Perimenopause and Low Sexual Desire

by Eileen Bailey Health Writer

Perimenopause is the stage leading up to menopause. It can begin anytime after age 35 and lasts for an average of 4 years, however, for some women, this stage can be only a few months or could last much longer than 4 years. During perimenopause, hormonal fluctuations can cause irritability, mood swings, weight gain, anxiety and an increase in headaches.

Another symptom can be a decreased sex drive. This symptom can be frustrating and disappointing. For some, it can interfere with your relationship. Because perimenopause can begin years before menopause starts, you may not realize what is going on and why you suddenly have less interest in a sexual relationship. Make sure if you are experiencing any of the symptoms listed or your libido is lower than it was previously, talk with your doctor. There are tests that can be done to find out if you are entering the perimenopause stage.

Why Sexual Drive Decreases

During perimenopause, a number of changes in your body begin to take place. Each of these can contribute to lower libido.

Lack of Ovulation

Sexual desire often peaks around the time of ovulation, nature's way of increasing the chances of procreation.
During perimenopause ovulation does not necessarily occur each month. Anovulatory cycles are those where no ovulation occurs but you still have a regular period. Because of this, you may not realize that you are not ovulating, even so, without ovulation, your body may not react with desire in the same way as with ovulation.

Decrease in Progesterone

Progesterone helps fuel desire. During perimenopause, your progesterone levels slowly begin to decrease causing a decrease in sexual desire.

Lower Estrogen Levels

Just as progesterone decreases during perimenopause, so does estrogen levels. With lower estrogen levels, you may not feel the same pleasure from physical touch and intercourse. Estrogen also helps to elevate mood, making you more interested in sex. Lack of estrogen can cause vaginal dryness and thinning of vaginal tissue, making intercourse uncomfortable and even painful for some women. Pain during sex will certainly decrease your desire.

Testosterone Imbalance

While we most often think of testosterone as a male hormone, women also have it, just in much lower quantities. During perimenopause, the level of testosterone decreases even more as this hormone is directly related to sexual drive. This hormone also plays a role in vaginal lubrication and, as with estrogen, reduced lubrication can lead to uncomfortable and painful sex.

Mood Swings and Depression

Besides the hormonal changes, perimenopause can cause irritability, mood swings and depression. Because sex is just as much emotional and physical for women, feeling down may affect your desire for intimacy and sexual intercourse.


Hot flashes and night sweats can severely impact your ability to get a good night's sleep. Physical exhaustion can leave you too tired to want to engage in sexual activities.

What You Can Do

Because perimenopause is a medical condition, the first step is to talk with your doctor. He or she can request tests to let you know whether you are in perimenopause. Once you understand why you are experiencing a decrease in sexual desire, you can better cope with and find solutions for it. A blood test will also tell you if there are any other physical problems, such as low thyroid function, that may be contributing to your decreased sexual desire.

While men can take a pill to help with desire and performance, there is no such option for women. Although some women have tried Viagra and other sexual performance medication, studies have shown it is not effective.

Some methods that may work:

Estrogen - These creams can be applied in the vagina to help with lubrication, making sex more comfortable and can help increase sexual desire. Oral estrogen has been linked to cancer, however, using localized estrogen is considered safe. This type of estrogen comes in creams, suppository tablets or small rings which sit inside the vagina and slowly release estrogen.

Testosterone creams - Applying testosterone to the vagina or clitoris can increase sensation during intercourse and increase your ability to have an orgasm.

Vitamin E - If you are experiencing problems with lubrication, applying vitamin E directly in the vagina may help.

Personal lubricants - As with Vitamin E, personal lubricants, such as KY Jelly, can help with moisture and make intercourse more pleasurable.

Testosterone - Taking testosterone orally or using a patch or injection can help to increase sexual desire, however, there are risks involved with this. Side effects include acne, facial hair and mood changes.

Communication is Important

Most importantly, as you go through perimenopause, keep up communication with your partner. He needs to understand what you are going through and you will need to educate him on what to expect. As your sexual desire decreases, he may feel left out or rejected. Knowing that it is medical, not personal, can go a long way to keeping the relationship intact. Talk about other ways to be intimate, including cuddling, on days you are not interested in sex. Your partner's support will go a long way to making you feel better. Print out articles, such as this one, to share with your partner about what to expect and what types of things you can do to improve your sexual desire. You may want to make an appointment with your doctor so he can explain the symptoms of perimenopause and you can talk together about how to cope with all the symptoms.


"Management of Libido Problems in Menopause," 2000, Summer, Jeanne L. Leventhal, M.D., The Permanente Journal

"Menopause," Reviewed 2011, Sept 13, Reviewed by David Zieve, M.D., National Institutes of Health

"Perimenopause - a Time of Change," Modified 2011, July 20, Marcy Holmes, N.P, Certified Menopause Clinician,

Eileen Bailey
Meet Our Writer
Eileen Bailey

Eileen Bailey is an award-winning author of six books on health and parenting topics and freelance writer specializing in health topics including ADHD, Anxiety, Sexual Health, Skin Care, Psoriasis and Skin Cancer. Her wish is to provide readers with relevant and practical information on health conditions to help them make informed decisions regarding their health care.