Dealing with Loss of Libido in Perimenopause and Beyond

Loss of libido is common in the years before and after menopause. 

Sexual desire problems generally peak around ages 35 to 64. So what’s happening to your libido? Well, there’s a lot going on! Hormones are changing. Roles are changing. Relationships can become “meh”. Stress may be through the roof. Feelings about your body changes can cause shame. All of this is a recipe for libido falling off a cliff!

So what’s the fix for sex drive issues? The first step is to tease out the complex causes and address them. Let’s take a look at these sex drive zappers.

Pain, dryness and other hormonal issues

Before menopause, your libido peaks just before and after you ovulate to encourage baby-making. But when you begin to ovulate less frequently, those revved-up days in your cycle vanish. Progesterone levels tumble and declining estrogen also means less blood flow to the vagina and more dryness. So when you do have sex, it hurts. And who craves more of it when it feels like that?

What helps: Start by removing pain. And to do that, you need to fix the underlying thinning of vaginal tissue. Over-the-counter water- or silicone-based lubricants will reduce friction, but they don’t solve the problem. Vaginal estrogen or DHEA work to plump up thin tissue. My clients and friends who have tried this product have raved about it. And even better, it’s available without a prescription.

You may want to ask your doctor. Also, ask the doctor about low-dose vaginal estrogen in a cream, suppository, or ring. 

The drug ospemifene is used to treat severe vaginal pain due to menopause, but it can cause hot flashes. The medication flibanserin is approved for premenopausal women who have hypoactive sexual desire disorder (loss of libido) with no other things affecting desire. More about this next week.

Midlife Stress

In midlife, many of us are deep into a marriage, a job, raising teens, and possibly caring for our parents. Any of these things can amp up stress, and the tension puts sex drive in park. Avoiding sex because you’re not feeling it can, in turn, make you get along less well.

What helps: Make plans for dates and lovemaking, even if you never had to do this before. Downplay the focus on sex and focus on just making time to be together, along with foreplay, massage, and any forms of sex that you find pleasurable. Consider getting short-term couples counseling when your sex life or relationship in general hits a rough patch.

Normal aging

Desire generally slows with age for both women and men. Women are two to three times more likely to have this problem. This is, in part, due to a drop in testosterone. Men also experience this drop, but they have much larger blood levels than women at baseline. This is the hormone active in every stage of sex response, starting with desire.

What helps: There’s no FDA-approved testosterone therapy for women. However, compounded creams or injections may help (more on that in a coming post).

There’s good news about aging and sex, too: many women say they feel an uptick in desire after menopause because of fewer worries about pregnancy, kids finally out of the house, etc.

Mood disorders and meds

Depression and anxiety can add to sexual problems, and menopause itself can cause mood changes. Women get mood disorders more, and they peak around 40 to 59.

It doesn’t help that main treatments for depression, SSRI and SNRI antidepressant drugs, can also mute desire and slow sexual response. Many women who aren’t depressed are prescribed antidepressants short-term to deal with hot flashes and other menopause symptoms. Though the pills fix these problems, desire can tank.

What helps: See a doctor about treating depression with both pills and talk therapy. Some non-SSRI antidepressants, such as bupropion, cause fewer sexual side effects.

Your thinking

If graying hairs, extra pounds, and dry skin make you see yourself as “old,” you’re less likely to see yourself as “hot.” However, you are fully in charge of how you think about these things. Instead of focusing on what you DON’T love about your body, focus on the things you can appreciate about it.

Women may also blame menopause for lost desire when other health problems are the real stoppers. Common culprits: Bladder problems, an underactive thyroid, chronic pain, and medication side effects.

What helps: Get a checkup to make sure there’s nothing else going on with symptoms that bother you. Then make time to take care of your body and relationships now, it pays off in many ways — including more fun in bed. Your brain is one of your best sex organs.

Mojo that is MIA in perimenopause and menopause can be frustrating. It’s important to note that any loss of libido during perimenopause is not necessarily a permanent condition.  Once the hormonal chaos of perimenopause passes, many women report the return of their sexual desire. With the added benefit of hormone therapy to address any potential physical issues, there is no reason that women in midlife cannot continue to enjoy a healthy sex life.