Yes, a lower sex drive is common in perimenopause. Changing hormones play a part, but so do poor sleep, vaginal dryness, stress, mood and your relationship, so there is rarely one single cause, and there is a lot that can help.
In short
- Lower interest in sex is a recognised symptom of perimenopause and menopause.
- It usually has several causes at once: hormones, dryness or discomfort, tiredness, mood, medicines and relationship stress.
- It's worth raising with your doctor. Treatment depends on the cause, and it's a normal thing to ask about.
Is it normal to lose interest in sex in perimenopause?
It is common. The European Menopause and Andropause Society (EMAS) says that around one in two women have some kind of sexual problem. Germany's IQWiG notes that some women become less interested in sex around menopause, while others notice little change.
There is no "right" amount of desire. It only becomes a problem if it bothers you or your relationship.
Why does sex drive change?
Estrogen levels swing and then fall in perimenopause, and testosterone declines gradually with age. Both are involved in desire and arousal.
Lower estrogen can make the vaginal tissues drier and thinner, so sex may be uncomfortable or painful. When sex hurts, desire often drops too. Read more in Vaginal dryness in perimenopause.
Night sweats and 3am wake-ups leave less energy for anything else.
Anxiety, low mood and a busy midlife (work, children, ageing parents) all affect desire.
EMAS lists some antidepressants, as well as conditions such as diabetes, thyroid disease and heart disease, among the causes of sexual problems. Hormonal contraception can affect desire too.
IQWiG points out that changes in sex life aren't always caused by menopause alone: how things are with your partner matters too.
What can help?
- Treat what's in the way. Dryness and pain can usually be eased; ask a pharmacist or doctor about lubricants, moisturisers and local treatments.
- Look after sleep and stress. Better nights often bring more energy and interest.
- Talk about it. An honest conversation with your partner about what has changed can take pressure off. Relationship or sex therapy can help too.
- Ask your doctor. Depending on the cause, options may include hormone therapy, local estrogen, a change of medicine or talking therapy. In some cases, specialists consider testosterone for women with low desire after menopause; only your doctor can say if that suits you.
When to see a doctor
Talk to your doctor if low desire worries you, if you think a medicine or contraception is the cause, or if sex is painful. See a doctor promptly if you have bleeding after sex, bleeding between periods or any bleeding after 12 months without a period.
If low desire comes with persistent low mood, hopelessness or loss of interest in most things, talk to your doctor soon; it can be a sign of depression. If you have thoughts of harming yourself, seek help the same day.
Before the appointment, it can help to note for a few weeks how you sleep, how you feel and what has changed, on paper or in an app like Pausie. It makes a hard topic easier to start.
Frequently asked questions
Does perimenopause kill your sex drive for good?
No. For many women desire changes rather than disappears, and treating dryness, sleep problems or mood often helps.
Can HRT help with low libido?
It can help some women, especially when dryness, poor sleep or hot flushes are part of the picture. Ask your doctor about benefits and risks for you.
Is it my relationship or my hormones?
Often both. That's why it helps to look at the whole picture with your doctor, and with your partner.
Who should I talk to?
Your GP or gynaecologist is a good start. They can refer you to a menopause or sexual health specialist if needed.
See the whole picture
Log »Sexual problems«, sleep, mood and your cycle in Pausie. Over a few months you can see what goes together, and bring it up with your doctor when you're ready. No account, and your diary stays on your phone.
This article is general information, not medical advice. Written by the Pausie team. Published and last reviewed 2 November 2026.
Sources
- EMAS Menopause Essentials: Sexual problems
- EMAS Menopause Essentials: Vulvovaginal atrophy
- InformedHealth.org (IQWiG): Menopause
- Cleveland Clinic: Perimenopause
- NHS: Low sex drive (loss of libido)