"No two women are the same in their experience of sexual health and menopause," says Lyndsey Harper, MD, FACOG, IF and founder/CEO of Rosy, an award-winning women’s health technology company that connects women who have sexual health concerns with hope, community, and research-backed solutions. "But there are some common threads that we often see."
Chief among them? Being less interested in sex than you used to be. While specific estimates vary, up to half of menopausal women report experiencing low sexual desire.1 And unless your partner has experienced a similar drop-off, and you're both satisfied with the shift, that can have a significant impact on your relationship.2
These may be challenging issues, but they're not insurmountable, Dr. Harper says. By understanding the complex factors that can change your feelings towards intimacy during perimenopause and menopause, you and your partner can work together to find a frequency that works for both of you – and deepen your connection along the way.
Factors That Impact Your Sex Drive
Though a sluggish sex drive can be more common during perimenopause or menopause, it's possible to experience a drop in libido at any age. The most likely culprit? "Stress. It's the number one killer of desire, and it can happen during any stage of life," Dr. Harper says.
It's easy to lose interest, too, if sex just isn't that satisfying or if you struggle to achieve an orgasm. "Women who are not experiencing pleasure during sex might not be as excited to have sex," explains Dr. Harper.
Physiological changes can factor in too. Hormonal shifts that occur during pregnancy3 and breastfeeding4, for instance, can make sex less appealing for some women.
How Perimenopause and Menopause Affect Desire
Less interest in sex during perimenopause or menopause often stems from a combination of physical and emotional factors, Dr. Harper says. Shifting levels of estrogen can cause vaginal tissues to become drier and less elastic, which can make sex uncomfortable. Reduced blood flow to vaginal tissues may also make it more difficult to achieve an orgasm. And if sex doesn't feel good, you'll likely shy away from wanting to do it.
Menopause also "emphasizes the stress piece, since there are so many things that are changing with our bodies, our self-concept, and our roles," details Dr. Harper. Mood swings, irritability, anxiety, and depression can become more common during perimenopause and menopause, for instance. At the same time, "changes to the way the body stores fat can cause a negative impact on body image, which can affect confidence and interaction with partners," she continues.
Is It Normal for Desire to Drop as You Age?
When you consider all of the factors that can impact your sex drive during perimenopause and menopause, it's no wonder that so many women notice a drop-off. "Not only is it common, but it's probably the number-one complaint we hear from a sexual health perspective," Dr. Harper says.
That said, a decrease in desire or having sex less often only becomes a problem if it's having a negative impact on your relationship. When we asked how often married or long-term couples have sex, Dr. Harper advises; "there's no magic number. You should be doing what fulfills you and your partner."
Sexual Dysfunction in Women
Around 10% of women meet the criteria for hypoactive sexual desire disorder or HSDD.5 A medical diagnosis, HSDD is different than just not being in the mood for sex. "Most women with low desire still have responsive desire, meaning if they are exposed to a sexual cue, they'll become aroused," Dr. Harper explains.
That's not the case with HSDD, which is marked by a persistent and distressing lack of desire even when a woman experiences a sexual cue. "When exposure to sexual situations or reading erotica don't cause a woman to become responsive, something may be going on with the brain's neurotransmitters, which could be HSDD," Dr. Harper says. In that case, medications like flibanserin (Addyi) combined with talk therapy can help.6
How Lack of Interest Affects Relationships
Sexual equilibrium changes within a relationship can lead to potential problems if both partners aren't on the same page. "When both people don't feel happy about how often they're having sex, that can cause some stress," Dr. Harper says.
That's especially true when the partner who wants sex more often doesn't understand why the other person has less interest. "The partner internalizes the problem as something wrong with them," explains Dr. Harper. "They wonder, why is this no longer an important piece of our relationship? Is there something wrong with me? Is there someone else?"
Letting your partner in on your experience – and framing it as part of a health stage in your life – can help ease their concerns. Dr. Harper recommends starting by sharing your specific symptoms, then inviting your partner to work with you to find a solution. "You can say, 'I'm trying to understand how to address these things. It has nothing to do with you, they're health changes happening in my life. How do you feel about being by my side while I figure this stuff out?'"
How to Increase Your Sexual Desire
When it comes to giving your sex drive a boost, there are several options at your disposal. A few that Dr. Harper likes to recommend:
- Utilize vaginal moisturizers and lubricants. They're the first step for managing pain caused by vaginal dryness, Dr. Harper says. Applying a vaginal moisturizer several times a week will help make tissues more supple overall; using a lubricant right before sex will reduce dryness and discomfort.
- Consider vaginal estrogen or other prescriptions. Hormonal therapies like vaginal estrogen "can help return the tissue of the vagina back to its premenopausal state by increasing elasticity and decreasing pain," Dr. Harper explains. For low desire not related to dryness, such as with HSDD, FDA-approved therapies such as flibanserin or an off-label, compounded testosterone may be options. It’s best to consult with your healthcare provider first, to determine the best treatment option for you based on your health history.
- Stay active. Sedentary lifestyles may increase the risk for sexual dysfunction.7 "Cardiovascular activity three times a week before sex has been shown to improve sexual desire," Dr. Harper says.
- Plan ahead and give yourself time to get aroused. Putting sex on the calendar might not feel sexy. But knowing that you'll be intimate later on can give you time to get excited about it. "If you want to have a date night tonight, you might plan to read erotica earlier in the day to get the wheels turning," says Dr. Harper.