies intrigue you? Understanding your unique erotic blueprint is vital to a more satisfying sexual journey. Shed any feelings of guilt or embarrassment and embrace your sexuality with pride and joy.

Menopause can begin an exciting new chapter, inviting you to embrace and celebrate your desires fully.

Passion Prescription

One of the biggest lies that we have been told about ageing is that sex gets worse with menopause or even drops off a cliff completely.

Menopause is a natural phase of women’s lives, and while it brings challenges, it doesn’t mean the end of your intimate life.

Embrace this new chapter with knowledge, grace, and a touch of adventure.

One of my 67-year-old patients, who implemented most of the advice discussed here, came back to tell me that she is now having the most incredible sex of her entire life.

But just like with health and fitness, that kind of sexual fulfilment doesn’t just happen. You do need to communicate openly and put an effort to keep the spark going.

It doesn’t matter if you’re 47 or 77; great sex can definitely be part of your life if that’s what you choose.

And remember, not every woman wants to continue with sexual relationships, and that’s okay, too.

With understanding, communication, and the right interventions, you can navigate this transition and enjoy great sex and exciting relationships. Remember, you’re not alone, and there are many options available.

Let this be your passion prescription: re-engage with sexuality that is meaningful for you.

And when it comes to the bedroom, more foreplay, powerful vibrators, and new positions can be exactly what the doctor prescribed.

Other helpful resources to continue the conversation:

1. Facebook support group for women in menopause with low libido: The Pleasure Possibility

2. Sex and age-positive information for people over 50

3. For ongoing vulval issues, resources like the Vulval Pain Society offer invaluable support and information, helping women navigate these challenges with greater ease and confidence.

4. Book Recommendations:

• Come as You Are” by Emily Nagoski, Ph.D.

A transformative book that explores the complexities of female sexuality, backed by science and psychology, offering a roadmap to overcoming obstacles and embracing a fulfilling sex life.

• “Mind The Gap” by Dr. Karen Gurney

This insightful read delves into the psychology of desire and the societal myths that can create unnecessary pressures and gaps in our sexual expectations and realities.

• “Mating in Captivity” by Esther Perel

A provocative take on long-term relationships, this book challenges the idea that domesticity quenches desire, offering strategies to maintain passion and intimacy over time.

• “Pussy Yoga” by Coco Berlin

An empowering guide that combines the physical aspects of yoga with a deep dive into feminine sexuality, aiming to enhance sexual well-being and self-awareness.

• “Becoming Orgasmic” by Julia R. Heiman and Joseph Lopiccolo

A therapeutic program designed to help women, whether beginning their sexual journey or seeking deeper experiences, to achieve orgasmic pleasure.

• “Rekindling Desire” by Barry McCarthy and Emily McCarthy

A book about the challenges of maintaining sexual desire provides practical advice and exercises for couples looking to reignite their passion.

• “Enhancing Couple Sexuality” by Barry McCarthy and Emily McCarthy

This book offers a comprehensive approach to improving sexual intimacy and satisfaction within a committed relationship.

Author Spotlight: Joan Price. As a woman who embraced her sexuality during her menopausal years, Joan Price has authored several books on the topic. Her works are celebrated for their candidness and practical advice on ageless sexuality.

By incorporating these readings into your journey, you can gain diverse perspectives and strategies to enrich your sexual well-being and relationship dynamics.