Can your sex drive return after menopause? Here’s what you should know

Has your sex drive dipped recently with no obvious explanation? It’s common for your sexual appetite (also known as your libido) to change at different times throughout your life — particularly in your 40s and 50s during perimenopause and beyond.

For many of us, sex plays an important role in maintaining healthy and satisfying relationships. If your sex drive has started to change or has disappeared entirely, it might not bother you all that much. But for some people, it can lead to feelings of insecurity and a loss of intimacy. If you’re going through menopause, and your lack of desire for sex is bothering you or affecting your relationship, then it’s a good idea to get help. And there are certainly some things you can do.

Menopause is a normal life event that all women and people who have periods go through, but everyone experiences it differently. If you’re not sure how perimenopause and menopause differ, you’re not the only one. The easiest way of understanding perimenopause is that it’s your transition through menopause, which is your last ever period. It covers the years leading up to menopause and the 12 months after, at which point you can be sure your periods have stopped. 

Perimenopause usually begins somewhere between your late 30s and 50s, but most often happens in your 40s. You’re diagnosed as having gone through menopause when you haven’t had a period for 12 months (this part usually happens between the ages of 45 and 55). From then on, you are postmenopausal.

Not everyone experiences the same things, but for some people, perimenopause can bring a host of physical and psychological symptoms that may impact you in different ways. These can include mood swings, hot flashes, changes to your libido, and more. And there’s no telling whether reaching menopause will signal the end of these symptoms, because every body works differently.

If your sex drive has taken a hit during the menopause transition, it might feel like you’re losing an important part of yourself and your ability to connect with your partner, but don’t lose hope. There are lots of things you can do to reignite the spark, and it is absolutely possible to have regular, satisfying sex throughout perimenopause, menopause, and beyond.

Of course, it’s useful to remember that your desire for sex can change for reasons other than perimenopausal (and beyond) hormone changes. Pregnancy and childbirth, illness, mental health challenges, drinking too much alcohol, lack of exercise, stress, and relationship problems can all directly impact your sex drive.  Fortunately, there are a number of approaches that can help to revive your sexual desire. 

Here, obstetrician and gynecologist Dr. Brandye Wilson-Manigat, California, US, shares everything you need to know about sex drive after menopause. But if you have any questions or concerns, always reach out to your health care provider for advice.

Key takeaways

• It’s not uncommon for our sexual desire to decrease in our 40s and 50s. Hormonal changes are believed to contribute, but other factors can also play a part, including your physical and emotional well-being, lifestyle, and relationships.
• Up to 45% of women report painful sex after menopause, so it’s understandable that your desire for sex might change if it feels uncomfortable.
• Treatment options include a combination of lifestyle changes, sex education, and counseling. Talking openly with your partner may also be an important factor in getting your sex life back on track. Simple additions to your routine such as using lube and vaginal moisturizer can also help if sex is uncomfortable for you.

If you’re experiencing other perimenopause symptoms like hot flashes or vaginal dryness, then hormone therapy (HT, previously called hormone replacement therapy or HRT) might also be an option. Chat with your doctor for advice, and they’ll help you explore your options.

How might menopause affect your sex drive?

Before we get started, it’s worth noting that everyone’s sex drive is different, and there is no gold standard sex target to aspire to. What’s right for you will depend on a number of things including your health, your relationship, and a shared desire to be intimate with your partner. So, if you both decide that you’re happy to substitute sex for snuggling in front of the TV, that’s totally fine. However, if your enthusiasm for physical intimacy has dropped and it’s bothering you or affecting your relationship, then please know that you don’t need to just put up with it. Support and help is available.

Before we look at things that can help, here’s a very quick science lesson. Libido problems during perimenopause or after menopause are often linked to decreasing hormone levels, which can impact your sex drive in a number of ways. 

“Lower estrogen levels are associated with physical changes like vaginal wall atrophy [when the vaginal wall becomes thinner and drier], decreased vaginal lubrication, and decreased clitoral sensitivity,” explains Dr. Wilson-Manigat. “These can lead to a decrease in sexual desire because sex is not as enjoyable, it can take longer to orgasm, and for some women, it can become painful. This often leads to avoidance of sex.” Some people may also avoid sex because they’re anticipating pain or discomfort and feeling stressed or anxious about it, which can make sexual function worse. 

That said, your sex drive is incredibly complex, and it can be impacted at different times in your life, even before you approach menopause. “Sexuality is an intimate part of a woman’s identity, her self-esteem, and vulnerabilities, and as such, influences all areas of her life,” Dr. Wilson-Manigat explains. 

While hormones play a part, your desire for sex is based on a number of factors including your physical and emotional well-being, experiences, beliefs, lifestyle, and your current relationship. For this reason, it can change at any life stage for any number of reasons. 

If you’re struggling with having a lower sexual desire — or any other perimenopause-related symptoms — chatting in a judgment-free place with others who are going through a similar thing may help. 

In the Flo app, you’ll find a safe, closed space called Secret Chats, where you can share your experiences with other people who know what you’re going through. You’ll also find lots of helpful resources such as a symptom tracker where you can log things like hot flashes, ready to share with your doctor. Download the Flo app now.

What else can affect your sex drive throughout menopause? 

A number of menopause-related symptoms can contribute to changes in your sexual desire. If you find that any of these resonate, remember that it’s all very normal. And there are things you can do to address many of the root causes of a low libido, so don’t lose hope. 

Tiredness 

If you still find your partner attractive and want to enjoy a mutually fulfilling sex life, but by the time bedtime rolls around, you’re too tired, you’re not alone. “Many women are just too tired for sex, with overloaded schedules and already not getting adequate, restful sleep,” says Dr. Wilson-Manigat. “The ‘extra energy’ needed to generate sexual interest is seen as a drain on an already depleted battery.”  

We get it — life is busy, and there’s often so much to juggle. Being open with people close to you about how they can help to lessen your load is a good place to start. Suggest practical things they can do, such as picking up chores at home or being flexible with meetings at work so you can build in regular breaks. Book an appointment with your doctor, too. They’ll be able to provide advice, help with treatment options, and direct you to support services if you need them.

Vasomotor symptoms (VMS)

Are you constantly battling uncomfortable waves of heat in your body? VMS — also known as hot flashes — are a common menopause symptom that can dial down your desire for sex. “The effects of lower estrogen levels change a woman’s heat set point, leading to hot flashes and night sweats,” explains Dr. Wilson-Manigat. 

The intensity of the hot flashes, plus how often they happen, can also impact your desire for sex. “[You] may avoid sex because the physical activity of sex may trigger hot flashes. [You]  may avoid sex because being close to another person while [you are] feeling sweaty and clammy may be off-putting,” Dr. Wilson-Manigat adds. This is where hormone therapy can be a game changer for some people. It helps with soothing and managing symptoms like hot flashes and night sweats. More on that below.

Physical changes

Lots of us experience changes to our body around the time of menopause, including weight gain. And this can have a big impact on our confidence and desire for sex.

“With decreased metabolism as a part of aging and increased cortisol [stress hormone] levels from inadequate sleep, a woman is more prone to gaining weight in her midsection and to have difficulty [losing it],” explains Dr. Wilson-Manigat. “This can contribute to a poor body image and body confidence, and avoiding sex so that her partner won’t see the changes to her body.”

If this sounds familiar, please remember you’re not alone in feeling like this. It can be hard to bring back body confidence overnight, but if you can, try to be kind to yourself. If you wouldn’t say the same things about your friends’ bodies as you do your own, try going easier on yourself. That could be the first step toward regaining more confidence to be seen and desired.

Societal or cultural expectations

For too long, women have been made to feel as though they become invisible as they get older. It’s common for us to internalize this, and when we do, it can impact our feelings of desirability.

“Sex may be thought of as a ‘young person’s activity,’ and many of the changes of perimenopause are thought to be the precursor of a woman’s decline in her attractiveness sexually and her desire for sexual activity,” Dr. Wilson-Manigat explains.

It may be a gradual process, but it can help to try to challenge these assumptions. Therapy — such as cognitive behavioral therapy — can be useful here because it teaches you to question and reframe your thinking.

Mood changes

Perimenopause has been associated with mood changes, like feeling more irritable, low on energy, or tearful. “These mood changes can lead to decreased interest in things that used to bring a woman pleasure, including sex,” explains Dr. Wilson-Manigat. It might feel challenging to overcome this, but support is available to help you start feeling more like yourself again. The first step is making an appointment with your doctor. They’ll be able to point you to support services and prescribe medication if you need it.

Vaginal dryness

If vaginal dryness is interrupting your sex life, you’re not alone. Over half of women experience lubrication problems postmenopause. Vaginal dryness is part of a wider menopausal condition called genitourinary syndrome of menopause (GSM), which can happen during the menopause transition thanks to decreasing hormone levels. This drop in hormones makes the walls of your vagina thinner, dryer, or irritated. Symptoms of GSM include bleeding, burning, itching, an increased urge to pee, urinary incontinence, and painful sex — all of which can impact your desire for sex.

Vaginal lubes and moisturizers are designed to reduce the discomfort of dryness, making sex more enjoyable. More on that below.

Can your sex drive return after you reach menopause?

While some of us will still have a healthy sexual appetite well into older age, it’s also natural for sex drive to change with the passing of time. One study found that 53% to 73% of women aged between 57 and 74 reported a drop in their sexual activity. And those who didn’t said they had sex less than twice a month. 

If your reduced sex drive is largely driven by a change in hormones, as is very common, it’s probably worth preparing yourself that this is unlikely to instantly reset after menopause. That’s because during perimenopause your estrogen levels go up and down before eventually reducing for good, meaning the resulting symptoms may well remain.

That said, if sex is important to you and something you want to keep doing, it is definitely still possible to enjoy a pleasurable sex life postmenopause. “Your sex drive can be restored no matter what stage in life you’re in, including perimenopause and [post]menopause,” says Dr. Wilson-Manigat. “It just takes being intentional about addressing it.”

Menopause might affect the way you feel about sex and your body, and your love life might look a little different these days, but with a few adjustments, you can get your sex life back on track. “Sex drive is like a wave — it ebbs and flows — but there really isn’t an end to it. Things just get in the way of it being expressed,” Dr. Wilson-Manigat adds. 

How to increase sex drive when you hit menopause

If you’d like to enjoy regular sex with your partner, but you’re finding it hard, there are a number of things you can do to get your sex life back on track.

Speak to your doctor

Asking your doctor for help figuring out the underlying cause of your low libido is the first step to getting it resolved. They will be able to help you figure out what’s going on or refer you to a specialist if necessary. “Sex is still considered a taboo subject, but just talking about any challenges you are having with a trusted medical professional or therapist may help alleviate your concerns about what is normal and what isn’t,” says Dr. Wilson-Manigat.

If you feel awkward or embarrassed about discussing this intimate topic with your doctor, that’s totally understandable. But it can help to remember that they have had similar conversations with countless other patients before, so there’s likely to be very little that could faze them. 

Communicate with your partner

Do you want less (or more) sex than your partner? Sex involves both of you, so the best way to figure out what you both want and need from your sex life is to talk about it. Communicating openly with your partner can also help you to feel more connected and might even give your sex drive a boost, says Dr. Wilson-Manigat. “[Your partner is] typically just as in the dark as you are about what is happening, and if they don’t know what’s going on, they can’t support you in getting through it,” she explains. 

These conversations can be tricky to navigate. So, try talking about it at a time when neither of you is initiating sex. This may remove some of the immediate pressure and allow for more honest sharing. Our sex therapist has more tips on what to say in our sexless marriage guide. 

Rethink what counts as sex 

Don’t stop having sex altogether — unless you want to. Regular stimulation actually increases blood flow that can boost your vaginal health. It may help to reframe your idea of satisfying sex, too. Vibrators have been shown to improve sexual function, so you could explore these either on your own or with a partner. And consider alternative ways to enjoy intimacy with your partner. “Getting curious and switching things up, like exploring and stimulating different areas of your body can help make sex pleasurable again,” suggests Dr. Wilson-Manigat. 

You may also want to try a technique called sensate focus, which involves using sexual exercises to explore and learn about each other’s bodies without focusing on the genitals. “Involving your five senses in your sexual experiences can also help boost desire for sex,” adds Dr. Wilson-Manigat.  

Experiment

If you’re stuck in a sex rut, shaking up your routine might help. “As women age, many things can change, including what turns you on and what ‘works’ to get you to orgasm,” explains Dr. Wilson-Manigat. If you’re not sure where to start, using sex toys together can be a fresh way to enjoy sex. And if you’re struggling with lack of sensation, using clitoral-targeted sex toys can boost your chances of climaxing.

Use vaginal lube 

For many people, sex becomes less pleasurable because they have less natural lubrication than before. If you’re struggling with vaginal dryness, take plenty of time to build arousal and apply lube before you get started. Lubricants work by reducing friction during penetrative sex, so while they won’t fix the underlying cause of your problems with sex, they can be used anywhere on your body for a fun sensory experience to help you in the moment.

“Decreased sensation and pain may lead to the avoidance of sex,” says Dr. Wilson-Manigat. “Using sexual arousal oils and lubricants can help stop the cycle of avoidance by decreasing pain and increasing pleasurable experiences. Sexual arousal oils can help by increasing blood flow to the genital area and making it easier to orgasm.”

Generally, silicone-based lubes are recommended for vaginal dryness instead of water-based ones. That’s because water-based lubes may change the microbiome in your vagina, which could cause problems at this stage of life. 

Make healthy lifestyle choices

Good sex has many health benefits, says Dr. Wilson-Manigat, such as “decreased blood pressure and heart rate, improved mood, decreased stress, a minimized perception of pain, improved connection with your partner, it makes you look younger, and burns calories.” 

But it works both ways, so prioritizing your health can improve your sex life, too. “Eating healthy foods [aim for a balanced diet], staying hydrated, moving your body regularly, and getting adequate, restful sleep are the foundations of a good sex drive,” Dr. Wilson-Manigat adds. 

Get plenty of exercise

Exercise is a great tool to improve sex drive, explains Dr. Wilson-Manigat. “It addresses body image/confidence through improved muscle tone and shape, improves mood via the release of endorphins, and over time increases energy levels,” she says. 

“Exercising to improve your body’s muscle tone and shape can boost your confidence and increase the release of feel-good hormones, which can also increase your sex drive,” adds Dr. Wilson-Manigat. 

Try sex therapy

Sex may be a physical act, but how you think and feel can have a huge impact on your sexual experiences. If it’s troubling you, it may help to talk to someone. 

Speaking to a mental health specialist or sex therapist can help with improving sex drive, explains Dr. Wilson-Manigat. “Typically, cognitive behavioral therapy focuses on identifying and changing beliefs and miseducation around sex and can help with developing practices to communicate with your partner about sexual needs and preferences,” she says. “Whereas mindfulness-based therapy focuses on reducing stress through attention to the present moment, accepting the thoughts and feelings present without judgment, and calming the nervous system.”

Consider hormone therapy

Hormone therapy involves taking medication that boosts levels of female hormones. A particular type of HT called vaginal estrogen may help to revive your sex life by treating menopause-related symptoms of the vagina, such as dryness and lack of blood flow to the area. But as Dr. Wilson-Manigat points out, “Hormone therapy really only helps with sex drive if hormones are the issue. There may be other reasons why sex drive is low, and it’s important to treat those reasons, even if hormone therapy is recommended for you.”  

Whether you think vaginal estrogen could be useful to you or there’s another reason behind your low sex drive, the best thing is to speak to your doctor about what options you have.