How to increase sex drive during perimenopause: A 5-step guide

Why don’t I want sex anymore?

During your reproductive years, your hormones fluctuate throughout your menstrual cycle. You may have noticed you feel hornier around the mid-cycle when ovulation occurs. It’s driven by a surge in estrogen that signals luteinising hormone (LH) to trigger the release of an egg. Think of it like a biological insurance policy to increase your chances of pregnancy.

As perimenopause progresses, you experience more pronounced hormonal fluctuations. These changes can cause perimenopause symptoms like low sex drive, mood swings, and hot flashes. Lower estrogen levels cause decreased blood flow to the vaginal walls, making them dry, thin, fragile, and less elastic. The thinning walls are more susceptible to tearing, irritation, burning sensation, itching, and bleeding, especially during high-friction activities like sex. You may also notice decreased clitoral sensitivity from the lessened blood flow.

These symptoms can cause anxiety and relationship issues, since you and your partner may not understand how your changing hormones can cause a shift from spontaneous desire to responsive desire. Waiting to “feel horny” may not work anymore, and that’s normal. Understanding that you may need to focus more on responsive desire, where you feel horny in response to an external stimulus, can take the stress off of forcing a sex drive that biologically isn’t there.

You’re probably thinking, “It’s a relief to know why my libido is lower, but now I want to know how to increase sex drive during perimenopause.” We’ve created this 5-step guide to improving sex during perimenopause so you can start enjoying intimacy again.

Step 1: Track your cycle to understand your sex drive

Navigating low libido during perimenopause can feel overwhelming, and you may not know where to begin. As perimenopause progresses, your cycle becomes more erratic and ovulation can be harder to predict. Tracking cycle and symptom patterns is one of the most reliable ways to understand what’s happening to your body.

The Hormona app is an award-winning diagnostic tool that lets you log daily symptoms and cycle days so you can identify patterns. For example, if you notice your mood and energy dip at specific times, you may be able to predict when your libido might be naturally lower and when it might peak.

Hormona removes the guesswork and puts you back in control. Your hormones are talking – you just need the right tool to listen. Symptom tracking gives you the insights you need to better understand your body and feel your best.

Step 2: Address vaginal dryness and pain

Thinning tissue in the vaginal walls can cause dyspareunia or painful sex. When intercourse is painful, your brain shuts down desire as a defense mechanism, which can further reduce your libido.

Addressing the pain that occurs during sex can help improve your sex drive and make it more enjoyable. A good way to combat vaginal dryness is by using a daily moisturizer designed specifically for the vagina. These products can provide long-lasting relief from irritation, burning, and dryness by restoring natural moisture.

While moisturizers act as a daily maintenance for vaginal tissue health, lubricants are excellent for protection and moisture during intimacy. A water-based lubricant is a great option for sensitive skin, while a silicone-based lubricant can provide more intense moisture. When combined, both moisturizers and lubricants can help provide continuous comfort, both daily and for special events like date nights.

Step 3: Natural and lifestyle solutions

There are natural ways to increase sex drive during menopause and perimenopause if you’re not ready for a medical intervention. Natural remedies like maca root are shown to improve libido in perimenopause. Ashwagandha can help regulate hormone levels and lower stress-induced cortisol levels, which may boost sex drive. You may have also noticed that both of these supplements target stress as a contributing factor for low libido, and that’s because there is a connection between cortisol and sexual desire.

Women who experience heightened anxiety around sex may have a higher cortisol response. Cortisol, also known as the stress hormone, can cause anxiety and an increased heart rate – it is the hormone responsible for the fight or flight response after all. When there is stress surrounding sexual desire, it can interfere with arousal.

One way to combat sex-related anxiety is to prioritize sensate-focused sessions with your partner. Sensate focus is when you strictly limit touch to non-erogenous, non-genital zones like the face, legs, back, or arms instead of traditional arousal techniques. When you “ban” intercourse or genital touching, it forces both partners to enjoy a deeper level of physical intimacy without the pressure of “performing” or orgasming.

Step 4: Medical interventions

If natural solutions aren’t working, it may be time to speak with your GP or OB-GYN. Before starting you on medications, they’ll ask about your medical history and may order a blood test to view your hormonal profile. This step is an essential part of your health, so they can ensure there are no other issues behind your low libido. There are typically four medical treatment options for perimenopause-related low libido.

1. Local estrogen – A topical cream containing estrogen can be applied to the vagina, helping restore moisture and lubrication. This option is safe for most women and is helpful for treating dryness-related pain during intercourse.
2. Systemic MHT – Systemic MHT (menopause hormone therapy) uses estrogen or a combination of estrogen and progestogen to relieve moderate to severe perimenopausal symptoms like mood changes, vaginal dryness, hot flashes, and night sweats. MHT is available in pills, transdermal patches, gels, or sprays.
3. Testosterone therapy – While estrogen levels drop as perimenopause progresses, testosterone actually starts to rise about a year before your final period and continues to climb for the next 3 to 4 years. However, if estrogen therapy is ineffective, you may benefit from testosterone therapy. Testosterone therapy is used to treat hypoactive sexual desire disorder, or HSDD – a distressing, persistent, or absent interest in sex that lasts at least six months.
4. Flibanserin (Addyi) – Flibanserin, also called Addyi, is a prescription medication used to treat HSDD in perimenopausal women. Unlike viagra, which increases blood flow, flibanserin acts as a serotonin receptor that increases sexual desire.

Before starting any MHT, it’s important to speak with your doctor and explain your symptoms and goals so you can develop a treatment plan that’s right for you. Having the insights available from Hormona’s symptom tracker will make it easier for your doctor to understand what you’re experiencing and make an informed medical decision.

Step 5: Psychological and communication strategies

When it comes to navigating low libido in perimenopause, communication is essential. It can be tricky figuring out how to talk with your partner without blaming them, but it is possible. Here are a few perimenopause and libido tips you can use to deepen intimacy and strengthen partner support.

• Create a sex schedule – While it may not seem romantic, scheduling sex can help take the fear out of intercourse. Not only does it give your partner certainty on when to expect sex, but it can make it easier for you to prepare. Having a consistent schedule helps you stop viewing sex as a chore and allows you to prioritize intimacy in your busy life.
• Explain what you’re feeling – If your partner is a man, he most likely doesn’t understand what your body is going through. Even if your partner is a woman, unless she’s in perimenopause or menopause herself, she has not yet gone through the same biological experience that causes low libido. Calmly explaining what you’re feeling will help them better understand you, so they can realize you’re not blaming them – it’s just part of this natural life transition.
• Be patient – Restoring your libido in perimenopause takes time and won’t happen overnight. Be patient with yourself and your partner as you both figure out how to navigate intimacy and sexual connection.
• Practice self-care – Self-care is an important part of keeping your body and mind healthy. Try integrating mindfulness exercises, using sensual massage to get you in the mood, or self-pleasure to help you get to know what you like and don’t like during this stage of life.

Common concerns about perimenopause libido

Will my sex drive come back after perimenopause?

Yes, for some women, their sex drive returns as their hormones stabilize after perimenopause, especially when paired with management techniques or treatment. In fact, some even find sex more enjoyable after perimenopause than it was before.

Can I increase libido without taking hormones?

If you don’t want to take hormones to restore your libido, you can try taking supplements like maca root or ashwagandha. Lowering stress through mindfulness techniques is also helpful, along with exercises like strength training or cardio to boost serotonin and decrease anxiety.

How do I know if I need testosterone?

Signs of low testosterone include low energy, loss of muscle tone, and no libido despite relationship happiness. While the treatment can vary across regions, the BMS recommends testosterone therapy to women with low libido when estrogen therapy was unsuccessful.

Does removing the ovaries affect sex drive?

Removing the ovaries, a process called oophorectomy, can decrease libido since it causes a sudden drop in the hormones estrogen and testosterone. This sharp hormone decline causes a condition called surgical menopause, with symptoms like low libido and vaginal dryness.