Lower libido in perimenopause

Is low libido a sign of perimenopause?

It can be. The NHS perimenopause symptom list includes a lower sex drive alongside hot flashes, sleep problems, mood changes and vaginal dryness. The NHS page on low sex drive names lower hormone levels with age, "particularly during the menopause", as one of its main causes.

It is far from universal, though. The Menopause Society's sexual health page says some women feel a clear drop in desire at midlife, some feel more interest, and others notice no change at all. It adds that there is no standard to meet: only you and your partner know whether your sex life works for you. So the question worth asking is whether the change bothers you, not whether it is "normal" for your age.

Why sex drive changes in perimenopause

The Menopause Society describes hormone changes as "only part of a complex set of factors". Most women with a lower libido in their 40s have more than one of the causes below, and each one can be looked at separately.

Dryness and pain during sex

Falling oestrogen thins the lining of the vagina and makes it drier, which can make penetrative sex sore. Once sex hurts, wanting it less is a sensible response, and the NHS lists vaginal dryness among the sexual problems behind a low sex drive. Our page on vaginal dryness and bladder changes in perimenopause covers the signs and the infections that can look like it.

Sleep, night sweats and tiredness

The Menopause Society links desire to sleep directly: night sweats break up the night, and someone who is "tired from rustling the covers all night" may simply put sleep first. If your sex drive dropped around the time your sleep got worse, that is worth saying out loud at an appointment, because the sleep problem may be the one to look at first.

Mood, stress and anxiety

The NHS lists stress, anxiety and depression as causes of low libido, and mood changes are a perimenopause symptom in their own right. Loss of interest in things you used to enjoy, sex included, is one of the core signs of depression. If low mood has been there most of the day, most days, for two weeks or more, read our page on perimenopause or depression and see a GP about the mood itself.

Medicines and contraception

Several common medicines can lower desire. The NHS names antidepressants and medicines for high blood pressure, and hormonal contraception such as the pill, the patch and the implant. Do not stop any of these yourself. Ask the doctor who prescribed yours whether it could be playing a part, and remember that contraception still matters in perimenopause, as the page on getting pregnant during perimenopause explains.

Your relationship and your life

Midlife brings a lot of change at once. The Menopause Society lists divorce and dating, children leaving home or adult children living at home, and caring for ageing or ill parents. It also names a partner's own sexual problems, body image and worries about getting older. The NHS puts relationship problems first on its list of causes.

Other health conditions

The NHS says long-term conditions can affect sex drive, naming heart disease, diabetes, an underactive thyroid and cancer. An underactive thyroid also brings tiredness, low mood and weight gain, which overlap with perimenopause. The page on perimenopause or thyroid sets out how to tell them apart. Drinking too much alcohol is on the NHS list of causes as well.

Low sex drive in your 40s: hormones or something else?

A drop in desire on its own rarely tells you the cause. What helps is the company it keeps. A drop that arrived with changing periods, hot flashes and dryness points towards perimenopause. One that started with a new tablet, a hard year or a slide in mood points somewhere else, or to both at once. The look-alike finder walks through the conditions that share these symptoms, and the perimenopause symptom checklist helps you see the wider picture.

There is no blood test that settles it. For women over 45, NICE advises identifying perimenopause from symptoms and cycle changes rather than hormone tests, which our page on whether there is a test for perimenopause explains.

When to raise it with a doctor

The NHS suggests seeing a GP if you are worried about your low sex drive, or if you think a medicine or hormonal contraception is affecting it. That bar is deliberately low. The Menopause Society notes that many people find sexual problems hard to bring up, and that an assessment can find medical or psychological causes behind low desire.

A few signs need attention in their own right, whatever is happening with your libido:

• bleeding after sex or between periods, which our page on bleeding after sex in perimenopause explains
• pain during sex that does not settle
• low mood most days for two weeks or more, or any thoughts of harming yourself, which need help the same day

What to tell your doctor

The appointment goes better when you arrive with the details rather than a vague "my libido has gone". I would note:

• roughly when the change started, and whether it came on slowly or suddenly
• whether you have pain, dryness or bleeding during or after sex
• how you are sleeping, and whether night sweats wake you
• your mood, stress and anything big going on at home or work
• every medicine you take, including contraception and anything started in the last year
• your period dates for the last few months, and any other symptoms, each marked mild, moderate or severe
• what you would like to change, in your own words

If writing it down feels easier than saying it, the one-page appointment summary lets you hand the doctor a sheet. To keep a record over a few weeks, the printable symptom diary works on paper. On a phone, Her Good Days is a free app that logs symptoms with their time and severity next to your period dates, sleep, mood and medicines, and turns the dates you pick into a PDF for your doctor, with your notes and questions. It keeps what you report and does not interpret it, and it is coming soon to the App Store and Google Play.

My take

I'd start with pain. If sex hurts, that is the first thing I would raise, because it is the cause with the clearest next step and it feeds every other one. After that I'd judge the rest by timing: did the change start when sleep got worse, when a new medicine began, or during a hard stretch at home? Often two or three of these turn out to be true at once, and each has its own route to help. I'd skip waiting for it to pass and bring it up at the same appointment as the other perimenopause symptoms, in plain words, since the Menopause Society notes how hard many people find it to raise.

Related reading

Lower libido sits alongside the rest of the list in perimenopause symptoms and how to track them. The symptoms topic collects every symptom page on the site.