Perimenopause & Libido: What to Know About Low Sex Drive in Your 40s and 50s 

Sexual health is a core part of overall wellness, yet it’s one of the least talked-about issues as women enter perimenopause. If you've found yourself asking, “Why is my sex drive changing?” in your 40s or 50s, you’re not alone — and you’re not imagining it. Perimenopause can significantly affect libido, and understanding the why behind those changes is the first step to reclaiming confidence and control in your sex life. 

Let’s break down how perimenopause affects libido and what you can do about it. 

Why Perimenopause Can Cause Low Sex Drive 

Up to 87% of women experience reduced sexual desire as they age. For many, these changes begin during perimenopause — the transition to menopause when estrogen and progesterone levels start to fluctuate. 

What affects your sex drive during perimenopause? 

• Hormonal shifts (especially estrogen and testosterone balance) 
• Vaginal dryness or pain with sex 
• Hot flashes, fatigue, and poor sleep 
• Mental health and stress 
• Medications 
• Relationship dynamics and self-image 

Libido is personal — there’s no “normal” sex drive — but if you’re noticing a consistent drop, it may be time to take action. 

Do I Need to Worry About Low Libido? 

Not necessarily. Changes in libido during perimenopause are extremely common and often not linked to serious health issues. However, if your loss of desire is persistent and causing distress, it’s worth discussing with a healthcare provider. 

In some cases, low libido with ongoing emotional discomfort may be diagnosed as Female Sexual Interest/Arousal Disorder (FSIAD). This is a treatable condition that includes low sexual desire and difficulty with arousal. Treatment may include counseling, hormone therapy, or medication. 

Is Testosterone Safe for Libido Loss in Perimenopause? 

Low-dose testosterone therapy has been shown to help some women, but it must be prescribed and monitored carefully. There are no FDA-approved testosterone products for women, and risks include side effects like acne, hair growth, voice changes, and cardiovascular concerns. 

Gennev physicians do not recommend testosterone in compounded or pellet form due to safety concerns and lack of regulation. Always consult a menopause-trained physician before starting any hormone therapy. 

How to Boost Libido During Perimenopause 

Improving sex drive often requires addressing multiple areas of health. Here are some evidence-based steps to consider: 

1. Treat Physical Symptoms 

• Use lubricants or vaginal moisturizers 
• Address hot flashes and fatigue 
• Explore hormone therapy if appropriate 

2. Manage Mental Health 

• Talk therapy or sex therapy 
• Address anxiety, depression, or relationship stress 
• Prioritize emotional intimacy 

3. Reconnect with Desire 

• Responsive desire is common — arousal may come after intimacy begins 
• Build in non-sexual touch and sensual connection 
• Schedule time for intimacy (it works!) 

4. Explore Safely 

• Try new positions, toys, or erotica 
• Focus on what you enjoy, solo or partnered 

5. Talk to Your Doctor About Medication 

• FDA-approved options like Addyi (pill) and Vyleesi (injection) are available for premenopausal women with persistent low libido 

What If My Libido Is Higher Than Usual? 

Surprisingly, some women report increased sex drive in perimenopause. Possible reasons include: 

• Relative testosterone effects as estrogen drops 
• Reduced fear of pregnancy 
• Less parenting stress 
• New relationships or improved communication 
• Increased confidence about sex 

If your heightened desire feels disruptive, speak with a provider. But for many, it’s a welcome change. 

What Happens to Libido After Menopause? 

Every woman’s experience is different. While sex drive may continue to evolve, pleasure is still possible — even if partnered sex isn’t your focus. 

Managing dryness, pelvic pain, or emotional concerns can help keep sex comfortable and enjoyable in postmenopause. Masturbation, physical touch, and open communication with a partner can all support a healthy sex life at any age. 

Bottom Line: Your Libido May Change, But Your Sexuality Doesn’t Disappear 

Perimenopause can bring both challenges and discoveries when it comes to libido. Whether your desire has decreased or increased, there are options to support your sexual health. You deserve to feel confident, comfortable, and connected — now and in the years ahead.