Perimenopause Sex Drive: Libido Decrease Or Increase?

Many women have questions and concerns surrounding their perimenopause sex drive. Perimenopause is the transition period leading into menopause, which is marked by the final menstrual period (FMP) Perimenopause typically occurs about four years prior to a woman’s last menstrual period, but can start as early as ten years prior (1). 

Perimenopause Sex Drive

Sex drive during perimenopause can be influenced by various factors, including hormonal fluctuations as well as physical and emotional factors. Understanding these aspects can help individuals better navigate the changes in their libido during this time in their lives. In the vast majority of women, sex drive decreases during perimenopause. 

Understanding Perimenopause

Perimenopause on average lasts 4 to 5 years but can last as long as 7 to 10 years in some individuals. During perimenopause, the body begins to produce less estrogen and women may experience various symptoms, including irregular periods, hot flashes, mood changes, mood swings, insomnia, and sexual problems like changes in libido or low sex drive. Many of these symptoms can be managed, and treatments like hormone therapy are available for those who find them more challenging to handle. 

It’s essential to understand that changes in sex drive during perimenopause are common and can manifest differently in each individual. Some women may experience a decrease in libido due to lower hormone levels, which can lead to vaginal dryness potentially causing pain during sex.

On the other hand, some women may notice an increase in their sexual desire during this time, however, this is far less common. It’s crucial to maintain open communication with one’s partner and explore ways to adapt to these sexual changes.

Hormonal Changes During Perimenopause

Testosterone levels can play a significant role in one’s sex drive and while not directly to menopausal transition, it does decrease throughout the lifespan. The relationship between testosterone and sexual desire is complex however, low sexual desire as a result of declining testosterone levels is actually not well validated in scientific studies. 

Understanding Testosterone Levels During Perimenopause

Testosterone levels play a significant role in one’s sex drive, and although this hormone is typically associated with men, it is also present in women. During perimenopause, testosterone levels may decrease, leading to a potentially lower sex drive for some women. However, it is important to note that libido is not solely dependent on hormonal state, meaning that variations in testosterone levels might not affect all women the same way.

Why Sex Drive Might Increase During Perimenopause

During perimenopause, there is a decrease in estrogen and progesterone. These hormonal changes can affect the functioning of the hypothalamus, which is a region of the brain that regulates a variety of bodily functions, including sexual desire.

In some women, the decrease in estrogen and progesterone levels can lead to an increase in testosterone, a hormone that is associated with sexual desire. Testosterone is produced in the ovaries and adrenal glands, and it plays a role in the development and maintenance of the female reproductive system. During perimenopause, testosterone levels may fluctuate as the ovaries produce less estrogen and progesterone.The rise in testosterone can cause an increase in sexual desire. Hormonal changes affect each woman differently, and factors such as stress, relationship issues, and physical health can also play a role in sexual desire.

Additionally, women may experience a shift in their priorities and attitudes during perimenopause. They may feel more confident and empowered, which can lead to an increased interest in sexual activity. They may also have more free time, as children leave home or work schedules change, which can allow for more opportunities for sexual activity.

Overall, however, an increase in libido is less common during perimenopause. A decrease in sex drive during perimenopause is far more common.

Physical And Emotional Factors

Besides hormonal influences, physical and emotional factors also contribute to an individual’s sex drive during perimenopause. For example, changes in body weight, sleep patterns, and overall health can impact one’s libido. Emotional factors such as stress and mental health also play a role. Addressing these physical and emotional factors can help improve overall well-being and sex drive during perimenopause.

Understanding the different factors influencing sex drive during perimenopause, including hormonal changes, physical and emotional factors, and hormone levels, can help individuals better manage and navigate this stage in their lives. It is very important to acknowledge that each person’s experience with perimenopause is unique and that libido changes are not the same for everyone.

Managing Decreased Sex Drive During Perimenopause

What Is Hypoactive Sexual Desire Disorder

Hypoactive Sexual Desire Disorder (HSDD) is a medical condition characterized by a persistent and significant decrease in sexual desire or interest, causing personal distress or relationship difficulties. It affects both men and women, although it is more common in women, especially during perimenopause and menopause.

Low Libido Vs Hypoactive Sexual Desire Disorder

Low libido is a general term that refers to a decreased interest in sexual activity. While it can be a symptom of HSDD, not everyone with low libido has HSDD. The key difference between low libido and HSDD is the level of personal distress or relationship difficulties caused by the lack of sexual interest.

Related: Adrenal Adenoma: What Every Patient Should Know

Dealing With Vaginal Dryness

Vaginal dryness is a common problem during perimenopause that can contribute to decreased sex drive. To manage this issue, consider using a water-based lubricant or  vaginal moisturizers to reduce discomfort during sexual activity.

How To Treat Perimenopause Low Libido

There are several strategies to help improve libido during perimenopause. These can include:

  • Addressing any underlying psychological issues such as stress, anxiety, or depression.
  • Improving communication with your partner to create a more satisfying sexual relationship.
  • Incorporating new sexual experiences or fantasies to increase arousal.
  • Speaking with your doctor regarding newer medications that can assist with increasing desire

Lifestyle Adjustments

Making small changes to your daily routine can also help improve your sex drive. Examples may include:

  • Exercising regularly to boost energy levels and reduce stress. 
  • Getting adequate sleep to help maintain hormonal balance.
  • Eating a balanced and nutritious diet to support overall health and well-being.

Medical Treatments

Treatment options for low libido during perimenopause can include hormone replacement therapy. HRT involves using estrogen pills or patches to help alleviate menopausal symptoms, including decreased sex drive. However, HRT may not be suitable for everyone and should be discussed with a healthcare professional.

There are also two new therapies on the market that can help treat HSDD. It is important to speak with your doctor to determine if these options may be right for you.

Alternative Therapies For Low Perimenopause Sex Drive

There are very limited proven therapies that are scientifically validated to improve women’s sex drive. Before you try anything, be sure to consult a physician if you are thinking about trying herbal supplements. Acupuncture may also be explored as an alternative therapy but this is also not well studied and is not know to have a significant effect on sexual drive. Always consult with your healthcare provider before beginning any new treatment to ensure it is safe and appropriate for your individual needs.

When To Ask A Doctor About Perimenopause Sex Drive

It’s essential to consult a healthcare professional if you’re experiencing any unusual changes in your sex drive during perimenopause. For instance, if you notice a sudden decline or are concerned about your sexual health or overall well-being, it may be time to seek assistance. 

Physical symptoms, such as vaginal dryness, thinning of genital tissues, or pain during intercourse, should also prompt you to speak with a doctor. Painful sex may also contribute to a decrease in sexual arousal as vaginal dryness, vaginal atrophy and thinning of the vaginal wall happens during this time. This issue can makecan that make the lack of sex drive even more pronounced. Vaginal moisturizers can help to improve sexual satisfaction and quality of life. It is important to speak to your doctor if you are experiencing these symptoms.

A healthcare professional will also consider your mental health when examining your sex drive during perimenopause. Conditions like anxiety and depression can often lead to sexual dysfunction and reduced libido. In such instances, appropriate treatment may be recommended to improve your overall well-being and sexual health.

Perimenopause Sex Drive: Summary

A decrease in sex drive is not uncommon during perimenopause. The good news is that there are ways to deal with loss of libido and the research in the space of alleviating menopause symptoms is growing. Loss of sex drive is far more common and has more evidence to support it than any increase of sex drive during this time period.

Discuss your concerns and symptoms with a healthcare professional can provide insights, guidance, and possible solutions to help you navigate the changes during perimenopause. Seeking help is the first step in regaining a healthy and satisfying sex life during this time.


  1. Delamater L, Santoro N. Management of the Perimenopause. Clin Obstet Gynecol. 2018 Sep;61(3):419-432.

We discuss products we think are useful to people. If you buy something through our links, we may earn a commission. Remember to check with your personal physician to see if a product recommended is right for you.

Similar Posts

Leave a Reply

Your email address will not be published. Required fields are marked *

1 + 15 =