Has perimenopause changed your sex drive? You’re not alone

If you've noticed your sex drive shifting during perimenopause, you're in good company. This stage of life brings profound changes to many aspects of your wellbeing, and sexual desire is one of them. While it can feel isolating, many women experience fluctuations in libido during this transition — and understanding why can help you navigate it with a sense of confidence.

With the right strategies and support, it's entirely possible to maintain a fulfilling sex life during perimenopause. Let's explore what's happening in your body, why your desire might be changing, and — most importantly — what you can do about it.

How does perimenopause affect your libido?

Perimenopause and sex drive are intricately connected, largely due to the hormonal shifts happening in your body. During the menopause transition, which typically begins in your 40s but can start earlier, your hormone levels fluctuate dramatically before eventually declining [1].

Interestingly, some women experience an increase in libido during early perimenopause or in the years leading up to it. As oestrogen and progesterone levels begin to fluctuate and decline, the relative level of testosterone in your body becomes more prominent, which can actually boost sexual desire temporarily [2]. This experience is just as normal as a decrease in libido — every woman's hormonal journey is unique.

The role of hormones like oestrogen and testosterone

Oestrogen plays a crucial role in sexual function. As oestrogen levels decrease during perimenopause, it can lead to physical changes that affect intimacy. Lower oestrogen contributes to vaginal dryness and changes in vaginal tissues, making penetrative sex uncomfortable or even painful for some women [4]. The vaginal walls may become thinner and less elastic — a condition known as vaginal atrophy — which can reduce blood flow to the pelvic area and diminish sexual arousal [5].

Testosterone, though present in smaller amounts in women than men, is equally important for desire. Decreasing levels during perimenopause can directly impact your interest in sexual activity [6]. This hormone influences not just libido but also energy levels and overall well-being.

These hormonal changes affect everyone differently. Some women report minimal changes to their sexual desire, while others notice a significant decrease.

What influences libido during perimenopause?

While hormones are the primary culprit, there are actually a few different reasons libido can shift during perimenopause. Understanding these factors can help you identify what's impacting you most.

Physical, emotional, relationship, and sociocultural factors

Physical symptoms beyond vaginal dryness can dampen desire. Hot flushes (or hot flashes) and night sweats disrupt sleep, leaving you feeling tired during the day [4]. Fatigue naturally leads to less interest in intimacy. Weight changes and other physical changes can also affect body image and self-esteem.

Emotional well-being shifts significantly during perimenopause. Mood swings and mood changes are common perimenopause symptoms that can create distance between you and your desire for intimacy [4]. When menopausal women are managing these emotional ups and downs, sex might feel like yet another demand, rather than a source of pleasure.

Relationship dynamics matter enormously. Stress from other aspects of life — career pressures, caring for children or ageing parents, financial concerns — can spill over into your intimate relationship. Open communication with your partner becomes more important than ever.

Sociocultural factors also play a role. Many women internalise messages that sexuality diminishes with age. These beliefs can become self-fulfilling prophecies, negatively impacting your confidence and desire [7].

Navigating the emotional and physical changes of perimenopause

Perimenopause is a significant transition, and it's natural to feel overwhelmed by the changes happening in your body. Acknowledging these shifts — rather than fighting against them — can be surprisingly empowering.

The physical changes you're experiencing are your body adapting to a new hormonal landscape. This doesn't mean your body's broken or that pleasure is out of reach. It just means you might need to approach intimacy differently than you have before.

How to talk about sex and perimenopause with your partner

One of the most powerful tools at your disposal is an honest conversation with your partner. This might feel awkward or vulnerable, especially if you've never discussed sexual challenges before.

Start by choosing a relaxed moment outside the bedroom. Approach the conversation with curiosity rather than blame. You might say something like, "I've been noticing some changes with perimenopause, and it's messing with how I feel about sex. Can we talk about it?"

Be specific about what's changed. If vaginal dryness is causing pain, say so. If you're feeling tired or there's less spontaneous desire, explain that. Your partner may be relieved to understand what's happening rather than wondering if you're no longer attracted to them.

You could also use the conversation to discuss what feels good, not just what's challenging. Perhaps you need more time to become aroused, or physical intimacy feels better at certain times of day. Try to focus on possibilities rather than limitations.

Ways to make sex more pleasurable during perimenopause

There are many practical strategies to enhance comfort and pleasure during sex.

Comfort, communication, and connection tips

• Address vaginal dryness. Vaginal moisturisers, used regularly, can help maintain tissue health and reduce discomfort [4]. Unlike lubricants, which are applied just before sexual activity, moisturisers are used several times a week. When you do engage in intimacy, use a high-quality vaginal lubricant to reduce friction.
• Expand your definition of intimacy. Penetrative sex is just one form of intimacy. Focus on activities that build connection and pleasure — kissing, massage, oral sex, or simply spending unhurried time together. Intimacy doesn't always have to involve a partner. Self-pleasure and masturbation are valuable ways to stay connected to your body, understand what feels good, and maintain sexual function.
• Prioritise arousal time. As hormone levels shift, your body may need more time to become aroused. Build in extra time for foreplay and physical touch. Think of it as an invitation to slow down and savour the experience.
• Experiment with comfort. Try different positions that reduce discomfort. Use pillows for support and keep the room at a comfortable temperature if hot flushes are an issue.
• Stay connected emotionally. Sexual arousal is deeply connected to how you feel about yourself and your relationship. If emotional intimacy or navigating these changes feels overwhelming, couples therapy or sex therapy can provide a safe space to work through challenges together.

How to boost libido during perimenopause

While you can't control your hormones entirely, there are meaningful ways to support sexual desire during this life stage.

Lifestyle, self-care, and treatment options

Movement and exercise benefit sexual health in multiple ways. Regular exercise improves blood flow throughout the body, including to the pelvic area, which can enhance sexual arousal [8]. Exercise also boosts mood and helps maintain energy levels. Pelvic floor exercises specifically can improve sexual function by strengthening the muscles involved in arousal and orgasm. Seeing a women’s health physio for guidance and support can make a big difference, too.

Prioritise sleep and stress management. When you're exhausted or overwhelmed, libido naturally takes a back seat. Establish good sleep hygiene to combat night sweats [4]. Incorporate relaxation techniques, like meditation, yoga, or deep breathing, to manage stress.

Nourish your body. A balanced diet supports hormonal balance and overall energy [9]. Staying hydrated can help with vaginal dryness. Try to limit alcohol and caffeine if you find they worsen perimenopause symptoms or disrupt sleep [10]. Foods rich in omega-3 fatty acids may help with inflammation and mood swings [9], while phytoestrogen-rich foods like soy, flaxseeds, and legumes may help balance hormone levels [9].

Consider treatment options. For some women, hormone therapy or hormone replacement therapy can be transformative for managing perimenopause symptoms, including low libido [4]. These treatments work by supplementing declining hormone levels and can improve vaginal dryness, hot flushes, mood changes, and sexual desire. A healthcare provider can discuss whether hormone therapy is appropriate for you.

There are also non-hormonal treatment options available, including therapies specifically designed for vaginal atrophy. Research shows that addressing physical symptoms often has a positive ripple effect on desire [11].

Does your sex drive come back after perimenopause?

Lots of women wonder about this, and the good news is that your sex drive doesn’t just vanish after menopause. While libido can dip during perimenopause, many women find their desire — and their overall sexual satisfaction — improves once things settle down after menopause [12].

After menopause, hormone levels settle into a new, more consistent pattern. Many postmenopausal women find this stability allows them to reconnect with their sexuality. Life circumstances often shift favourably too — children may be older and more independent, career pressures might ease, and freedom from worrying about menstrual periods or pregnancy can make intimacy feel more spontaneous.

Research shows that women who maintain sexual activity during perimenopause tend to experience fewer issues with sexual function in the years that follow [3]. Staying engaged with your sexual health — whether through solo pleasure or partnered intimacy — helps maintain blood flow to vaginal tissues and keeps the neural pathways associated with pleasure thriving.

When to speak to a healthcare professional

While changes in sex drive during perimenopause are normal, professional support can make a real difference.

Consider speaking to a healthcare provider if:

• Vaginal dryness or pain during sex persists despite using moisturisers and lubricants.
• Low libido is significantly affecting your relationship satisfaction or causing distress.
• You're experiencing emotional symptoms that interfere with daily life.
• Other perimenopause symptoms are severely impacting your well-being.
• You're interested in exploring hormone therapy or other medical treatment options.

A healthcare provider can assess your situation, discuss treatment options tailored to your needs, and rule out other medical conditions that might be contributing to changes in desire [4]. They can also refer you to specialists if you need them.

Your sexual health is a key part of your wellbeing, and you deserve support as you move through this transition. While shifts in sex drive are common during perimenopause, understanding what's going on — and using practical strategies — can help you to stay connected, enjoy intimacy, and feel more confident in your sexuality.

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