Menopause Sex Drive: Embracing Pleasure in Every Stage of Life

By Naomi Braun, MPH, MSW • Published 11/27/2023

Medically Reviewed by Dr. Shannon Chavez, PsyD, CST

a couple hugging while discussing the connection between menopause and sex drive, including decreased orgasmic function, mood changes, and other menopause symptoms leading to lower interest in sex

Instead of saying, not tonight dear, I have a headache, you may be saying, not tonight dear, I just don’t have the (sex) drive! And if this sounds familiar, you're not alone! Almost 25% of females ages 40-65 say they struggle with low sex drive.*

One frustrating symptom of menopause is what the medical community calls hypoactive sexual desire disorder (HSDD). You and I call it low sex drive, low libido, or just not feeling in the mood. Want to understand why you may be feeling this way and what you can do about it? Read on.

What’s the connection between menopause and sex drive?

The primary hormones involved in menopause-related decreased sex drive are estrogen, progesterone, and testosterone. These hormones play a crucial role in maintaining sexual health as they help to keep your vagina lubricated and contribute to you feeling interested in sex.

Hormonal balance

As these hormone levels drop, sexual desire can as well since they all play a part in overall sensory perception and blood flow to the pelvic area, both of which drive motivation for sex.

Specifically, a decrease in estrogen causes the vaginal tissue to thin, dry out, and become inflamed. This is part of a larger set of symptoms called genitourinary syndrome of menopause (GSM) and it can cause pain during sex, making you potentially less likely to engage in sexual activity.

Testosterone also plays a role in sexual desire. You produce small amounts of testosterone in your ovaries, and those levels may decrease during menopause. This decline can contribute to a reduced libido and decreased sexual responsiveness.

Decreased orgasmic function

The hormone-related vaginal symptoms and decrease in blood flow to your pelvic region can also impact the intensity of your orgasm or even your ability to reach an orgasm at all. The experience of sex not being able to pleasure you as you’re used to can add to the challenges in interest and desire.

a couple laying in bed talking about how to increase their sex drive during menopause, discussing options of menopause hormone therapy or vaginal lubricants

Hot flashes and night sweats

Menopause symptoms, like hot flashes and night sweats, can disturb your sleep by causing you to wake up throughout the night. And potentially 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.

While some of this lower sex drive can be explained because of physical symptoms, there are also some emotional factors that contribute. Let's delve into some of the key factors that might impact your sex drive during this phase of life.

Mood changes

Lower levels of estrogen during menopause can also lower the level of chemicals in the brain called serotonin and dopamine. As a result, the changes in these brain chemical levels can contribute to mood swings, anxiety, and depression. These emotional changes may lead to decreased interest in sex and a lower overall sense of well-being.

Relationship dynamics

The natural course of long-term relationships can impact sexual desire. Stress, communication issues, health and mental health challenges, as well as social messages around a what a “healthy” sex life looks like are some of the most common factors at play when it comes to relationships and sex. Add to any of these the potential negative effects of menopause sex drive can make these issues feel even worse.

Open and honest communication as well as redefining what “sex” means in your relationship are key components to understanding and perhaps even increasing desire. Sex looks and feels different to everyone, and the most important part is to be on the same page and in the same playing field as your partner.

Body image concerns

Menopause can lead to weight gain, specifically a change in where fat on your body is located. The 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." Declining estrogen levels can also impact other parts of your body including an increase in age spots, thinning hair, newly formed wrinkles, and dry and sagging skin. For some, these changes can affect their self-esteem and body image. This, in turn, can impact your confidence and interest in sexual activity.

a couple smiling while having open and honest communication about their sex life, improving their relationship dynamic by understanding the connection between menopause and sex drive

How to increase sex drive after menopause

While decreased sex drive during menopause is common, you don’t have to suffer the consequences for the long haul. There are some strategies and treatments available to help you get back in the mood.

Menopause hormone therapy

Hormone therapy, or menopause hormone therapy (MHT) as it’s sometimes called, is one option to consider. Specifically, localized 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 of menopause related to low sex drive. It does so by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication.

Some people feel more comfortable with this type of hormone therapy since it’s localized to the vaginal region and comes with fewer potential side effects. It's essential to discuss the potential risks and benefits of MHT with a healthcare provider before you get started.


Over-the-counter vaginal lubricants can provide relief from vaginal dryness and discomfort during intercourse. There are different types of lubricants on the market including water-based, silicone, oil, and hybrid. Each has its pros and cons, and everyone has their own preference. Do your research before you choose what lube, if any, to use. Typically, these products can make having sex feel more comfortable and enjoyable.

Counseling and therapy

For emotional and relationship-related issues, counseling or therapy can be beneficial. A sex therapist can help you work through an emotional or mental roadblocks that may be causing sexual issues in your relationship. A sex therapist is a licensed provider who has specialized training is 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

Awareness and education are key. Making sure that you and your partner understand some of the challenges around sexual health and decreased sex drive that are common during menopause can help you to manage these issues together.

Decreased sex drive during menopause is a complicated issue and involves physical, emotional, and partner relationship issues. It's important for you to know that they are not alone in feeling this way and that there are things you can do to help.

Talking to healthcare professionals, therapists, and partners can help you regain control over your sexual health. With the right resources and mindset, you can continue to enjoy a fulfilling and satisfying sex life.

*Data from Attitudes & Usage study conducted in August 2021 with 4,578 female participants ages 40-65. Funded by Kenvue.

Last Updated 1/23/2024



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