Photography by Polina Tankilevitch
Perimenopause, menopause and libido: Tips for people who want to improve their sex drive
With all the changes of perimenopause, your sex drive may evolve
Top things to know about sex, perimenopause, and menopause:
Sex can change in the years leading up to menopause and sometimes in the years after you reach menopause
Common changes of perimenopause include thinner vaginal tissue, hot flashes, and changes in your libido
There are plenty of treatment options out there depending on your symptoms
Many women found that their libidos improved after menopause
Both you and your partner(s) will experience changes with age — you're not alone in this journey
What is menopause?
Menopause is the time in your life when your menstrual cycle comes to an end and you stop having periods, marking the end of fertility. It happens because the ovaries stop producing estrogen. This hormone controls parts of the menstrual cycle (1). Menopause happens to all women and people with cycles. However, some medications or surgeries can change its timing (2). Menopause is usually defined as the absence of a menstrual period for one year (3).
What is perimenopause?
Perimenopause is the years leading up to menopause. During this phase, reproductive hormone levels fluctuate. The ovaries shrink and produce less estrogen, causing many changes (3). It’s hard to pinpoint the exact start of perimenopause because it varies so much from person to person. One study found that changes in the predictability of menstrual cycles, which are a sign of perimenopause, began on average between ages 47-48. However, it can start much earlier or later (4). During perimenopause, your periods may change. They might become shorter or longer and heavier or lighter than usual. You may also skip periods, because some months you may not ovulate (3).
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Common changes during perimenopause that may impact your sex life include:
Hot flashes: a sudden feeling of heat, sweating, or anxiety. They often start in the chest and may spread to the neck and head (1). Hot flashes can impact your sleep, leaving you tired (5). Feeling tired might lower your desire for sex.
Changes to vaginal tissue: lower levels of estrogen can cause vaginal atrophy (1). It makes the vaginal walls become thinner, less elastic, and drier (1). Vaginal atrophy can make penetrative sex feel more painful (1).
Urinary tract infections: the urethra, the tube that lets urine leave your body, may become drier and inflamed. This can make you urinate more often and increase the risk of a urinary tract infection (1). One study showed that women with recurrent urinary tract infections experienced more sexual dysfunction (6).
Incontinence: one study found that over a third of women experienced urinary incontinence during perimenopause (7). Another study found that individuals with pelvic floor muscle issues — the muscles crucial for managing incontinence — also faced more challenges with orgasm and low libido compared to those without pelvic floor muscle issues (8).
Trouble sleeping: some people experience insomnia, night sweats, or wake up at unusual times. This leaves them feeling tired and less interested in sex (1).
Changes in appearance: one study found that seven out of ten women noticed changes to their skin during both perimenopause and menopause stages, including skin becoming thinner and drier (9). Hormonal changes during perimenopause can also cause thinning hair (9). Changes in appearance can make you feel less sexy and therefore curb your motivation for sex (5).
Mood changes: research shows that perimenopausal women are more prone to depression than premenopausal women. This can reduce their desire for sex (10,11).
Perimenopause can cause changes to libido, such as less interest in sex, trouble getting aroused, and pain during sex. These issues can be grouped into a term called sexual dysfunction (8).
Why might perimenopause impact my sex drive?
There is limited research on perimenopause and low libido. However, decreasing estrogen and testosterone levels likely affect sexual functions, including libido (12). Low hormone levels may affect the brain areas that cause sexual arousal. Additionally, changes like vaginal atrophy may cause painful sex (12). Arousal and sexual function are complex, and they’re affected by more than just hormone levels. Mood, relationships, self-esteem, body image, stress, and other health conditions can all play a role (12,13). One study found that a woman’s partner’s erectile dysfunction affected their sex drive during menopause (13).
Low libido may differ in perimenopausal women and postmenopausal people. One study found that around one in ten perimenopausal women experienced low libido. However, only about 3 in 100 menopausal women did (14). This may be because perimenopausal symptoms may improve after menopause (15). In any case, more research is needed on libido in premenopausal vs postmenopausal people.
Many believe that perimenopause reduces women's sex drive. However, research shows only about one in ten women report no sexual desire after entering perimenopause. This means that nine in ten women may still experience the desire to have sex (16). One of our Clue writers even found that she was “way hornier for much more of each cycle than ever before” during perimenopause. While your libido might change during perimenopause, it's more likely to remain the same. However, if you experience changes, there are ways to manage them.
What kind of treatments are available for people during perimenopause and after menopause to improve their sex lives?
If you're content with your sex life as it is and feel comfortable with your partner(s), a low libido might not be a concern for you. However, if you're looking to enhance your sex life and boost your libido, some methods can help. It's essential to remember that a fulfilling sexual relationship is about all parties involved. You're not solely responsible for a satisfying sex life. Whether you’re in the perimenopausal stage or after menopause, some methods include:
Hormone replacement therapy (HRT): treatment involving estrogen or estrogen with progesterone (17). Read on to find out how HRT can impact your sex life.
Non-hormonal drugs: one FDA-approved medication called Flibanserin can help with sexual desire (18). However, it’s not available in all countries and is only approved for premenopausal women in the USA.
Sex therapy: through therapy, you can explore other aspects that contribute to low libido. Sex therapy is a good way to explore communication, cultural considerations, and practical exercises for both yourself and your partner(s) (18).
Lubricants: if you have vaginal dryness, penetrative sex may be painful, so you may consider using vaginal lubricants. If you’re using condoms to prevent STIs or pregnancy, make sure to use a condom-friendly lubricant (19).
Vaginal moisturizers: some over-the-counter vaginal moisturizers can help with pain during penetrative sex (19)
How can hormone therapy affect sex during perimenopause?
Hormone therapy uses hormones like estrogen or a combination of estrogen and progesterone to ease perimenopausal symptoms (20). It’s also known as Hormone Replacement Therapy (HRT). It can be given as skin patches, sprays, gels, creams, tablets, or implants (20). This therapy may improve sexual function by helping with dryness, itching, and painful intercourse. It does this by increasing lubrication, blood flow, and sensitivity in vaginal tissues (20).
One review found that HRT likely improved symptoms of sexual dysfunction in menopausal women within five years of their last period. In menopausal women whose last period was more than five years ago, estrogen likely did not affect sexual function (20). Another study found that estrogen, given via a pill or skin patch, improved vaginal dryness and pain during sex. However, only the skin patch helped increase libido (18).
Another hormone therapy that may boost sexual desire during perimenopause is testosterone. It may also reduce anxiety about sex. A review of several studies found that women who used a testosterone patch experienced a noticeable increase in sexual desire (21).
What are the risks of hormone therapy?
Hormone therapy can treat perimenopause symptoms. But, like all drugs, it has potential side effects. Estrogen-only therapy can thicken the uterine lining, which can raise the risk of endometrial cancer (17). This isn’t the case for topical estrogen such as creams. Incorporating progestin can help reduce this risk (17). Both combined hormone therapy and estrogen-only HRT carry a slight increase in breast cancer risk (17). Doctors recommend people with a history of hormone-sensitive breast cancer explore non-hormonal treatments for perimenopause symptoms first. However, combined hormone therapy may also offer some protection against colon cancer (17). You should consult your healthcare provider to find the best hormone therapy for you.
How do I talk to my partner(s) about sex during the perimenopausal stage and after menopause?
Starting a conversation about sex with your partner can be hard. This is especially true if you’re in perimenopause or after menopause. Research shows that many couples often struggle to communicate about sex (22). You’re not alone if you feel that way. However, research shows that discussing their sex life helps couples. It boosts both their relationship and sexual satisfaction (22). A good start would be to share your feelings and experiences honestly. Explain any changes you’ve noticed in your libido, physical sensations, or emotional state. If you feel like you can, you could express what you need from your partner. Also, tell them how they can help you through your perimenopause or menopause.
There are many ways to enjoy intimacy with your partner during perimenopause and after menopause. If you’d like to increase your sexual intimacy, you can try new things. Think sex toys, impact play (spanking), or rope play. For some people, it might mean focusing on different parts of sex like foreplay. Research shows that foreplay, such as kissing, can improve sexual arousal and receptivity (23). If sexual intimacy is difficult for you, or too painful, there are other ways to connect with your partner. You could hold hands, cuddle, or give massages. Masturbation, which involves touching yourself for pleasure, is a great way to explore sex without a partner.
How does menopause affect LGBTIQ+ people’s sex lives, specifically?
LGBTIQ+ people who experience menopause have unique experiences. This includes lesbian, bisexual, and queer-identified cisgender women, as well as trans and non-binary individuals. One review suggests that sexual minority groups are more open with their partners about sexual function during menopause and often experience greater sexual satisfaction. This is largely due to their broader and more inclusive understanding of sex and pleasure (24). For non-binary people, perimenopause and menopause can cause stress, isolation, and gender dysphoria. However, the research on this is minimal (24). If anything, the knowledge gap highlights that more research is needed to understand the experiences of LGBTIQ+ people who go through menopause. This will help healthcare professionals better support their needs.
Introducing Clue Perimenopause
With all the changes of perimenopause, including changes in libido and vaginal dryness, it can be difficult to feel in control of your body. Tracking and sharing your experiences with your healthcare provider during perimenopause can help you feel better. It empowers you with knowledge and can support any decisions you make about your healthcare. Clue Perimenopause is for anyone in, or who thinks they’re in, perimenopause and wants to track their experiences to monitor changes and patterns over time. If you have a Clue Plus subscription, you can easily find it by switching modes in the app.
FAQs
Can I still get wet after menopause?
During perimenopause and postmenopause, low estrogen levels cause lower levels of vaginal fluid. Women may produce some natural fluid during sexual arousal, but it will be less than before perimenopause. Lubricants or vaginal estrogens can help for penetrative sex (1,25).
Will menopause lower my sex drive permanently?
No. Research shows that only some women experience a lower sex drive when they enter perimenopause (16). Research also indicates menopausal women have a higher sex drive than perimenopausal women (14).
