Perimenopause Can Make Your Sex Drive Dip—Here’s a Doctor’s Top Tips to Boost it Naturally
Issues like insomnia and vagina dryness take a toll on your libido, but these tips reignite intimacy
We all know about perimenopausal hot flashes, irritability and insomnia. But the shocker for many women is how perimenopause affects your sex drive. Just like those erratic periods, your perimenopause sex drive can feel unpredictable and frustrating. But the reasons go beyond changes in your hormone levels. If your desire for intimacy has taken a hit, there are real solutions to bring the spark back to your sex life.
What causes a low sex drive in perimenopause?
It’s not as simple as blaming a low libido on declining estrogen levels during perimenopause and menopause. “There’s this myth that as soon as your estrogen drops, your sex drive is automatically going to tank,” says Susan J. Baumgaertel, MD, a Washington-based primary care physician and founder of myMDadvocate and MenopauseMenu. “But that’s not always the case. The drop in estrogen doesn’t directly cause a decrease in libido. That being said, there’s a lot to unpack.”
Perimenopause often coincides with major life changes. “Many women in their 40s are dealing with things like kids in high school, becoming empty nesters, divorce or caring for aging parents,” Dr. Baumgaertel explains. “These life events are stressful, and stress is a big contributor to low libido.”
Here’s what else can affect your desire for sex during perimenopause:
Vaginal discomfort
Hormones influence sex drive, but they’re not the whole story. The drop in estrogen during perimenopause can make sex uncomfortable for some women. “As estrogen declines, vaginal tissues become thinner and less elastic and natural vaginal lubrication decreases,” explains Dr. Baumgaertel.
Vaginal dryness, pelvic floor issues and an increased risk of urinary tract infections (UTIs) also contribute to discomfort and a dip in sexual desire. “Many women start getting UTIs because everything’s dry and the tissue is thin,” she adds. “When sex starts to hurt, your brain remembers that and you naturally avoid it.”
Fatigue, irritability and anxiety
The physical and mental symptoms of perimenopause can take a serious toll on your sex drive, suggests research in the Journal of Women’s Health. “It’s hard to feel sexy when you’re exhausted, irritable and tossing and turning all night,” says Dr. Baumgaertel.
The drop in estrogen can also heighten anxiety and depression, adding to the emotional strain. Many antidepressants used to treat these mental health issues come with a frustrating side effect: a decreased sex drive. “Some of the best medications for anxiety and depression have low libido as a top side effect,” Dr. Baumgaertel notes.
Body changes and low self-confidence
For some women, perimenopause can feel liberating as fertility pressures fade. For others, physical changes can trigger a loss of confidence that impacts your sexual health.
“If I had a dime for every time I heard a woman say, ‘Oh my god, where did those 10 pounds come from?’ I’d be rich,” says Dr. Baumgaertel. “It’s not just the weight gain, it’s where it shows up—right around the middle. When you’re not thinking about yourself in a positive way, it’s hard to feel sexy or want to engage in sex.”
How to increase your sex drive during perimenopause
If you want to renew your desire for being sexually active again, there are steps you can take to increase your libido. Here’s what helps:
Make time for Intimacy–and yourself
It’s important to carve out some quality time with your partner and time for yourself during perimenopause. “If you’re so tired that the last thing you want to do is have sex, maybe you need a date night,” suggests Dr. Baumgaertel. “Time away from work, from your family—just to have fun again.”
Talk it out
Understanding what’s causing your sex drive to dip during perimenopause often requires open communication and honesty. Whether it’s with your partner, a mental health expert or trusted friends, talking it through can help improve your sex life and overall health, too.
“If there’s a lot of stress in your life, all the pills and potions in the world aren’t going to help if you’re not addressing the elephant in the room,” adds Dr. Baumgaertel.
Redefine intimacy
Moving away from the idea of traditional intercourse, especially if it’s painful, opens new possibilities. “Redefining intimacy is a huge relief for some women,” Dr. Baumgaertel says. “Not all sex has to be penetration. Oral sex, sensual touching or simply being physically close can be just as intimate and pleasurable.”
Learning about self-pleasuring and understanding what feels good can be transformative. “Exploring your own body and knowing your anatomy can boost confidence and reignite desire,” adds Baumgaertel.
Add vaginal lubricants
Vaginal dryness can make sex uncomfortable, but there are plenty of products to help. “Moisturizers improve vaginal tissue suppleness, while lubricants make sex more comfortable,” says Dr. Baumgaertel. Regular use can relieve dryness and make intimacy more enjoyable. (Not sure where to start? See why a silicone-based lubricant can be more helpful than a water-based lubricant.)
Ask your doctor about HRT
For some women, hormone replacement therapy (HRT) can be a game-changer for alleviating perimenopause symptoms that affect sex drive. Localized estrogen treatments, like creams or vaginal rings, can specifically address vaginal dryness.
However, Dr. Baumgaertel urges caution with testosterone therapy, as it may cause side effects like acne, facial hair or voice changes. “While some women benefit from it, testosterone therapy isn’t for everyone,” she explains. Ask your doctor what’s best for you and your long-term health.
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