Combating Your Decreasing Desire During the Menopausal Transition
Decreased sexual desire is common in women going through the menopausal transition, but there are ways to get your groove back.
The average length of perimenopause is four years but can last up to 10 years. During this time, your body gradually slows the production of reproductive hormones, which causes the onset of perimenopausal symptoms, including hot flashes, mood swings, depression, vaginal dryness, poor sleep and more. It's no wonder then that your sex drive might dwindle.
Experiencing a decrease in sexual desire can happen to all genders and ages, but research shows that it's especially common for women in midlife. It's tricky to define something like libido because there's no such thing as a "normal" sex drive. It's completely natural for arousal and desire to fluctuate as you age. A change in libido is challenging only when it causes you—or your relationship—distress.
How perimenopause affects your sex drive
Sexual desire isn't as linear as we're made to believe—it's not a switch that you can flip on and off. Anything that puts a strain on your physical or mental health, or the happiness of your relationship, can impact your sex drive.
Perimenopause can negatively affect sexual desire in several ways. During the menopausal transition, a loss of libido is likely due to either hormonal fluctuations or drastic lifestyle changes, or a combination of both.
"As a specialist in female sexual function, lots of women come to me with these concerns," said Jessica Pettigrew, M.S.N, C.N.M., a midwife and co-director of the women's sexual health consultation service at the University of Colorado OB-GYN department. "In a large study of over 40,000 women, 43 percent of women reported some degree of sexual dysfunction, so these concerns are very common, but care providers do not routinely ask women about sexual function."
During perimenopause, your body starts producing less estrogen, progesterone and testosterone, the hormones that play a key role in libido. Lower levels of estrogen can lead to uncomfortable physical changes, such as vaginal dryness, which can make sex uncomfortable or painful.
Other reasons why your sex drive might hit the brakes are symptoms such as stress, hot flashes, fatigue, anxiety and sleep issues, which are hardly turn-ons. Women who experience these symptoms have been shown to report lower levels of arousal, according to a 2010 study published in the Journal of Women's Health.
"Anything that affects sleep quality will affect sexual function, as a tired person wants to get into bed and sleep at the end of the day," Pettigrew said. “I often try to help women prioritize and remedy their sleep issues by treating nighttime hot flushes or other causes of disrupted sleep. Addressing these concerns can help improve sleep and sexual function."
Sexual desire is also significantly affected by emotional and lifestyle factors such as self-esteem, relationship satisfaction and overall quality of life, which can all dwindle around the time of perimenopause.
"Many women who have small children at home, are busy working full time and may be in long-term relationships begin to note decreased desire as their lives become very busy, and intimacy is often the first thing to get cut from the 'to-do list,'" Pettigrew said.
How to increase libido during perimenopause
If your sexual desire has been affected by perimenopause, the first step is to identify the underlying cause. Your doctor can help you find the best course of treatment, which can include prescription medications and therapy.
Medications
Although there's no such thing as "viagra for women," there are several prescription medications that can target the perimenopausal symptoms affecting your sex drive.
Menopausal hormone therapy (MHT) is the first line of treatment for menopausal symptoms. MHT (now less commonly called hormone replacement therapy, or HRT) uses prescription medications that contain synthetic or bioidentical versions of estrogen and progesterone, which aim to replenish the hormones your body isn't producing as much of anymore. MHT can help alleviate symptoms including hot flashes and vaginal dryness.
There is some early evidence that testosterone may increase libido in women going through perimenopause and menopause, but there is limited data on its long-term safety and efficacy, so more research is needed.
The Food and Drug Administration (FDA) has also approved two therapies, Addyi (flibanserin) and Vyleesi (bremelanotide), for hypoactive sexual desire disorder (chronically low libido) in premenopausal women.
"Given that the brain is the primary sexual organ, both of these medications are nonhormonal and act on neural pathways by increasing dopamine and norepinephrine," Pettigrew explained.
However, both treatments have been shown to be only marginally better than a placebo and can cause side effects including nausea, fainting and low blood pressure.
"There is some data to support the supplement l-arginine that can be found in various supplements for sexual health," Pettigrew added, but she cautioned women to be skeptical of fads. "Do not fall prey to magic fixes, hormone pellets and medications/procedures that are not clinically validated and for which you are asked to pay large sums of money out of pocket."
Although it won't target low libido directly, using over-the-counter vaginal moisturizers or lubricants during penetrative sex may help increase your desire for sex if vaginal dryness was affecting your libido.
Therapy and relationship counseling
Where medications aren't effective or appropriate, there's solid evidence that psychological interventions such as counseling or therapy (solo, couples or groups) can help bring back sexual desire.
"Of course, addressing relationship concerns, such as stress or discord in the relationship, is essential to healthy sexual functioning," Pettigrew said. "Many couples are sexually bored after years together and benefit from the introduction of new sexual practices, which, in the context of a long-term relationship, can sometimes be difficult to bring up with their partner."
She recommended seeking a provider who specializes in evidence-based care for menopausal women and sexual function.
"Working with a therapist or psychologist with expertise in sexual function is invaluable as women navigate these changes," Pettigrew added.
Practicing mindfulness, whether at home or with the supervision of a therapist, can also help. Learning to be present at the moment can help tune out distractions and focus on sexual activity.
The best treatment will depend on the reason you're experiencing low libido and why it's becoming a problem for you. Clinicians should consider their patient's changing biology as well as ongoing life challenges.
"Women do best when treated with a holistic model called a biopsychosocial approach that addresses their whole person, their relationship, past trauma, beliefs about sexual function, assessment of anxiety/depression, and overall well-being," Pettigrew said. "Recognize that menopause is a natural life transition and that sexual function changes throughout the life span. It is normal to experience less sexual desire at some point in life."
If you're experiencing a loss of desire because of perimenopause, rest assured that there is nothing wrong with your body, and if this change is bothering you, solutions are available.
