Ever find yourself saying, "Not tonight dear, I just don’t have the (sex) drive"? You're not alone. Almost 25% of females ages 40-65 say experience low sex drive.* This frustrating symptom of menopause is medically known as hypoactive sexual desire disorder (HSDD).
What’s the connection between menopause and sex drive?
The main hormones involved in menopause-related decreased sex drive are estrogen, progesterone, and testosterone. These hormones are crucial for sexual health, maintaining vaginal lubrication, and influencing sexual interest.
Hormonal balance
As hormone levels drop, sexual desire can decrease. Those hormones are doing double-duty. They influence both your sensory perception and the blood flow to your pelvic area. Both drive motivation for sex.
Specifically, a decrease in estrogen affects vaginal tissues, causing them to thin, dry out, and become inflamed. This is part of a larger set of symptoms called genitourinary syndrome of menopause (GSM). It can lead to painful sex and decreased sexual interest.
Testosterone also plays a role in sexual desire. You produce lower amounts of testosterone in your ovaries, and those levels may decrease during menopause. This decline can contribute to a lower sex drive and reduced response to sexual activity.
Decreased orgasmic function
Hormone-related vaginal symptoms and reduced blood flow to the pelvic area can impact orgasms, affecting their intensity or your ability to achieve them. When sex isn't satisfying, it can add to the challenges in maintaining interest and desire.
Hot flashes and night sweats
Menopausal symptoms, like hot flashes and night sweats, can disrupt your sleep by causing you to wake up throughout the night. This can make it hard for you to fall back to sleep. Lack of quality sleep can cause fatigue, moodiness, and irritability. These negative feelings can also affect interest in sex.
Sometimes a lower sex drive can be because of physical symptoms. But there are also emotional changes that can affect it.
Mood changes
Decreasing estrogen levels can cause lower levels of chemicals in the brain called serotonin and dopamine. Changes in these brain chemical levels can contribute to mood swings, anxiety, and depression. These emotional changes may lead to a decreased interest in sex.
Relationship dynamics
It's normal for sexual desire to ebb and flow over the years in a relationship. Common factors that can affect relationships and sex include:
- Stress.
- Communication issues.
- Health issues.
- Mental health challenges.
- Ideas about what a “healthy” sex life should be.
Add to any of these the potential negative effects of a lower menopause sex drive, and it can make these issues feel even worse.
Open communication and redefining what “sex” means in your relationship are key to understanding and perhaps even increasing desire. Sex looks and feels different for everyone. The most important thing is to be on the same page as your partner.
Body image concerns
Menopause can lead to weight gain and changes in body composition. Lower estrogen levels, along with the decline in muscle mass, forces fat to accumulate more in the abdominal area, leading to the infamous "menopause belly".
As estrogen levels decrease, other body parts can be affected. You may notice more age spots, thinning hair, and new wrinkles. Your skin may become dry and saggy. For some, these changes affect self-esteem and body image, which can then impact confidence and interest in sex.
How to increase sex drive after menopause
While decreased sex drive during menopause is common, that doesn't mean you have to accept it. There are strategies and treatments that can help.
Menopause hormone therapy
Hormone therapy, or menopause hormone therapy (MHT), is one option to consider. Specifically, localized vaginal estrogen therapy which comes in the form of a vaginal ring, cream, or a tablet, can be used to alleviate some of the physical symptoms related to low sex drive. It does so by improving vaginal tone, elasticity, blood flow, and enhancing lubrication.
Some people prefer this type of hormone therapy because it works only in the vaginal region and has fewer possible side effects. Discussing the potential risks and benefits with a healthcare provider is essential.
Lubricants
Over-the-counter vaginal lubricants can effectively relieve vaginal dryness and discomfort during sex. There are several types of lubricants on the market, including water-based, silicone, oil, and hybrid. Each has its pros and cons, so do your research to find the best option for you. Typically, these products can make having sex more comfortable and enjoyable.
Counseling and therapy
For emotional and relationship-related issues, counseling or therapy can be helpful. A sex therapist can help you work through emotional or mental roadblocks that may be causing sexual issues. A sex therapist is a licensed provider who has specialized training in sexual health. In addition, individual or couples therapy with a trained therapist can be helpful.
Finding the right therapist can provide a safe space for you and your partner to discuss your concerns, improve communication, and strengthen your emotional connection.
Sexual health education
Understanding the challenges around sexual health during menopause can help you and your partner manage them together.
Decreased sex drive during menopause is a complicated issue and involves physical, emotional, and partner relationship issues. You're not alone in feeling this way and there are things you can do.
Talking to healthcare professionals, therapists, and partners can help you gain the resources and mindset to enjoy a fulfilling sex life.
*Data from Attitudes & Usage study conducted in August 2021 with 4,578 female participants ages 40-65. Funded by Kenvue.
FAQs
Can menopause hormone therapy (MHT) improve my sex drive during menopause?
Yes, MHT, particularly localized estrogen therapy, can help improve vaginal lubrication and elasticity, potentially enhancing sexual interest and response.
How do menopausal symptoms affect my sexual health?
Menopausal symptoms like vaginal dryness, hot flashes, and mood changes can significantly impact sexual health by causing discomfort during sex, reducing sexual desire, and affecting overall well-being.
Are there non-hormonal treatments for vaginal dryness?
Yes, over-the-counter vaginal lubricants or moisturizers can provide relief from vaginal dryness and discomfort. This can make sexual activity more enjoyable.
References
AlAwlaqi, A., Amor, H., & Hammadeh, M.E. (2017). Role of hormones in hypoactive sexual desire disorder and current treatment. Journal of Turkish-German Gynecological Association, 18(4): 210-218. doi: 10.4274/jtgga.2017.0071
Chopra, S., Sharma, K.A., Ranjan, P., Malhotra, A., Vikram, N.K., & Kumari, A. (2019). Weight management module for perimenopausal women: A practical guide for gynecologists. Journal of Mid-Life Health, 10(4): 165-172. doi: 10.4103/jmh.JMH_155_19
Dewitte, M. (2014). On the interpersonal dynamics of sexuality. Journal of Sex & Marital Therapy, 40(3): 209-232. https://doi.org/10.1080/0092623X.2012.710181
Krause, M., Wheeler, T.L., Snyder, T.E., & Richter, H.E. (2012). Local effects of vaginally administered estrogen therapy: A review. Journal of Pelvic Medicine and Reconstructive Surgery, 15(3): 105-114. doi: 10.1097/SPV.0b013e3181ab4804
Thakurdesai, A. & Sawant, N. (2018). A prospective study on sexual dysfunctions in depressed males and the response to treatment. Indian Journal of Psychiatry, 60(4): 472-477. doi: 10.4103/psychiatry.IndianJPsychiatry_386_17
The Menopause Society. Menopause topics: Sexual health. Accessed 1/13/2026 from https://menopause.org/patient-education/menopause-topics/sexual-health
U.S. Department of Health & Human Services, Office on Women’s Health. (2025). Menopause and sexuality. Accessed 1/13/2026 from https://www.womenshealth.gov/menopause/menopause-and-sexuality
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