Hi Friend!
Women’s sexuality is anything but static.
What sparks desire in our twenties may look and feel very different in our forties, fifties, and beyond. As a woman enters perimenopause and eventually menopause, she may start to notice shifts in her libido—sometimes subtle, sometimes dramatic. These changes can be surprising or even confusing, especially in a culture that doesn’t talk candidly about sexual health, much less midlife sexual health.
Maybe you’re nodding your head in agreement because you’re in the thick of a libido that has a mind of its own. Perhaps you haven’t experienced any changes personally but know someone who has. Either way, it’s a meaningful conversation to have. Let me be exceedingly clear: changes in libido are entirely natural.
Hormones, physical comfort, emotional well-being, and relationship dynamics all play a role in shaping sexual desire. Understanding why these shifts happen can help replace frustration with compassion and uncertainty with confidence. So many women try to navigate these seasons of life on their own, too afraid to speak up because they think something is wrong with them.
I hope that after reading this, you or someone you love can embrace this new season of intimacy with clarity and confidence.
it’s all natural.
Your ovaries begin producing fewer sex hormones during perimenopause. Your estrogen levels fluctuate unpredictably, your progesterone levels steadily decline, and your adrenal glands and ovaries continue to produce testosterone during this time, although those levels also decrease.
These hormonal changes are part of the natural aging process and can be entirely unrelated to menopause. But they can lead to various mental, physical, and emotional changes that impact libido, arousal, and pleasure.
Libido
For many women, perimenopause and menopause can lead to a decrease in libido. A 2019 research review1 found that sexual function may begin to noticeably decline as much as 20 months before the last menstrual period.
However, for some women, the drop in estrogen and progesterone levels can amplify the effects of testosterone, which may result in an increased libido instead.
Arousal
Hormonal changes can influence more than just your libido; they can also have visible effects on your genitals. Sexual arousal typically involves:
- Increased blood flow to the genitals
- Enlargement of the clitoris
- Wetness in the vaginal canal
However, hormonal fluctuations can disrupt this process. Lower estrogen levels can lead to reduced blood flow to your genitals, which can negatively impact your ability to become aroused.
Additionally, this reduced blood flow can hinder your body’s ability to produce natural lubrication, resulting in vulvovaginal tissue becoming thinner, less elastic, and ultimately more fragile.
Pleasure
If you don’t enjoy having sex, you may not want to do it again. The same applies to sex or masturbation that causes pain or discomfort. Vaginal dryness and tightness can lead to burning, itching, and irritation, which may worsen with manual stimulation or penetration.
This can increase the likelihood of accidental cuts and tears, raising the risk of infection. It should not be any mystery as to why you would want to abstain from something that doesn’t feel good, but often, I see patients questioning themselves.
add in the ‘pauses
You’re getting older, your hormones are doing what hormones do, and now you enter your perimenopause and/or menopause era. And things can change even more. Note to self, change will be the one constant in this era, so plan accordingly.
Perimenopause and menopause can cause a host of symptoms like brain fog, headaches, hot flashes, urinary incontinence, weight changes, fatigue, insomnia, night sweats, restless legs, mood swings, low self-esteem, and more.
Suppose you have underlying health conditions like diabetes, kidney disease, heart disease, multiple sclerosis, or vulvar lichen planus/sclerosis, to name a few, before perimenopause or menopause. In that case, those symptoms can also be exacerbated.
Just one of these symptoms can be enough to cause you to lose interest in, be too tired for, or completely turned off by anything sexual. Most women will experience several of these symptoms at the same time, so it’s no wonder that libido and sexual desire change.
double-edged swords.
Aging has a profound impact on every aspect of the body: influencing physiological functions, mental capabilities, and emotional well-being.
Physiologically, the body experiences changes such as decreased muscle mass, reduced bone density, and slower metabolic processes, which can impact overall health and mobility.
Mentally, cognitive functions may decline with age, potentially leading to memory loss or difficulties in processing information.
Emotionally, you may face challenges such as increased feelings of loneliness, anxiety, or depression as you navigate the changes that come with aging.
The good news is that there are ways to support you during this time, including therapy, mindfulness, exercise, and even medication. That said, there are some medications that, while incredibly helpful and an integral part of your well-being as a whole, can affect your libido.
Common Medications That Can Lower Libido
- Antidepressants (SSRIs, SNRIs, tricyclics) – May dampen dopamine/norepinephrine, reducing arousal and orgasm intensity.
- Anti-anxiety medications (benzodiazepines) – Can cause sedation and lower responsiveness.
- Birth control pills – Hormonal shifts may reduce natural testosterone levels, impacting desire.
- Hormonal therapies (for cancer, endometriosis, etc.) – Often suppress estrogen/testosterone.
- Blood pressure medications (beta-blockers, diuretics) – Can limit blood flow and interfere with arousal.
- Antipsychotics – May alter dopamine pathways and cause sedation or weight gain.
- Opioid pain medications – Can disrupt hormone production and lower energy/interest.
- Chemotherapy drugs – Affect hormones, energy, and overall well-being.
- Anti-seizure medications – May impact nerve signaling and dampen arousal.
Please hear me say this: not every patient will experience libido changes while taking one of the medications mentioned above. The reason I share this list is because I have spoken with many patients who were prescribed, by another doctor, a medication listed above without discussion of potential side effects.
Sometimes there are alternative medications that you can try. Sometimes you’re on the proper medication and simply knowing that sexual changes can be a side effect is more than enough to give you peace of mind.
I wholeheartedly believe that knowledge is power. Knowing the ‘big picture’ details can make a world of difference.
Have you ever thought something may be wrong with your vehicle, and the moment you allow that thought into your mind, you start hearing or feeling things that are breaking? You hit a pothole and brace yourself for the tire to roll across the median or the tailpipe to fall off, only to arrive at your destination and discover plastic stuck in your grille. No wonder funny noises were coming from the front end, right?
Not knowing about the potential side effects of medication can be akin to not seeing the plastic stuck in the grille.
Imagine with me for a moment: You start taking a low-dose blood pressure medication. Your libido begins decreasing, so you go searching for answers. You remember you had a headache for several days. You haven’t been sleeping well, either. Dr. Google has you convinced that you’re suffering from some serious, undiagnosed medical condition.
When maybe, if you knew beforehand that your blood pressure medication could affect your sexual desire, you wouldn’t have the headache or sleepless nights from worrying about why your sexual desire has suddenly tanked.
Is this an oversimplification for the sake of a blog post? Of course it is.
However, I want to reiterate the importance of communicating with your doctor and understanding how all the various systems of your body work together. Sometimes, something meant to make you feel better can have a ripple effect that, on the surface, may seem completely unrelated.
I think, therefore…
Mental health and libido are deeply linked. Considering your emotional well-being is just as crucial as addressing hormonal or physical changes when navigating desire as you age, especially during perimenopause and menopause.
Hormones or physical changes are not the only things that impact libido. Mental health plays a central role in shaping desire, arousal, and satisfaction. It’s important to be aware that when women experience stress, mood changes, or emotional strain—especially during perimenopause or menopause—these factors can directly and indirectly affect sexual interest.
Stress and Anxiety
Stress floods the body with cortisol, also known as the “fight-or-flight” hormone. While helpful in short bursts, chronic stress interferes with sex hormones like estrogen and testosterone, making desire harder to spark.
Anxiety adds another layer by keeping the mind racing, making it challenging to stay present in intimate moments. For many women, this means feeling too distracted, tense, or fatigued to enjoy sex.
Depression and Low Mood
Depression drains energy and motivation, often leaving women feeling flat or disconnected from pleasure. In scientific terms, lower dopamine and norepinephrine levels blunt the brain’s reward system, directly reducing sexual interest.
Antidepressants, while effective for mood stability and overall well-being, can add to libido changes, creating a frustrating cycle.
Body Image and Self-Esteem
Menopause often brings physical changes—weight fluctuation, hair thinning, or skin changes—that affect how women view themselves. When body image takes a hit, sexual confidence can decline, too.
Even if your partner tells you how beautiful you are and is as attracted to you as ever before, if you don’t feel attractive, intimacy may be less desirable.
Trauma and Emotional Safety
For women with a history of trauma, emotional safety is paramount. Even subtle triggers—stress, conflict, or discomfort—can shut down desire. During perimenopause and menopause, unresolved emotional wounds may surface and intensify the impact on intimacy.
Relationship Stressors
Mental health doesn’t exist in a vacuum—it often intertwines with relationships. Conflict, resentment, or feeling emotionally disconnected may decrease sexual interest. The menopausal journey can feel isolating, and you may struggle to put feelings into words, creating a disconnect with your partner.
That disconnect and subsequent decline of interest in intimacy are the by-products of the unfamiliar season in which you find yourself. Our minds are incredibly powerful. Acknowledging the far-reaching impact your mental and emotional well-being has on your sexual desire is the first step in giving yourself grace and leading with compassion.
it’s not game over.
If you find yourself frustrated and discouraged that intimacy is over as you age, don’t give up. The changes can feel overwhelming. You must allow yourself to acknowledge those feelings instead of trying to deny or ignore them. You are going to work through this phase, not around it.
For the sake of brevity, I compiled a simple Top 10 list of ideas for you to explore while finding that lovin’ feeling again:
Top 10 Ways to Boost Libido During Menopause
- Use Lubricants and Moisturizers – Alleviate dryness and enhance comfort during intimacy.
- Consider Vaginal Estrogen or Hormone Replacement Therapy (HRT) – Consult your doctor about hormone therapies that can support sexual health.
- Try Pelvic Floor Exercises – Strengthen your muscles, improve circulation, and increase sensitivity.
- Prioritize Stress Relief – Engage in meditation, yoga, or journaling to lower cortisol levels and create space for desire.
- Address Mental Health – Seek therapy and practice self-care to alleviate anxiety, depression, or body image concerns that may impact libido.
- Move Your Body – Regular exercise can elevate mood, boost energy, and increase confidence.
- Communicate with Your Partner – Honest discussions about needs and comfort create trust and deepen connection.
- Redefine Intimacy – Focus on touch, closeness, and sensual experiences rather than solely on intercourse.
- Keep Things Fresh – Explore new activities, plan date nights, or introduce playful ideas in the bedroom to spark excitement.
- Take Care of Your Overall Health – Maintain a balanced diet, ensure adequate sleep, and limit alcohol and smoking for improved energy and hormone balance.
With the proper support—whether through lifestyle changes, medical options, or honest discussions—you can continue to enjoy a vibrant and fulfilling sex life. Menopause doesn’t have to be an ending; it can be an opportunity to rediscover connection, embrace new ways of experiencing pleasure, and honor the body’s wisdom in this next stage of life.
As always, if you are experiencing symptoms of perimenopause or menopause and would like to know what options are available to alleviate them, please call the office at 405-701-6717. My staff and I would be honored to walk with you through this season.
With love,
Dr. Ronni Farris
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