Andy Devaney
If you’ve found your sex drive has gone missing during menopause, you’re not broken, you’re not “past it”, and you’re certainly not alone. According to the British Menopause Society, more than half of women say that menopause has negatively impacted their life, with 51% admitting that menopause has affected their sex drive. In other words: this isn’t a private failing. It’s a common, fixable health issue that deserves more than a resigned shrug and a new pair of pyjamas.
Dr Wendy Molefi, a GP and Menopause Specialist at Spire Healthcare, holds an Advanced Menopause Specialist accreditation from the British Menopause Society and has a special interest in the psychological impact of menopause on women’s quality of life. Here, she shares her knowledge on a common problem that women face during the menopause – low libido. But just what can we do about it?
How common is low libido during menopause?
Let’s put a number on it, because numbers are oddly comforting. The British Menopause Society confirms that between 40 to 55% of women report a lower sex drive during menopause. That’s not a niche complaint. That’s half the room.
And the reason it can feel so isolating is simple: people talk about hot flushes like they’re bad weather. Libido? That gets filed under “too awkward”, which leaves plenty of women wondering if they’re the only one staring at the ceiling at 2 am, sweating through the sheets, thinking, When did this become my life?
Why menopause can lower sex drive
Low libido in menopause is rarely down to one thing. It’s more like a relay race where sleep hands the baton to mood, mood hands it to pain, and pain sprints off with your desire.
Hormone changes and painful sex
Menopause is, at its core, a hormonal handbrake turn. And the knock-on effects can be stubbornly physical.
Dr Molefi states: “Menopause leads to a drop in your hormone levels, specifically oestrogen, progesterone and testosterone. This causes changes in your vaginal and vulval area, specifically causing atrophic vaginitis i.e. thinning, drying and inflammation of the walls of your vagina. This can make sex painful.”
That last line matters because desire and discomfort are not compatible roommates. If sex hurts, your body learns to avoid it. That’s not psychology. That’s self-preservation.
Dr Molefi adds: “Sex can also become painful due to urinary tract infections, which can become more common during menopause as the microbiome of your vagina (bacteria that naturally live in your vagina) changes in response to reduced oestrogen levels.”
And it’s not only pain. It’s the full-body drag of menopause symptoms stacking up: “Other physical symptoms of menopause, such as tiredness due to sleep disrupted by night sweats, painful, heavy and/or irregular periods, and achy joints, can also leave you uninterested in sex.”
Sleep disruption, fatigue and night sweats
Even if your relationship is strong and your confidence is intact, it’s hard to feel romantic when you feel like you’ve been tumble-dried. Along with mental challenges, menopause can bring plenty of physical changes too. The British Menopause Society confirms that 22% of women experience sleeping problems and insomnia throughout the menopause, with 70% experiencing night sweats.
A tired body doesn’t chase pleasure; it chases survival. Sorting sleep isn’t a luxury add-on here. It’s a foundation.
Mood changes, confidence and brain chemistry
Menopause doesn’t only shift hormones — it can shift how you feel about yourself. Mood changes are commonly experienced during menopause and can result in a significantly reduced sex drive. You may also find that intimacy needs to be rebuilt in other ways first: holding hands, cuddling, being close without pressure. It sounds simple, but it can be the bridge back to feeling connected.
Dr Molefi notes: “Low mood and depression, which are common during menopause, can also reduce your sex drive. While low mood and depression can occur due to direct effects of menopause on your brain chemistry, they can also happen as a result of physical changes that make you feel less confident in your body or less like yourself.”
That’s the double hit: chemistry and confidence. Either can lower libido; together they can make you feel like a stranger in your own skin.
Relationship strain and partner misunderstandings
@drmartinkinsella Did you know that THIS is the number 1 cause of divorces? And here’s why 🤯 #menopause ♬ Very Sad – Enchan
Menopause can be lonely, even when you’re not alone. One of the most frustrating parts of menopause is the lack of understanding from a partner leading to further relationship problems, with 28% of partners having arguments because they don’t understand what the other is going through. That’s not trivial. That’s a pressure multiplier.
Dr Martin Kinsella, a leading aesthetic practitioner and hormone specialist, is also known as the ‘hormone doctor’ across his platform of over 270,000 followers on TikTok. Dr Kinsella actively talks about menopause being one of the leading causes of divorce, noting that due to a drop in estrogen, testosterone, and progesterone, this can cause physical and mental changes that can impact any relationship.
Dr Molefi adds: “The mental and physical changes that happen during menopause can put a strain on your personal relationships. You may feel that your partner doesn’t understand what you’re going through and this can consequently have an impact on your sex life.”
The blunt truth: libido doesn’t thrive under misunderstanding, pressure, or silent resentment. If menopause has changed the rules, both partners need the new rulebook.
What to do about low libido during menopause
The fix is rarely one magic switch. It’s usually a layered approach: relieve pain, support hormones where appropriate, rebuild confidence, and reduce pressure. Dr Molefi’s advice is clear: start by working out what’s driving the change.
Dr Molefi suggests: “If you’re concerned about your sex life and/or reduced sex drive due to menopause, it’s important to think about what factors are contributing to this. Speaking to your GP can help you work through this.”
Medical options: HRT and vaginal preparations
If physical symptoms are leading the problem — dryness, pain, recurrent UTIs, tightness — treat the physical symptoms first.
“If your reduced sex drive is mainly due to physical changes, treatments such as hormone replacement therapy (HRT) and vaginal preparations (including lubricants and moisturisers) can make a significant difference. Sex toys and vibrators can be helpful too for vaginal symptoms, such as pain and tightness, as they stimulate blood flow — this helps soften ligaments, which makes sex less painful. It is also important to avoid using soaps on your vaginal and vulval area as they have a drying and irritant effect; just use water.”
You don’t need to read that as “go buy gadgets”. Read it as: improve comfort, improve blood flow, reduce irritation, and your body has a better chance of responding again.
Therapy options: CBT, couples and psychosexual counselling
If the main drivers are mood, anxiety, relationship stress, or confidence, treat those with the same seriousness you’d treat a physical symptom.
“If your reduced sex drive is mainly due to psychological and/or relationship factors, you may benefit from talking therapies such as cognitive behavioural therapy (CBT), couples counselling and psychosexual counselling.”
This is the part many people skip because it feels “dramatic”. It isn’t. It’s maintenance — like physio for the mind and the relationship.
Testosterone: when it may be discussed
Testosterone is often misunderstood as a “male hormone”, but women have it too, and it plays a role in libido.
“Your doctor may discuss testosterone supplements with you; while testosterone levels decline gradually with age, this can become more apparent during menopause and can lower your sex drive.”
The key phrase there is may discuss. This is a GP conversation, not an internet self-prescribing project.
Lifestyle levers: sleep, exercise, diet and alcohol
This is where Sustain Health readers tend to win: small, repeatable habits that create a better baseline.
“In addition to specific therapies and treatments, taking steps to follow a healthy lifestyle, such as exercising regularly, following a healthy balanced diet, getting enough sleep and avoiding drinking too much alcohol can help through improving your mood, confidence and the way you see yourself.”
Not glamorous, not viral, but effective. Move your body, protect your sleep, and reduce the things that quietly sabotage mood and energy.
When to speak to your GP
If sex is painful, if UTIs are recurring, if night sweats are wrecking sleep, or if low mood is hanging around, speak to your GP. Menopause is not a “grin and bear it” era. It’s a healthcare era.
Dr Molefi sums it up without false promises: “In most cases, there is not one single treatment that can solve reduced sex drive. However, a rounded approach to therapies and treatment can address the problem.”
That’s the realistic message: progress is built, not discovered.
FAQ
Is low libido normal in menopause?
Yes. The British Menopause Society says between 40 to 55% of women report a lower sex drive during menopause.
Can menopause cause painful sex?
Yes. Hormone changes can lead to vaginal and vulval changes, dryness and inflammation, making sex painful.
Does HRT help libido in menopause?
It can help, particularly when low libido is linked to physical symptoms and hormone-related changes. Your GP can advise.
What can I do if my partner doesn’t understand menopause?
Start with education and low-pressure intimacy. If stress and conflict are entrenched, consider couples or psychosexual counselling.
Can testosterone help with menopause low libido?
It may be discussed by a doctor in some cases, as testosterone levels can decline with age and during menopause.
