A lower sex drive is common around menopause, and the NHS lists it among menopause symptoms. It usually has several causes at once: hormone changes, vaginal dryness or pain, poor sleep, low mood, stress, medicines and relationship factors. Treating physical symptoms often helps, and NICE recommends considering testosterone if HRT alone doesn’t. It’s only a problem if it bothers you.
What does low libido look like?
- Thinking about sex less often, or not at all
- Less interest in starting sex, or responding to a partner
- Difficulty becoming aroused, or reduced sensation
- Difficulty reaching orgasm, or less intense orgasms
- Avoiding sex because it’s uncomfortable or painful
Desire varies naturally between people and across life. Some people are untroubled by lower libido; others find it distressing or feel it affects their relationship. What matters is how you feel about it.
Why does menopause affect libido?
Low libido rarely has a single cause:
- Vaginal dryness and pain. Thinner, drier tissues can make sex uncomfortable, which naturally reduces desire. See vaginal dryness.
- Hormone changes. Falling estrogen affects arousal and lubrication. Testosterone declines gradually with age, and more suddenly if the ovaries are removed. See surgical menopause.
- Other symptoms. Hot flashes, poor sleep, fatigue and bladder symptoms can leave little energy or comfort for sex.
- Mood and stress. Low mood, anxiety and stress reduce desire. See low mood.
- Body image and confidence, which may be affected by changes in weight, skin or hair
- Relationship factors, such as communication, conflict, a partner’s health or sexual difficulties, and familiarity
- Life circumstances, such as caring responsibilities, work pressure or grief
What else can affect libido?
- Medicines, particularly some antidepressants, and some blood pressure, contraceptive and hormonal treatments
- Depression
- Thyroid problems or other hormonal conditions
- Chronic illness or pain
- Alcohol
- Past trauma, which can influence sexual comfort and desire
What will a clinician assess?
A clinician may ask about:
- When the change started and how much it bothers you
- Whether sex is painful, and about vaginal and bladder symptoms
- Mood, sleep, stress and energy
- Your relationship, and any concerns about your partner’s sexual health
- Medicines and other health conditions
They may offer an examination if there’s pain or dryness. Blood tests may be suggested in some cases, but hormone levels alone don’t diagnose low libido.
What treatments help?
Treat physical symptoms first
- Vaginal dryness and pain: moisturizers, lubricants and low-dose vaginal estrogen. NICE recommends offering vaginal estrogen for genitourinary symptoms, including alongside HRT.
- Hot flashes and sleep problems: hormone therapy, non-hormonal medicines or CBT.
- Bladder symptoms: pelvic floor training and other treatments. See urinary changes.
Hormone therapy
HRT can improve symptoms that affect desire, such as vaginal dryness, poor sleep and hot flashes. The 2024 international guideline on premature ovarian insufficiency notes HRT may improve sexual function, although the effect is generally small.
Testosterone
- NICE: recommends considering testosterone supplementation for low sexual desire associated with menopause if HRT alone isn’t effective.
- After surgery or cancer treatment: the 2024 POI guideline recommends considering testosterone for low desire in women with POI caused by medical treatment, once other causes have been addressed.
- Not needed by most: NHS patient information notes testosterone isn’t needed by the majority of women.
- Availability: testosterone for women isn’t licensed in every country, and it’s often prescribed "off-label" using products designed for men, at much lower doses. It requires monitoring.
Talking therapies
- Psychosexual or sex therapy can help with desire, arousal and communication.
- Couples counseling can help if relationship issues are involved.
- CBT can help with low mood, anxiety and stress.
Review your medicines
If a medicine may be affecting desire, don’t stop it on your own. Ask your clinician whether an alternative is possible.
Practical steps that may help
- Talk to your partner about what’s changed, what feels good, and what you both need.
- Broaden what intimacy means: touch, closeness and non-penetrative sex can maintain connection.
- Allow more time for arousal.
- Use a lubricant during sex, and a moisturizer regularly if you have dryness.
- Plan intimacy for times when you’re less tired.
- Look after your wellbeing: sleep, exercise, stress management and less alcohol.
- Be kind to yourself. Changes in desire are common and not a personal failing.
Understanding desire
Sex therapists often describe two kinds of desire:
- Spontaneous desire: feeling interested in sex "out of the blue"
- Responsive desire: interest that builds once you’re already being touched or feeling close
Many people, especially in long-term relationships and in midlife, mainly experience responsive desire. That’s normal, not a sign that something is wrong. Creating time, relaxation and physical closeness without pressure can help desire emerge.
For partners
- Avoid taking it personally. Changes in libido around menopause usually reflect symptoms, hormones and life pressures, not a lack of love or attraction.
- Ask what would help, whether that’s more closeness, less pressure, or changes to how you have sex.
- Share the load at home. Tiredness and stress are powerful desire-dampeners.
- Consider going together to a clinician or therapist.
When should you get help?
Book an appointment if changes in desire bother you or affect your relationship, or if sex is painful.
See a clinician promptly if you have:
- Bleeding after sex, or any bleeding 12 months after your last period
- New or severe pain during sex
- Low libido with persistent low mood, loss of interest in things, or thoughts of harming yourself. If you have thoughts of harming yourself, contact emergency services or a crisis line in your country straight away.
Questions to ask at your appointment
- Could menopause be affecting my sex drive?
- Would treating vaginal dryness help?
- Could any of my medicines be contributing?
- Would HRT help, and if not, is testosterone an option for me?
- Can you refer me to a psychosexual therapist or sex therapist?
See your first menopause appointment.
Vaginal dryness · Urinary changes · Low mood · Fatigue · Sleep problems
Frequently asked questions
Is it normal to lose interest in sex during menopause?
It’s common. Hormone changes, vaginal dryness, poor sleep, mood and life circumstances all play a part. It’s only a problem if it bothers you.
Does HRT increase libido?
HRT may help indirectly by improving vaginal dryness, sleep and hot flashes. Its direct effect on desire is generally small.
Can women take testosterone for low libido?
NICE recommends considering it for low sexual desire associated with menopause if HRT alone isn’t effective. It isn’t licensed for women in every country and needs monitoring.
How can I talk to my partner about low libido?
Choose a relaxed moment, explain that it’s linked to menopause rather than feelings about them, and talk about what you’d both like. A therapist can help if conversations feel difficult.
Can I use testosterone gel prescribed for someone else?
No. Testosterone for women needs a much lower dose than products designed for men, and it needs monitoring for side effects. Always get it prescribed and monitored by a clinician.
References
- NHS: Symptoms of menopause and perimenopause (reduced sex drive)
- NICE guideline NG23: Menopause, identification and management (2024 update: testosterone, vaginal estrogen)
- ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024 (sexual function and testosterone)
- Worcestershire Acute Hospitals NHS Trust: Your journey through the perimenopause and menopause (testosterone)
- NHS inform: Menopause: symptoms, treatment and support (sex and relationships)
- NHS: Hysterectomy: considerations (ovarian testosterone)
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
