Of the many things that have gone the way of the dodo in recent years (think: DVD collections, people writing notes on actual paper, and the ability to stay up past midnight on New Year’s), your libido since menopause is one of the most noticeable. If you’ve experienced this very normal dip in drive, you may be wondering, where did that go, and why didn’t it leave a note? You also may want to know how to increase sex drive during menopause.
Let’s make one thing clear: if you find your book, your Wordle, a bass-fishing reality show marathon on cable, anything!—more interesting than sex, it’s totally normal. Women’s libidos often putter out along with their menstrual periods. Many of us find we don’t mind living with a lower sex drive, and our partners are riding on a parallel track. It’s only a problem if you do miss it, or your partner wants sex more than you do and it causes tension in your relationship.
The reasons your sexual thermostat feels like it’s on energy saver mode are complex and multifactorial, a tangle of lifestyle and physiological factors that are hard to unwind.
About the Experts
Stephanie Trentacoste McNally, M.D., is an associate professor at Hofstra University Zucker School of Medicine in New York, as well as the director of OB/GYN Services at the Katz Institute for Women’s Health.
Cynthia Stuenkel, M.D., is a Clinical Professor of Medicine at the University of California, San Diego, School of Medicine, and an attending physician for UC San Diego Endocrinology and Metabolism Service.
12 Ways to Increase Sex Drive During Menopause
The upside to having a complex problem with multiple contributing factors: there are boatloads of options to help increase your sex drive during menopause. Depending on the causes of your dearth of desire, trying a few different tactics may help you find your missing mojo.
“First and foremost, recognize what’s going on with your body,” says Stephanie Trentacoste McNally, M.D., an associate professor at Hofstra University Zucker School of Medicine in New York. Here’s where to start:
1. Look at the whole picture
Pay attention to your body and your level of desire. Ask yourself, “Are there changes in my life? Are there changes in connection in my relationship? Is there something medically going on?” says McNally, adding that it is important to look at yourself holistically.
“Sexuality is a true mind/body connection,” she explains. “I try to look at sexual arousal issues with a head-to-toe, front-to-back approach. [Libido] is complex and there is no simple on/off switch,” McNally says. Consider “what’s going on in terms of work, life, family, stress, relationships?” she says. Questions to ask yourself include, “what is at the root of what’s happening?,” “why is my body feeling like this?,” and “how can I get the help I need?”
You may also want to experiment with different ways to help you get in the mood. Do you prefer written erotica? Porn? Music? Invite your partner to join you, or enjoy your favorite sexual medium on your own.
Bring your insights up with your doctor. While there’s no single diagnostic test for low libido, many clinicians find that the Decreased Sexual Desire Screener, a short questionnaire, is a helpful part of an evaluation, says Cynthia A. Stuenkel, M.D., a Clinical Professor of Medicine at the University of California, San Diego School of Medicine.
2. Talk to your partner
You may share a bottle of wine, toothpaste, even a dog and kids, but many of us don’t share our experience with menopause with our partners. “It’s kind of surprising how many people don’t!” says Stuenkel. “You’re having sex with this person, you should be able to have a conversation with them,” she says. Give it a go, even if it feels awkward, communication is important. What’s happening with your body is normal, if sometimes challenging.
It may also be helpful to schedule (yes, schedule) some time for intimacy, be it cuddling on the couch, waking up early to drink coffee and talk about your day, or sex.
3. Try alternative activities
If you’re dealing with vaginal dryness and low libido, maybe penetrative sex is just too big of an ask right now. And that’s OK. But you know all too well that just cause you don’t want to have sex, doesn’t mean you don’t want to be close to your partner. Alternative activities to increase intimacy, such as oral sex, a make-out sesh, caressing, or a sensual bath, can spice things up.
4. Take the DIY approach
Yes, we are writing you a prescription to masturbate. What happens when you focus on yourself and your needs? There may not be anything physically wrong with you or your libido; you may be just prioritizing other things—like what every single other person in your house and office needs over what you need.
“Lack of desire is not necessarily a physiologic problem,” says McNally. Which is why you should view the situation through a wide lens. “It is okay to use sex tools and masturbation to get really comfortable with your body. Understand that your needs will change, and what you need at different stages may vary,” she says. “Change doesn’t mean bad, it’s just different,” McNally notes.
5. Try pelvic floor therapy
Research suggests that estrogen loss can lead to pelvic floor dysfunction, which may increase the odds of urinary incontinence or GSM (2). Pelvic floor muscle rehabilitation has been shown to help reduce signs and symptoms of GSM.
“Pelvic floor therapy is so underutilized! It’s an incredible resource for women having GSM and pain,” McNally says. Pelvic floor muscle training helps improve blood flow in vulvovaginal tissues and aids in muscle relaxation and tissue elasticity in postmenopausal women with GSM and urinary incontinence, according to a small study published in the journal Climacteric (3). If your doctor doesn’t have a referral, check out the directory of the American Physical Therapy Association.
6. Lubricate
Many women forget this easy aid. Regular use of lubricants is enough help for some women to feel more interested in sex, notes Stuenkel. Lube can help improve sexual pleasure and reduce pain related to vaginal dryness, according to a review published in Sexual Reproductive Health Matters in 2022 (4).
Experiment with formulations and ingredients, to see what feels the best. They’re not all boring and tasteless, she says. “There are moisturizers and lubricants that come with stuff that tingles and stuff that’s flavored, have fun trying some of them as experiments.”
7. Address underlying physical issues
Unlike hot flashes, which eventually go away on their own, vaginal dryness only gets worse, so it’s important to get help. Treatments will vary based on your and other menopausal symptoms. It’s also important to get evaluated for Genitourinary Syndrome (GSM), a cluster of symptoms that make sex after menopause painful. These include genital symptoms (vaginal dryness, burning, and irritation), sexual symptoms such as lack of lubrication, discomfort or pain with penetration, impaired function, and urinary symptoms (urgency, burning, recurrent urinary tract infections).
Some 24 to 84 percent of postmenopausal women have GSM, according to the Merck Manual, but there are some approved treatments. Below are some of the medications that address various physical problems that get in the way of better sex in menopause.
Low-dose vaginal estrogen(comes in cream, tablet, capsule, or ring form)
Vaginal DHEAwhich stands for dehydroepiandrosterone, a steroid hormone
Systemic estrogen therapy (used when a woman has multiple menopausal symptoms)
Ospemifene (Osphena), a selective estrogen receptor modulator (SERM), that can be taken orally.
8. Get regular exercise
Exercise can help make everything better, relieving stress and inducing endorphins. “If you have some depressive symptoms, moving more helps, and it may help with body image issues,” says Stuenkel.
When you get a flood of endorphins from physical activity, you may get an instant body image and mood boost. Overtime, exercise improves stamina—which you can bring back to the bedroom.
9. Look at your diet
Foods rich in phytoestrogens—which mimic your body’s natural estrogen—may provide some relief menopause symptoms like low libido (7). These include:
Flaxseeds
Soy
Legumes
Whole grains
Estrogen isn’t the only hormone at play. Fluctuating testosterone levels in perimenopause can also lead to low libido. These foods with zinc may give you a boost of T:
Red meat
Beans
Whole grains
Dairy
Eggs
You can also experiment with aphrodisiac foods like maca root, dark chocolate, and oysters. But ultimately, eating a balanced diet is most effective for optimizing your sexual health.
10. Reduce stress
Stress is the opposite of an aphrodisiac. While menopause symptoms on their own can make you spiral, there’s also the stress of being the age you are when menopause hits.
“Our parents are older, our kids are teenagers, and we might have what seems like a teenage boss that may not appreciate all our attributes,” says Stuenkel. “There may be marital issues or other things may be going on with them. There’s often stress around our parents, our health, and our work. It is a challenge.”
11. See a specialist
Depending on the issues at play, a psychologist, couples therapist, or sex therapist may be able to help you approach multiple factors related to low sex drive during menopause. If your doctor can’t give you a referral, search the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) provider finder. You can also find a Certified Menopause Provider through the Menopause Society’s directory.
12. Ask about medications
In recent years, some potentially helpful drugs for low libido have been developed or employed off-label, such as flibanserin (Addyi),bremelanotide (Vyleesi), and testosterone. There isn’t a lot of long-term safety data for use in women, however, so you’d need to do a cost-benefit analysis with your doctor, says Stuenkel.
Menopause, or “the change,” as you may remember Edith Bunker calling it on All in the Family when you were a kid, occurs around the same time as a lot of other things are changing: Maybe you’re now the boss at work but have been fired as far as your teenage kids are concerned, so your sense of self and priorities are shifting. When your sex drive also shifts during menopause, it can be difficult to isolate why, says Stuenkel. Below are some of the things that may be spraying your formerly burning libido with flame retardant:
Physical changes
What’s happening in your body during perimenopause and menopause might influence how revved up you feel. These aren’t only hormonal changes, says Stuenkel. “From a health standpoint, midlife is when things start coming up. Many women who are approaching menopause may already have things like hypertension, diabetes, or metabolic syndrome. And these—or the medications that we prescribe for them—can have a negative effect,” she says. For instance, antidepressants, anti-seizure medications, and beta-blockers can reduce desire, according to the Merck Manual. And then there is the magic that menopause can bring, in terms of symptoms, that wet the blanket on your connubial bed:
Vaginal issues
The biggie is general dryness or dramatic discomfort down under. As estrogen levels lessen, the cervix secretes less mucus, the skin and tissues in and around the vagina have less elasticity, and pelvic and bladder support muscles may weaken (5). “For some women, vaginal dryness leads to sex becoming uncomfortable. And if something is uncomfortable, you’re going to try to skirt around it,” says Stuenkel.
Vaginal estrogen cream can support elasticity and prevent dryness, making sex more enjoyable.
Big-time sleep problems
Difficulty falling asleep and staying asleep and night sweats, which are hot flashes that happen during the night, are incredibly disruptive and leave you exhausted the next day. The combined loss of estrogen with stress, anxiety, and other late-night symptoms can create a perfect storm for feeling too pooped for menopause sex, says the North American Menopause Society (NAMS).
Genitourinary Syndrome (GSM)
If you have GSM, sex after menopause can be painful. GSM includes genital symptoms (vaginal dryness, burning, and irritation), sexual symptoms such as lack of lubrication, discomfort or pain with penetration, impaired function, and urinary symptoms (urgency, burning, recurrent urinary tract infections). There’s no craving for anything but a pain reliever when you have a UTI.
Mental changes
Midlife hormone flux may impact your state of mind, showing up as anything from irritability to body dissatisfaction. Mood changes have been observed in up to 23 percent of peri- and postmenopausal women, according to NAMS.
Symptoms of anxiety, such as tension, nausea, nervousness, and worry, are reported more frequently during perimenopause than before it. And you know what often holds hands with anxiety? Depression: Hormone level fluctuations may make women vulnerable to it, which can be both a cause and a result of lower female arousal after menopause.
These mood issues have historically been dismissed as something women simply have to deal with, but that is starting to change. In 2021, a study published in The Journal of Clinical Endocrinology & Metabolism concluded that the transition to menopause is “a disruptive process … It is important for clinicians to recognize early signs and symptoms of the transition and be prepared to offer treatment to mitigate these symptoms” (6).
What If I Have a Higher Sex Drive During Menopause?
Well, go you, if that’s the case! This phenomenon is certainly not the norm, and there isn’t much research on women wanting to have more sex during menopause than before. That said, “menopausal zest” is a thing: For some women, libido may sometimes be higher with the hormone flux around menopause, or they may find it easier to just relax and have fun when there is no threat of pregnancy or of a kid opening the door and being appalled at what his parents are doing. If this is you, just enjoy it—there’s nothing wrong with you and everyone is different.
The Bottom Line
Lower libido during menopause is totally normal. Hormonal shifts contribute to it, as do lifestyle changes. If you miss wanting to have more sex like you used to, pelvic floor therapy, medications, masturbation, and treating menopause symptoms like vaginal dryness can do to improve the situation. Be honest with yourself, talk to your partner, and then be brave—ask for help if you want it.
