How to Increase Sex Drive During Menopause: What Helps

You love your partner. You just can't remember the last time you wanted sex. A hand on your back at bedtime makes you tense up, and you find reasons to stay up late. Then the guilt sets in, and you wonder what's wrong with you.

Nothing is wrong with you. A lower sex drive is a common change in perimenopause and menopause. If you're searching for how to increase sex drive during menopause, the first step is working out what's getting in the way. It's rarely just one thing, and there is a lot you can do.

The NHS lists "lower hormone levels as you get older, particularly during the menopause" as one cause of low sex drive. It also says that treating the cause should help.

See your GP if:

sex is painful
you bleed after sex
you've felt low most of the day, every day, for more than 2 weeks (NHS depression symptoms)

If you feel unsafe in your relationship, or feel pressured into sex, help is there. The NHS says domestic abuse includes sexual abuse and controlling behaviour. You can call the free National Domestic Abuse Helpline on 0808 2000 247, day or night. In an emergency, call 999.

Is low sex drive a sign of perimenopause?

It can be. The Menopause Charity says hormone changes, especially in testosterone, can lower your sex drive. It adds that many women say they still love their partner but are no longer interested in sex.

That last part matters. Losing interest in sex is not the same as losing interest in your partner. Saying that out loud, to yourself and to them, can take a lot of pressure off.

It's also worth knowing that not every woman goes off sex. Relate, the relationship charity, says that for some women, menopause brings a sense of freedom, with no more periods or worries about pregnancy.

Why does menopause lower your sex drive?

There's usually a mix of reasons. Here are the common ones.

Hormones, including testosterone

Oestrogen falls in perimenopause and menopause. Testosterone matters too. Women's Health Concern, the patient arm of the British Menopause Society, explains that women make testosterone as well as men. Levels fall gradually as you get older.

Many women don't notice any change from this. Others are more sensitive to it. Younger women who have had their ovaries removed, or whose ovaries stopped working early, may notice it more.

But hormones are only part of the story. Women's Health Concern says the causes of low desire at menopause are complex, and rarely due simply to low testosterone.

Vaginal dryness and painful sex

The Menopause Charity explains that low oestrogen can make the tissues around the vagina thinner, drier and inflamed. The NHS says vaginal dryness can cause pain or discomfort, including during sex.

If sex hurts, it makes sense that you don't want it. Your body is protecting you. Relate notes that painful sex can make someone want sex less. The good news is that there are things that can help with dryness (see below, and our page on vaginal dryness).

Tiredness and broken sleep

Night sweats and early waking leave you running on empty. The Menopause Charity says night sweats can mean changing the sheets, and often disturb your partner's sleep too. It also lists tiredness, hot flushes and loss of confidence among the things that can strain a relationship.

Low mood, anxiety and stress

The NHS lists stress, anxiety and depression as common causes of low sex drive. Low sex drive is also on the NHS list of depression symptoms. If you feel flat, hopeless or not interested in much at all, please talk to your GP.

Your relationship

The NHS also names relationship problems. Resentment over chores, feeling unheard, or feeling more like flatmates than a couple all take their toll.

Relate lists other common reasons, such as feeling disconnected, being too busy and worries about how you look.

Medicines and alcohol

The NHS says some medicines can lower your sex drive, including some for high blood pressure and antidepressants. Hormonal contraception, such as the pill, can too. So can drinking too much alcohol.

Please don't stop any medicine on your own. If you think a medicine is affecting your sex drive, talk to your GP or pharmacist. There may be another option.

How to increase sex drive during menopause: things to try

There's no quick switch. But these steps tackle the things that most often get in the way.

Make sex comfortable first. The NHS suggests a water-based lubricant before sex and a vaginal moisturiser for everyday dryness. Use unperfumed washes around the vagina, and avoid perfumed soaps and douches.
Take penetration off the table for a while. Relate suggests small steps to bring back closeness, at a pace that suits you both. That might start with holding hands, kissing or a massage.
Look after your sleep. It's hard to feel close to anyone when you're exhausted. If night sweats or early waking are the problem, raise them with your GP too.
Go easy on alcohol. The NHS lists drinking too much as a cause of low sex drive.
Notice what's on your mind. If you're worried, low or resentful, that's worth looking at in its own right.
Keep a note. Write down your sleep, mood, flushes and how you feel about sex for a few weeks. It makes a GP appointment much easier.

Menopause and a sexless marriage: talking to your partner

When sex stops, couples often stop talking about it too. Each of you fills the silence with your own story.

Relate says partners can feel rejected, and may give up starting sex at all. That can open up a gap that neither of you wants. It also says it's not unusual for partners to have different sex drives at different stages of a relationship.

Some ideas that may help:

Pick a calm moment, not bedtime and not straight after a refusal.
Start with "I". Say "I've noticed I'm not interested at the moment, and I want to explain why", rather than "You always…".
Say what it isn't. "This isn't about you, and it isn't about how I feel about you" can be a huge relief to hear.
Explain what's going on. Many partners have no idea that menopause can affect desire, comfort and sleep.
Ask for what you'd like. That might be more cuddles with no pressure, help around the house, or patience while you see the GP.
Listen too. Relate says to listen to what your partner says and try to understand their view.

If saying it feels too hard, writing it down can help. We've written a menopause letter to your husband or partner that you can adapt.

If you're stuck, Relate offers relationship counselling and sex therapy for couples. The NHS also suggests relationship counselling when relationship problems are behind a low sex drive.

What your GP can offer

Your GP can help work out what's behind it and talk you through options. These are things to discuss, not things to start on your own.

HRT. The NHS says HRT may be offered when low sex drive is linked to the menopause. The Menopause Charity says there are many types and doses, so it can take time to find one that suits you.
Vaginal oestrogen. If dryness or soreness is part of the problem, your GP may suggest oestrogen that you put directly into the vagina, such as a cream, gel or tablet. The NHS vaginal dryness page says hormone treatment isn't right for everybody, so ask what suits you.
Testosterone. Women's Health Concern says testosterone is recommended for women with persistent low sex drive, but only once other causes have been looked at, including not having enough oestrogen. NICE says it can be considered if HRT alone hasn't helped. It doesn't help everyone.
Talking therapy. The NHS says CBT or antidepressants may be offered if low mood or anxiety is part of the picture.
A medicine review. If a medicine or your contraception might be playing a part, your GP can talk about other options.

More about testosterone

Women's Health Concern says that in the UK testosterone for women is usually a gel rubbed into the skin. These products aren't licensed for women in the UK, so they are prescribed "off licence". Some GPs will prescribe it. Others prefer to refer you to a specialist first.

It can take a few months to work, and a trial of 3 to 6 months is often suggested. Side effects are few at the right dose, but can include greasy skin, acne and a little extra facial hair. You'll usually have blood tests to check your levels stay safe.

When to see your GP

Book an appointment if:

your low sex drive is worrying you or affecting your relationship
sex is painful, or you bleed after sex
you've felt low most days for more than 2 weeks
you think a medicine or your contraception might be affecting it
you'd like to talk about HRT, vaginal oestrogen or testosterone

You could take your partner or a friend with you if that helps. It's fine to say, "I'd like to talk about my sex drive", right at the start.

You may also find these pages useful: vaginal dryness, painful sex after menopause and menopause mood swings.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms

Low sex drive in perimenopause and menopause: why it happens and what can help