Around menopause, many changes occur. Often, but not always, there is a fall in libido or sex drive. This can happen for various reasons, and treatment is available to help if it is a problem.

The medical name for low libido is hypoactive sexual desire disorder (HSDD). It is a common experience among females, especially around menopause. In 2012, the Food and Drug Administration (FDA) identified HSDD as one of 20 high priority diseases that need focused attention.

Usually, a decline in estrogen levels begins when a person is in their 40s. Over the next 2–8 years, periods may become less regular and then stop completely. The time before menopause is called perimenopause. Menopause is when a person has had no menstruation for 12 months.

Around menopause, a number of symptoms can occur, such as hot flashes. Other changes include a thinning of the vaginal wall, known as vaginal atrophy, and vaginal dryness.

These and other factors can contribute to a fall in libido or sex drive and pain during sex. Vaginal atrophy and dryness do not improve over time, but treatment can help manage them.

In this article, we look at how menopause might affect someone’s sex drive and some ways to enhance libido.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Menopause is when a female stops having her period permanently, but it affects more than the menstrual cycle. Menopause can cause physical and emotional changes that affect a person’s life, including their sex life.

Some symptoms and side effects associated with menopause include:

Depression can also affect libido. Depression is common among females in mid-life and around menopause, but researchers have not found a direct link between the two.

Each of these can affect a person’s quality of life and relationships.

Libido refers to sexual interest and sexual enjoyment.

After menopause, a person may experience:

  • low libido
  • fewer sexual thoughts and fantasies
  • physical changes that affect the enjoyment of sex

Doctors consider a low libido an aspect of sexual dysfunction. Other causes of low libido include issues of arousal, desire, orgasm, and pain.

Libido varies among individuals. Links between low libido and its possible causes after menopause are complex. A person should work with a doctor to address what may be causing low libido for them.

How do you know if it’s menopause?

Various changes and lifestyle factors can affect a person’s sex life around and after menopause. Not all of them relate directly to menopause.

Factors that contribute to a fall in libido may include:

  • hormonal changes
  • physical changes
  • sociopsychological factors

Experts have not linked a low libido directly with hormonal changes, but they may contribute to hot flashes and other factors that can play a role.

Physical effects on sex organs

Physical changes can contribute to a lower sex drive. Vaginal atrophy is the medical name for the vagina becoming drier and its walls thinner. These physical changes may include the following:

  • The tissues of the vagina and labia become thinner and less sensitive to sexual stimulation.
  • Vaginal lubrication decreases, leading to vaginal dryness. Sex may be uncomfortable or painful.
  • Dyspareunia may occur. With dyspareunia, persistent or recurrent genital pain happens before, during, or after intercourse.
  • Reduced blood flow may affect overall arousal. Sex may be less enjoyable, and it may be harder to have an orgasm.

Around 27–60% of people report vaginal dryness and pain.

Mental health

Fluctuating hormone levels can also affect a person’s mental health. In turn, this can affect libido.

High levels of stress can occur due to life’s daily needs. A person may be juggling work, parenting, and caring for older parents. The changes in hormone levels can lead to irritability or depression, and dealing with everyday stress may be challenging.

Relationship issues and body image can also affect mental well-being and libido.

Effect of other symptoms

Symptoms associated with menopause may affect a person’s sex drive.

Examples include:

Other factors

Other factors that can dampen libido around menopause include:

  • having another health condition, such as sleep apnea, heart disease, or diabetes
  • history of smoking
  • engaging in low levels of physical activity

Anyone with concerns about a fall in libido can speak with a doctor. They may be able to offer treatment.

Various measures may help increase libido. They include medical treatments, lifestyle tips, and home remedies.

Medical treatments can help manage factors that contribute to low libido, such as vaginal dryness, night sweats, and anxiety. Some treatments may address libido directly.

Flibanserin

Flibanserin (Addyi) has approval from the Food and Drug Administration (FDA) to treat low sexual desire but does not have approval specifically for females after menopause.

This drug may increase the number of times a person experiences sexual satisfaction by once a month or once every 2 months.

However, it can have adverse effects, such as low blood pressure and fainting. People should speak with their doctor about the benefits and drawbacks of Flibanserin before using it.

Bremelanotide (Vyleesi)

In 2019, the FDA approved bremelanotide (Vyleesi) to treat low libido in the years leading up to menopause.

In trials, around 25% of people who used this drug experienced an increase in sexual desire, compared with 17% who took a placebo. In addition, around 35% noted a reduction in other distress factors relating to sex, compared with 31% after using a placebo.

It appears to improve sexual desire and reduce related issues by activating a part of the nervous system known as melancortin receptors. However, experts do not know precisely how it works.

A person will need to inject it at least 45 minutes before sexual activity. Individuals can decide when to take it depending on how long they find the effects to last.

People should not use more than one dose in 24 hours or more than eight doses per month.

Side effects include a rise in blood pressure, and it is not suitable for those with a history of hypertension or cardiovascular disease.

Lubricants

An over-the-counter lubricant can reduce discomfort during sex. Over-the-counter moisturizers can help reduce dryness. A person will need to use it every few days. Note that non-water-soluble and silicone-based lubricants can break down condoms used to protect against sexually transmitted infections (STIs).

Which lubricants are best for menopause dryness?

Hormonal and nonhormonal pills

Estrogen pills, creams, or vaginal rings can help address vaginal dryness and vaginal atrophy. They require a prescription.

Hormone therapy can help with hot flashes and mood changes.

Ospemifene is a nonhormonal treatment for vaginal dryness and atrophy.

Counseling

Counseling can help manage depression, anxiety, and other mental health challenges that occur during menopause.

Couples therapy can help people address issues affecting their relationship, whether or not they are directly related to sex. It may also help them speak openly about how they feel.

What is the best online couples counseling service?

Treatment for other conditions

Around the same age as menopause, the risk of various other health issues increases, such as weight gain, cardiovascular disease, type 4 diabetes, and other chronic diseases. Addressing any underlying conditions may help a person feel better overall, and it may boost their interest in sex.

Anyone who would like medical advice or treatment related to menopause can find a qualified and certified practitioner through the North American Menopause Society.

Some lifestyle strategies may help increase libido, such as:

  • getting regular exercise
  • avoiding or quitting smoking
  • avoiding alcohol and recreational drugs
  • avoiding products that irritate the vagina, such as scented soaps and bath products
  • following a varied and nutritious diet
  • managing weight, which can boost overall well-being
  • doing pelvic floor exercises, as they can increase blood flow to the vagina and strengthen the muscles used in orgasm

What are some natural remedies for hot flashes?

There are many ways a person can foster a sense of intimacy with their partner, including:

  • Having sex more often: This can increase blood flow to the vagina and help keep tissues healthy.
  • Taking time to become aroused: Foreplay can raise moisture levels, making sex more comfortable.
  • Changing sexual routines: Use vibrators or other sex toys to enhance an intimate experience or engage in sexual activity or touching without the goal of orgasm.
  • Relieving stress together: Activities outside the bedroom can increase intimacy, such as going on planned dates, taking a walk, or spending time doing hobbies together.
  • Practicing masturbation: Spending time alone and exploring what types of touch and sexual stimulation work for an individual can help them talk with a partner about their needs and preferences. Masturbation can also help a person feel more comfortable with sexual activity without the pressure of a partner.

What are some tips and tricks for getting “turned on”?

Some people use natural supplements to try to increase their libido.

Various natural remedies may help increase libido around menopause:

  • Black cohosh (Cimicifuga racemosa) is a North American indigenous remedy that may improve various symptoms of menopause, including sexual function.
  • Ginkgo (Gingko biloba) may have some positive effects on sexuality after menopause, according to a 2021 review.
  • Tribulus (Tribulus terrestris) may help boost testosterone levels in the body and could be a safe alternative to hormonal medications, according to the authors of a 2016 study.

It is important to remember that the FDA does not regulate herbs and supplements, so it is essential to choose a reputable brand.

Always check with a doctor before using natural or alternative remedies, as some are not safe to use with certain other drugs or health conditions.

Soy, for example, aims to boost estrogen levels and may react with other estrogen therapies.

Do menopause supplements work?

Acupuncture, aromatherapy, yoga, and hypnotherapy may help with sexual dysfunction due to menopause.

Acupuncture

In a 2016 study, 13 women with low libido had acupuncture twice a week for 5 weeks. At the end of the study, they reported increased desire, arousal, and orgasm. The women were in perimenopause.

Aromatherapy

A 2018 review looked at the effect of aromatherapy on females with low libido around the time of menopause. Findings suggested that people experienced improved sexual function after using:

  • lavender oil
  • neroli oil
  • a combination of lavender, fennel, geranium, and rose

Yoga

There is some evidence that yoga may help with various symptoms of menopause, including fatigue. Participants in one study reported an improvement in sexual function.

Hypnosis

Some research has suggested that hypnosis can improve sleep and sexual function in people with low libido due to menopause.

One investigation found that reflexology significantly improved sexual function and hot flashes compared with nonspecific foot massages.

More studies are needed to confirm these findings.

What are reflexology and foot massage?

People should speak with a doctor if menopause has a significant impact on everyday life, including sexual activity.

A doctor can recommend medications or lifestyle changes that may benefit the individual.

A doctor can also rule out other underlying conditions that may reduce libido and cause pain with sex, such as:

Anyone who has concerns about low libido, pain during sex, and other related issues should speak with a doctor.

When should you worry about bleeding after menopause?

Here are some questions people often ask about sexual desire and menopause.

Many strategies may help, ranging from prescription medications to lifestyle measures, such as weight management and exercise. Some herbal and alternative remedies have shown promise in increasing libido, but more studies are needed.

What happens to libido during menopause?

A person’s libido often falls around menopause, but it is unclear if this is directly related to hormonal changes. Blood flow to the vagina decreases, leading vaginal atrophy and dryness. Symptoms such as hot flashes, night sweats, and sleep problems can also contribute.

Around this time of life, people often face stress due to family responsibilities, work, a chronic illness, and other factors. These, too, can play a role.

Can supplements help with libido around menopause?

Herbal remedies such as Ginkgo, Tribulus, and black cohosh may help, but more research is needed. Always check with a doctor before using supplements, as some are not safe for everyone, and supplements may interact with other medications.

Some females experience a fall in libido during and after menopause. Depending on the individual, this can be distressing.

Factors contributing to a low libido include other menopausal symptoms, such as night sweats, added stress, and discomfort due to vaginal dryness.

Anyone with concerns about the impact of menopause on libido should speak with a doctor, as treatments can help manage this.