Does perimenopause affect sex drive? 

Yes—libido changes are one of the most common (and least discussed) symptoms of the menopause transition. Studies suggest up to 87% of women notice a decrease in sexual desire as they age. For some, that shift begins in perimenopause. 

But libido is highly individual. What feels “low” to one person may feel completely normal to another. It’s natural for sexual interest, arousal, and satisfaction to fluctuate at different life stages. If you’re experiencing major changes in your desire for sex during perimenopause, shifting hormones are likely a key reason. 

What influences libido during perimenopause? 

Several factors—both physical and emotional—shape your sex drive, including: 

• Hormone fluctuations (declining estrogen and gradual testosterone changes) 
• Menopause symptoms like hot flashes, fatigue, or vaginal dryness 
• Medications (antidepressants, antihypertensives, etc.) 
• Stress, mood, or mental health concerns 
• Body image and self-confidence 
• Relationship dynamics and communication 
• How satisfying or comfortable sex feels 

Should I be concerned about low libido? 

Not necessarily. Low sexual desire during perimenopause is very common and usually not a sign of something more serious. However, if your reduced libido is accompanied by symptoms such as painful sex, irregular bleeding, or signs of conditions like thyroid disorders, PCOS, or endometriosis, it’s worth consulting your doctor. 

Even if no medical issue is present, it’s valid to feel frustrated by a lack of desire. Intimacy can support mood, relationships, self-esteem, pelvic floor health, and even immunity—so if changes are bothering you, it’s okay to seek solutions. 

Female Sexual Interest/Arousal Disorder (FSIAD) 

If low libido lasts six months or longer and causes distress, you may meet criteria for Female Sexual Interest/Arousal Disorder (FSIAD). This condition includes both hypoactive sexual desire disorder and female sexual arousal disorder. 

A diagnosis should come from a physician and may involve treatment such as hormone therapy, medication adjustments, counseling, or sex therapy. The most important factor: how you feel about your symptoms and how they affect your life. 

Testosterone therapy: is it worth it? 

Some women consider testosterone supplementation for low libido. While research shows low-dose testosterone can improve sexual function in some postmenopausal women, there are important cautions: 

• No FDA-approved doses exist for women; doses must be adjusted from male products. 
• Regular monitoring is essential to avoid unsafe levels. 
• High doses can increase cardiovascular risks and cause side effects such as acne, facial hair, hair loss, voice deepening, or irreversible clitoral enlargement. 

Strategies to boost libido during perimenopause 

If you want to support a healthier, more satisfying sex life, try approaching libido from multiple angles: 

Address physical barriers 

• Manage menopause symptoms (e.g., hot flashes, fatigue, vaginal dryness). 
• Stay active and prioritize sleep. 
• Eat a nutrient-dense diet with complex carbs, protein, healthy fats, and fiber. 
• Use lubricants or vaginal moisturizers for comfort. 

Support your emotional health 

• Reduce stress through mindfulness, exercise, or relaxation techniques. 
• Consider individual or couples counseling if relationship or emotional factors are contributing. 

Shift your mindset 

• Explore responsive desire (getting in the mood after intimacy begins). 
• Add variety—whether new positions, new locations, or intimacy tools. 
• Schedule intimacy (“sex dates”) to prioritize connection. 

Consider medical options 

• FDA-approved medications like Addyi (pill) or Vyleesi (injection) can help certain premenopausal or perimenopausal women. Discuss pros and cons with your doctor. 

What if my libido is higher during perimenopause? 

While less common, some women experience an increase in sexual desire during perimenopause. This may be linked to hormonal shifts (more pronounced testosterone effects as estrogen dips), fewer family obligations, more confidence, or new relationship dynamics. 

A higher sex drive isn’t a problem unless it feels disruptive. If your increased libido is enjoyable and healthy, embrace it. If it causes stress, know that intensity usually evens out over time, and support is available if you need it. 

Sex and libido after menopause 

Every woman’s experience is different. Some notice a continued decline, while others adapt and maintain fulfilling intimacy. The key is addressing any barriers—whether physical (vaginal dryness, pelvic floor dysfunction), emotional (stress, body image), or relational. 

With the right strategies and support, a satisfying sex life is possible well beyond menopause.