Will menopause affect my sex life? For some people desire increases when hormones change in perimenopause and menopause, and for others it can reduce, to a point that they would like to talk about it and get further support. Sexual wellbeing is complex, and many other factors in your life can play a part in the reason desire changes. Talking about can help.
The science of sex and pleasure
Lets ask ourselves if there is there a linear model of sexual response for women, in which spontaneous sexual desire always comes first, leading to feelings of arousal (wanting) and then to orgasm? If this is so, it does not consider the role of pleasure in sex and the difference between spontaneous and responsive desire.
At the start of most relationships desire for women is predominantly spontaneous. Women are more likely to enjoy sex, and sexual desire is less likely to be an issue. Unlike men, women need novelty to sustain their sexual interest. With familiarity and lack of this novelty, their interest in sex may reduce. If they are inhibited or distracted by other things in life (work/children/washing up/housework), particularly if female sexual pleasure is not addressed during sex then their spontaneous desire may turn off, they may become emotionally unavailable for sex, and over time, they might forget any motivation to have sex. They could then believe they have gone off having sex and they have lost their desire. If lack of desire or arousal causes personal or distress in a relationship over a six month period, it can be diagnosed as female sexual interest or arousal disorder.
But what if spontaneous desire is not needed to initiate their sexual response? What if arousal can turn on responsive desire for them which can lead to pleasure. What if that linear model is not accurate for women? This is actually the case. Spontaneous desire is not necessary to initiate the sexual response model described by Rosemary Basson. Desire is complex.
It could be that a woman doesn’t understand the pattern of female desire? She has a healthy responsive desire, feels pleasure and can climax but assumes that as she does not feel spontaneous desire, she has a problem with her sexual desire.
Learning more about this can help. This video and video series might help: Rock my sexology
What things might affect changes in sexual desire at menopause?
Let’s divide them into biological factors, psychological factors, and social factors.
Biological factors affecting desire can include:
- Vaginal dryness caused by a fall in the hormone oestrogen can lead to vulval and vaginal discomfort and even pain during sex. What can help? Advice about vulval care, non hormonal vaginal moisturisers and lubricants and low dose localised oestrogen, which, used together, are effective together to improve dryness and soreness.
- Night sweats and hot flushes as are a common menopause symptom and can cause an intolerable heat, so you may not want to be touched. What can help? There are effective hormonal and non-hormonal treatments to reduce flushes and sweats.
- Irregular periods can interfere with the spontaneity. What can help? There are ways to lighten heavy prolonged periods using hormonal and non hormonal treatments.
- Inflammatory skin disorders like lichen sclerosus.
- Cancer and side effects of treatment.
- Joints can become sore and stiff, and moving into different positions might cause pain.
- Leaking urine, incontinence at time of climax.
- Your partner may be experiencing problems with their health, they may be taking medication which can lead to difficulty getting erection, or cause them reduced sexual desire.
- Taking prescribed drugs like antidepressants, betablockers and Gabapentin, or drinking too much alcohol can affect desire
- Pregnancy, recent childbirth can affect desire
Psychological factors affecting desire can include
- Stress
- Emotional changes can affect your mood: mood swings, low mood, the feelings of wanting to be alone, anxiety and loss of self-confidence. What can help? Hormonal therapy and some non-hormonal therapies, including talking therapies, can be really helpful to improve your mood.
- You may be self-conscious because of physical changes that are occurring in your body. Weight gain and change in body shape are normal and common at midlife and during menopause and perimenopause. For some women, this is enough to cause them to avoid intimacy. Talking to a partner about this can help to improve your confidence.
- Having problems with your relationship – talking therapy might help
- Worry over pressures of life: balancing caring for young children, teenagers, work, elderly relatives etc
- Past history of trauma
- Desiring a change in your sex life, if sex is not bringing you pleasure then you may not want to do it.
Social factors affecting desire can include
- Caring for children, elderly relatives
- Bereavement or loss
- Problems with your relationship including domestic abuse
- Infidelity
- Recent unemployment
With sexual desire being complex and affected by so many things, a change in desire is likely to be due to a combination of the factors above. We need to take a biopsychosocial approach when we chat about this, looking at the biological reasons, the psychological reasons, and the social reasons that can affect why desire has changed. Desire can change for women having partnered sex and solo sex.
Sex hormones, particularly the hormone oestrogen, are important for healthy sexual function. Sexual health is important for physical, emotional, and relationship well-being.
Things to consider: How has your sexual desire changed?
Changes in your sexual wellbeing might include:
- Lack of interest in sex – it may be that you don’t ever think of having sex (spontaneous desire) or you don’t feel like having sex like you usually would when stimulated/given the invitation at a time you could accept (responsive desire).
- Difficulty becoming aroused, it might take longer to build up
- Difficulty having an orgasm or the quality of the orgasm might have changed
- Vaginal pain during intercourse because of vaginal dryness or pelvic floor muscle problems
Questions to ask yourself
- Has my sexual desire changed for me? How does sex make you feel? Is it pleasurable?
- If I was happy with my sexual desire in the past, when was this and why?
- If my sexual desire has reduced does this bother me and/or my partner?
- Would I like my level of sexual desire to increase?
- If I have a partner can I talk with them about it?
- Do I ever notice my body being turned on, even if I don’t act on it? This question explores possibility of spontaneous desire.
- Are there other things that you feel you would be better off doing? This can explore potential factors that might compete with sexual processing and your desire to be sexual, like your family and work commitments.
- Is sex always the same, the same order from start to middle to finish? This question can make you think about your sexual experiences and may reveal sexual boredom.
- Do you talk with your partner about what turns you on or off? This question can consider communication within your relationship. Any potential difficulties expressing how you feel pleasure, your needs, and your boundaries?
As we can see, helping you to enjoy a satisfying and happy sexual life involves more than just a medical intervention. It requires an open conversation about your sexual health and a comprehensive approach looking at your lifestyle, stress, sleep, your personal health and your partner’s health, and your hormonal balance.
What about hormonal treatments, will help improve sexual desire?
Hormone Replacement Therapy
If the change in sexual function is associated with menopause symptoms, then taking hormone therapy may improve sexual desire. But the effectiveness of taking the hormones varies between individuals. Systematic HRT can relieve some of the symptoms described above that contribute to a change in desire – the hot flushes, night sweats and the mood changes etc. Once you feel better, desire may improve.
Low dose localised vaginal/vulval oestrogen
Treatment of genitourinary symptoms of the menopause can significantly improve sexual pleasure. If vaginal dryness is left untreated, it can lead to pain during intercourse, which can then lead to secondary vaginismus. Involuntary tightening of the muscles in the pelvic floor around the vaginal entrance can make vaginal penetration very difficult, and it can be difficult to treat. So treating vaginal dryness, soreness, itching, and bladder symptoms early is really important. See our article about genitourinary symptoms.
Testosterone for women to support sexual wellbeing
About 2/3 of women with hypoactive sexual desire find an improvement in libido from a trial of the hormone testosterone in addition to hormone therapy.
Many women think that testosterone is a male hormone, but before the menopause women also produce testosterone from their ovaries and their adrenal glands. It plays an important role in female sexual function. The levels of testosterone can decline steadily with age from your 30’s, and levels will fall suddenly if you have your ovaries removed, during an operation.
Read more about testosterone therapy in women here on the women’s health concern fact sheet.
Would you like to explore more?
Books, audios and podcasts
- Come as you are by Emily Nagoski
- Mind the gap by Dr Karen Gurney
- The podcast with Dr Karen Gurney: Sex in long term relationships
- “Better Sex Through Mindfulness- how women can cultivate desire” by Dr Lori Brutto (Greystone Books, 2021). Includes exercises that readers can do on their own to increase desire and sexual enjoyment, whether their goal is to overcome a sexual difficulty or simply give their love life a boost.
- Mating in captivity by Esther Perel
Websites for further information about sex
These websites are recommended by speakers at the British Menopause Society and recommendations include online courses, information about pelvic floor awareness, use of vaginal dilators.
- Age, Sex and You – promoting better sexual health and wellbeing in older adults.
- Joan Price Senior Sex Tips – Joan Price is an author, speaker and advocate for ageless sexuality.
- Jean Hailes Sex & Sexual Health – this is a health website full of fantastic information.
- OMGYES – a one off payment for advice and information about exploring sex techniques
Talking with your partner might be helpful to give your partner some information to help them understand how you feel.
Psychosexual Therapy – this website can help you find a therapist, COSRT
Toys and vaginal trainers
- ‘Jo Divine’: www.jodivine.com. Online UK-based luxury sex toy shop, co-founded by a nurse, Sam Evans, who was in the first Davina show, selling a range of sex toys for people of any gender, including graded vaginal dilators made of silicone. Also includes lots of sexual health information (see above).
We are delighted to offer you this support through Rowena Health Menopause Clinic
Updated September 2026 Dr Carys Sonnenberg Rowena Health
Rowena Health is not responsible for the external website links from this page.
© Rowena Health | rowenahealth.co.uk
The information in this article was correct at the time of publication. This is for general information only and is not intended to be, nor should it form, individual medical advice. Always seek advice from your health professional about you medical care. Throughout the Rowena Health website, we use the term women when describing people who experience hormonal symptoms. However, we acknowledge not only those who identify as women require access to menopause and hormone health information. For example, some trans men, non-binary people, intersex people or people with variations in sex characteristics may also experience menopausal symptoms and hormonal mood changes such as PMS and PMDD.