Changes in sex drive during menopause: Causes, treatments, and relief strategies for 2025

What you’ll learn:       

• Many experience changes in libido during menopause due to hormonal shifts.      
• Lifestyle factors such as diet, physical activity, and stress management may play a crucial role in supporting libido during menopause.       
• Exploring various treatments and lifestyle adjustments can help manage changes in sex drive during menopause.

If you’re in your 40s, 50s, or beyond and noticing a dip in desire, you’re not imagining it—and you’re not the only one. Changes in sexual desire are a common (and often under-discussed) part of menopause. 68% to 86% of people going through menopause report sexual challenges during this transition.

Why are libido changes so common? One reason is that hormonal shifts can contribute to vaginal dryness and reduced arousal, but it doesn’t stop there. Menopause can also affect mood, sleep, energy levels, and mental well-being—all of which shape how you feel about sex. And unlike more visible symptoms like hot flashes, changes in desire can feel harder to pinpoint and even harder to bring up.

That’s because libido isn’t just about biology—it’s deeply tied to how you feel emotionally, mentally, and in your relationships. But you don’t have to just “live with it.” There are supportive, science-backed ways to navigate these changes, from medical treatments to lifestyle shifts that can help you feel more like yourself again.

Understanding changes in sex drive during menopause

Yes, sex drive changes during menopause are common, but how each person experiences them varies.  Some notice a drop, others feel no change, and some even see an increase. All are normal. As estrogen and testosterone levels decline, symptoms like vaginal dryness and reduced sensitivity can make intimacy less comfortable or appealing. But it’s not just physical; emotional and mental shifts matter, too. Stress, sleep quality, mood, relationship dynamics, and even how you feel about aging can all impact your interest in sex.

These changes can begin in perimenopause (typically beginning in the 40s)

and fluctuate over time. By menopause (12 months without a period), estrogen and progesterone levels stabilize, but desire may still be affected. Understanding what’s happening is the first step toward finding a solution. From lifestyle changes to medical support, there are many ways to feel more like yourself again, physically and emotionally.

What causes changes in sex drive during menopause

While hormones can be a big part of why things feel different during menopause, genetics, health conditions, medications, and lifestyle choices can contribute. Let’s take a look at how these things can affect you.

Hormonal shifts

Estrogen supports vaginal lubrication, blood flow, and arousal—when levels drop or become erratic, sex can become uncomfortable. Testosterone also declines with age (yes, even in females!) and may influence libido, though its role is less clear than estrogen. Progesterone mainly affects mood and sleep, and lower levels can lead to anxiety, irritability, and poor rest, which may reduce interest in sex.

Genetic predisposition

Research shows that 44 to 85% of menopause timing is genetic, though lifestyle factors like diet, smoking, and medical history also contribute. If your mother or grandmother experienced early menopause or sexual health changes, you may be more likely to as well. Some genes tied to hormone regulation and cholesterol can also impact libido, energy, and overall health.

Underlying health conditions

Health issues that can coincide with menopause, like diabetes, thyroid disorders, and heart disease, can affect hormones, blood flow, and energy, all of which may influence libido.

• Diabetes can damage nerves and blood vessels, reducing genital sensation and lubrication. Blood sugar swings may also lead to fatigue, mood shifts, and even early menopause.
• Thyroid disorders are linked to sexual dysfunction—about 42% of females with hypothyroidism and 60% with hyperthyroidism report issues. Hypothyroidism can cause fatigue and dryness, while hyperthyroidism may lead to anxiety and hormonal changes that lower desire.
• Heart disease reduces blood flow to the pelvic area, making arousal and sexual response more difficult. Fatigue, low stamina, and anxiety about exertion can also get in the way. In the Heart and Estrogen/Progestin Replacement Study (HERS), 65% of sexually active postmenopausal females with heart disease reported issues like low desire, difficulty with arousal or orgasm, or pain during sex.

Medications

Medications can also have an impact. Here are a few that are linked with lower libido:

• Mental health medications, including SSRIs (e.g., fluoxetine, sertraline), tricyclic antidepressants (e.g., amitriptyline), MAOIs, and antipsychotics (e.g., risperidone, haloperidol), may reduce libido. Sedation, fatigue, and emotional blunting also contribute.
• Cardiovascular medications, such as beta-blockers, diuretics, alpha-blockers, clonidine, methyldopa, statins, and fibrates, may impair blood flow, lower energy, or disrupt hormone levels, affecting libido and arousal.
• Hormonal contraceptives (e.g., oral pills, implants, vaginal rings) can lower testosterone or alter estrogen balance, leading to low libido, vaginal dryness, or discomfort during sex.
• Antiepileptic drugs like carbamazepine and phenytoin may reduce testosterone and disrupt hormone regulation, worsening menopause-related sexual symptoms.
• Antihistamines, including diphenhydramine and loratadine, can dry out mucous membranes and worsen vaginal dryness, making sex uncomfortable.

Lifestyle factors

Your daily habits can also help or hinder your libido. Here are a few things that can make a difference:

• Chronic stress: Ongoing stress doesn’t just drain your energy—it also raises cortisol levels, which can interfere with estrogen, testosterone, and other hormones that affect sexual desire. 
• Diet: What you eat plays a key role in how you feel, physically and hormonally. A diet rich in whole grains, healthy fats, fruits, vegetables, and lean proteins can support steady energy, balanced blood sugar, and better hormone regulation. Check out our menopause diet plan for more specifics.
• Exercise: Regular physical activity doesn’t just boost mood and energy—it may also help protect sexual desire. One study found that for postmenopausal women, each additional day of exercise per week was linked to an 80% lower risk of experiencing reduced sexual desire. Movement helps regulate stress, improve circulation, and support hormone balance, all of which are key to a healthy sex drive. 

Does sex drive return after menopause?

For some people, yes! While menopause can lower libido initially, some people regain their sex drive once hormones stabilize postmenopause. A healthy lifestyle, open communication, and medical support (if needed) can all help restore desire and pleasure.

How changes in sex drive are diagnosed during menopause

Because so many different factors can influence sex drive, figuring out what’s behind these changes isn’t always straightforward. Here’s how doctors typically assess what’s going on.

1. Symptoms and history: Doctors ask about desire, vaginal dryness, pain during sex, sleep, energy, and any chronic conditions like diabetes or thyroid issues.
2. Physical exam: A pelvic exam checks for dryness, thinning tissues, and other hormone-related changes in vaginal health and blood flow, and assesses the pelvic floor muscles for signs of prolapse or urinary issues.
3. Hormone and blood tests: Routine lab work can help rule out other conditions that may contribute to symptoms, such as diabetes or thyroid dysfunction.
4. Emotional and relationship factors: Stress, anxiety, depression, and relationship issues can all impact libido. A therapist may help explore deeper psychological or relational factors.
5. Identifying patterns of low libido: If desire stays low and affects daily life, doctors may assess for conditions like hypoactive sexual desire disorder (HSDD) or sexual interest-arousal disorder. Signs include an ongoing lack of interest, few fantasies, and less pleasure during intimacy.

Medical treatments for menopause-related sex drive changes

Once you have a better idea of what’s behind the change in your libido, there are plenty of options to help. From hormone therapy to non-hormonal meds—and even some newer treatments—there’s a range of ways to get your desire back on track.

Can hormone replacement therapy (HRT) help?

HRT, also called menopausal hormone therapy (MHT), can help manage menopause symptoms, including low sex drive, vaginal dryness, and discomfort during sex. By restoring estrogen levels, HRT may improve sexual function and overall well-being.

There are different types of HRT, and each serves a specific role:

• Local estrogen therapy: These low-dose treatments—available as creams, suppositories, or vaginal rings—deliver estrogen directly to vaginal tissues. They can be especially helpful for dryness, blood flow, and tissue elasticity. This option may be useful when standard-dose HRT (used for symptoms like hot flashes) doesn’t fully relieve vulvovaginal discomfort.
• Systemic estrogen therapy: Offered as pills or patches, this form addresses broader menopause symptoms like hot flashes and night sweats. While it can help with vaginal symptoms, it may not be enough on its own for localized relief.
• Progesterone therapy: If you have a uterus, progesterone is added to balance estrogen and lower the risk of endometrial overgrowth and abnormal bleeding.

HRT isn’t right for everyone. Some get significant relief, while others may see limited benefits or experience side effects. It may not be safe if you have certain health risks, such as a current or past history of blood clots or certain cancers. Talk to your doctor to see if it’s a good fit for you.

What about testosterone replacement?

Testosterone plays a role in sexual desire, too, and levels naturally decline with age. For some, especially if estrogen therapy hasn’t helped with low libido, a low-dose testosterone treatment might make a difference. Though it’s not FDA-approved for females in the U.S., doctors can prescribe it off-label when appropriate. 

Studies suggest it may improve desire, arousal, and satisfaction in postmenopausal women with hypoactive sexual desire disorder (HSDD). It’s not for everyone, though—testosterone therapy should be closely monitored to avoid side effects like acne or changes in cholesterol. Talk to your doctor about checking your hormone levels.

Non-hormonal medications and treatments

For those who can’t or prefer not to use HRT, several non-hormonal options can help:

• Ospemifene (Osphena^®) – This is an FDA-approved medication that mimics estrogen to help reduce vaginal dryness and discomfort. It’s not a hormone itself but a selective estrogen receptor modulator (SERM), meaning it acts like estrogen in certain tissues without affecting others.
• Flibanserin (Addyi^®) – Originally an antidepressant, this daily pill is FDA-approved for low sexual desire in premenopausal females and is sometimes used off-label postmenopause.
• Bupropion (Wellbutrin^®): This antidepressant has been shown to help improve sexual desire for some people, especially if low libido is tied to mood. If depression is part of the picture, treating that first can make a big difference.

Other treatments to consider

• Pelvic floor therapy uses guided exercises to strengthen vaginal and pelvic muscles, improving blood flow, tone, and arousal. It’s a proven option, especially for postmenopausal people with incontinence or muscle weakness.
• Vaginal moisturizers and lubricants – Over-the-counter water- or silicone-based lubricants help reduce friction, while vaginal moisturizers hydrate vaginal tissues over time.
• Couples and sex therapy: Sometimes, it’s not just about the physical symptoms. Therapy can help you and your partner navigate changes in intimacy, improve communication, and work through any emotional roadblocks together.

Advanced and emerging treatments

Researchers continue to explore new ways to improve sexual function during menopause. While some treatments show promise, their safety and long-term benefits are still under review. 

• Laser and radiofrequency treatments use energy to stimulate collagen, improving vaginal elasticity and moisture. Some studies report reduced dryness and discomfort, but these treatments are not FDA-approved for menopause symptoms and need more research.
• Platelet-rich plasma (PRP) therapy, also known as the “O-Shot®,” involves injecting your own plasma to boost sensitivity and blood flow. While some report benefits, evidence remains limited, and the treatment is experimental.

Lifestyle changes that can boost sex drive

We’ve already touched on how menopause can impact sex drive, and now let’s take a closer look at how lifestyle adjustments can help. While hormonal changes have a significant impact, diet, stress management, and sleep quality also shape how you feel—physically, emotionally, and sexually.

Nutrition supports hormone balance

What you eat during menopause can have a real impact on how you feel—physically, emotionally, and sexually. Nutrients like vitamin D and calcium support bone and muscle health, while omega-3 fatty acids (found in salmon, flaxseeds, and walnuts) are linked to improved mood, cardiovascular function, and circulation—all of which can influence sexual response.

A study found that diets rich in fruits, vegetables, whole grains, and healthy fats—like those found in the Mediterranean diet—were linked to less severe menopausal symptoms, including mood swings and fatigue, which can affect libido. Here’s how to apply that to your plate:

• Include lean proteins (like eggs, chicken, tofu, or fish) at each meal to help stabilize energy and support hormone health.
• Choose high-fiber carbs like quinoa, oats, lentils, and berries to keep blood sugar steady and digestion on track.
• Incorporate healthy fats, like fatty fish, avocado, olive oil, nuts, and seeds, which help with nutrient absorption and inflammation.
• Cut back on added sugars and refined carbs, which can cause energy crashes and worsen mood swings.

These simple shifts can support your hormones and your energy, mood, and sexual well-being, too.

Lowering stress improves desire

Chronic stress increases cortisol, which can blunt your body’s natural production of sex hormones like estrogen and testosterone. High cortisol is linked with lower libido, reduced arousal, and even vaginal dryness. A study found that women who practiced mindfulness meditation experienced significant improvements in sexual desire and arousal.

You don’t need hours of meditation to feel a difference. Try:

• 5–10 minutes a day of deep breathing or a short body scan meditation.
• Incorporating enjoyable, no-pressure movement, like walking, yoga, or dancing.
• Scheduling time weekly for things that make you feel relaxed and connected.

Regular physical activity can boost libido

Regular movement does more than just boost your energy—it can also improve circulation, help regulate hormones, and support a positive body image, all of which are important for a healthy sex life during and after menopause. Research shows that physically active postmenopausal people report better sexual function, especially in areas like desire, arousal, and satisfaction.

Here’s how to get started:

• Aim for 150 minutes of moderate aerobic activity a week, like brisk walking, biking, or swimming.
• Add strength training twice weekly to support muscle tone, metabolism, and mood, key contributors to confidence and desire.
• Choose movement that feels good. Whether it’s dancing, stretching, or yoga, anything that helps you connect with your body can support emotional and physical intimacy.

Even small increases in activity can make a meaningful difference in how you feel—inside and out.

Better sleep supports desire and overall well-being

Menopause can seriously disrupt sleep, and that lack of rest doesn’t just leave you feeling groggy or irritable. Poor sleep is also closely linked to changes in sexual health, including lower libido, reduced satisfaction, and increased vaginal discomfort. One large study found that postmenopausal women who slept five hours or less per night had significantly lower odds of being sexually active and satisfied, even after accounting for other health factors.

Prioritizing better sleep can help restore your energy, improve your mood, and support a healthier sex life. Try these simple strategies to promote more restful nights:

• Stick to a consistent bedtime and wake-up time—even on weekends—to keep your body’s natural rhythm on track.
• Create a cooler, more comfortable sleep environment to help ease hot flashes and night sweats.
• Limit screens, caffeine, and alcohol in the evening, all of which can interfere with deep, restorative sleep.
• Wind down with a calming bedtime ritual, like gentle stretching, reading, or deep breathing.

Getting better sleep isn’t just about feeling rested—it’s a foundational piece of feeling well, connected, and in tune with your body.

Can natural remedies work for low libido during menopause?

Some people turn to herbal remedies for sexual health during menopause, but many lack strong scientific backing. While a few show potential, most rely on anecdotal claims. Natural doesn’t always mean safe or effective, so it’s best to approach these options with caution.

• Maca root – Often labeled a “natural aphrodisiac,” maca has been linked to improved libido and mood in small studies. While some report benefits, research is limited, and its exact mechanisms remain unclear.
• Fenugreek – Some studies suggest that fenugreek may help with libido and hormone balance, but most research is small-scale. Its effects on estrogen and testosterone levels are not well understood.
• Ginseng – Korean red ginseng has been studied for its potential to enhance arousal and sexual function. While results are promising, the evidence is not strong enough to recommend it universally.
• Soy & phytoestrogens – Foods like soybeans and flaxseeds contain plant-based estrogens that may support hormone balance and vaginal health. Their effects vary, and some people see little to no benefit.

Other herbs—damiana, black cohosh, tribulus terrestris, and ashwagandha—are traditionally used for sexual wellness, but current research offers limited or mixed results.

Safety and herbal supplements

Herbal remedies aren’t always safe. Some interact with medications or cause side effects. Be wary of “cure-all” claims—no herb is a guaranteed fix. 

Before trying any supplement, it’s important to understand the risks and limitations. These products aren’t well-regulated, their safety and effectiveness are unproven, and they can be expensive. Still, some people may want to try them, especially with a possible placebo effect and relatively few reported side effects. If you’re considering this route, keep the following in mind:

• Talk to your doctor – Some herbs can interfere with hormone therapy, blood pressure meds, or other treatments.
• Choose reputable sources – Supplements are not well-regulated, and quality can vary. Look for third-party testing.
• Be realistic – Effects vary and may take weeks. Some herbs may not work for you.
• Watch for side effects – Digestive issues, headaches, or allergic reactions can occur, even with “natural” options.

Your next steps 

Changes in libido during menopause are common, but that doesn’t mean you have to accept them as your new normal. From hormone shifts to stress, sleep, and relationship dynamics, many factors can affect sexual desire, and there are just as many ways to support it. Understanding what’s happening in your body is the first step. From there, it’s about exploring options that work for your unique needs, whether adjusting your lifestyle, trying a new therapy, or having more open conversations with your doctor or partner.

Support is available, and meaningful progress is absolutely within reach. Whether it’s through strength training, hormone therapy, or daily habits that help you feel more energized and connected, small changes can lead to big improvements. If your sex drive has changed, it’s worth paying attention—and even more worth taking steps to feel better, inside and out.