Low libido in menopause: causes and what actually helps

Name: Low libido in menopause: causes and what actually helps
Creator: MenoWoman

Lower sex drive is common around menopause, but it is not universal, and it only needs treating if it bothers you. Causes are usually mixed, and the best-supported options target vaginal dryness, other symptoms and, for some postmenopausal women, testosterone.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor if low desire causes you distress or if sex is painful. Also get checked for any bleeding after sex or after menopause. Also seek help if low libido comes with low mood, anxiety or relationship strain.

What it is and how common it is

Desire can fall, rise or stay the same at midlife. There is no standard level of sexual activity you need to meet.¹

Low desire is common, but it is only a problem if it bothers you. In a US survey of about 32,000 women, 39% reported low desire, but only 12% were distressed by a sexual problem.²

That distress was most common in women aged 45 to 64.² Australian research found that over 32% of women aged 40 to 65 have low desire that causes them personal distress.³

When low desire keeps coming back and causes distress, doctors may call it hypoactive sexual desire dysfunction, or HSDD.⁴

Why it happens in menopause

Falling estrogen thins and dries the vaginal tissues. This can make sex uncomfortable or painful, which can lower interest further.¹ Some women also notice less genital sensation.⁵

Testosterone levels also decline with age.³

Other menopause symptoms get in the way. Hot flashes and night sweats disrupt sleep, and tiredness, joint pain and low mood can all dampen desire.^1,3

Bladder and pelvic floor changes, such as leaking urine, can put women off sex. Changes in body image can also affect how you feel.⁶

What else can cause it

Hormones are only one part of the picture.¹ Other common causes include:

Medicines. Some antidepressants are known to lower desire.⁷
Mood and stress. Depression, anxiety, work or money pressure and caring for parents all play a role.⁶
Relationship factors. Relationship stress, a new partner, loss of a partner or a partner's own sexual problems can all affect desire.^7,6
Health conditions. Poor general health and some medical problems can reduce desire.¹
Alcohol. Drinking habits can affect sexual wellbeing.³

There is often more than one cause. A good assessment looks at physical, emotional and relationship factors together.^3,4

Everyday measures

Talk openly with your partner about what has changed and what you both want.⁶
Use a good-quality lubricant for sex and a vaginal moisturizer for everyday dryness.⁷
Widen the focus beyond penetration. Touch, massage and other kinds of closeness count.³
Stay active, keep alcohol moderate and manage stress.³
Ask about a pelvic health physiotherapist if you have pain, leaking or prolapse.⁶

For pain caused by vaginal changes, doctors may prescribe vaginal estrogen, vaginal DHEA (prasterone) or ospemifene tablets, depending on the country.⁷

Two medicines for low desire, flibanserin and bremelanotide, are approved only for premenopausal women. Flibanserin is approved in the US and Canada, and bremelanotide in the US.⁷

Where testosterone fits

Testosterone is the hormone treatment with the best evidence for low desire. A 2019 position statement from nine medical societies, including The Menopause Society and ACOG, set out where it fits.¹⁰

They agreed that the only evidence-based use is for postmenopausal women with HSDD. There is not enough evidence to use it for any other symptom, or to prevent disease.¹⁰

It has not been shown to improve mood or general wellbeing. Other causes of low desire should be assessed and addressed first.⁴

Products licensed for women are not available in many countries, so doctors sometimes prescribe products made for men with careful monitoring. The societies advise against compounded (custom-mixed) testosterone.¹⁰

Possible side effects include acne and extra facial or body hair, and long-term risks are still being studied.¹ In trials, testosterone taken by mouth worsened cholesterol, while patches and creams did not.⁹

What helps: options rated

Option	Evidence	What the research shows
Vaginal estrogen	Strong evidence	Treats vaginal dryness and painful sex, and NICE recommends offering it. It does not raise desire directly, but easing pain often helps.^8,1
Testosterone (postmenopausal women with HSDD)	Strong evidence	A review of 36 trials found it improved desire, arousal, orgasm and satisfying sex in postmenopausal women. International societies support it only for this use, and products licensed for women are scarce.^9,10
Lubricants and vaginal moisturizers	Some evidence	Recommended by The Menopause Society to reduce dryness and friction. They improve comfort rather than desire itself.⁷
Systemic hormone therapy (HRT)	Some evidence	Can relieve hot flashes and night sweats that disrupt sleep and dampen desire. It is not a dedicated treatment for low desire.¹
Counseling or sex therapy	Some evidence	Recommended by The Menopause Society for relationship, emotional or medical issues behind low desire. Rated on guideline support rather than menopause-specific trials.⁷
Pelvic floor physiotherapy	Weak evidence	Suggested for pain, leaking or prolapse that put women off sex. Direct evidence for desire is lacking.⁶
Flibanserin and bremelanotide	Weak evidence	Approved only for premenopausal women and only in some countries. They are not approved for use after menopause.⁷

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.