Understanding Perimenopause and Libido

Perimenopause is a transitional phase that every woman and AFAB person experiences as their body prepares for menopause. It often starts in your forties but can begin as early as your mid-thirties, lasting anywhere from four to ten years. It’s what most people are actually referring to when they’re talking about menopause (which is defined as having gone twelve months without a period). 

During this time, your body undergoes significant hormonal changes that can affect various aspects of your health, including your libido. If you've noticed changes in your sexual desire, rest assured that you're not alone, and there are ways to address them. 

Below, we explore the connection between perimenopause and libido and discover practical solutions for reigniting your desire.

What is perimenopause?

Perimenopause — which means “around menopause” — is the time leading up to menopause. It’s the stage when your ovaries shrink and gradually produce less estrogen, a hormone that plays a crucial role in reproductive health. Along with estrogen, progesterone and testosterone levels can also fluctuate during this time. 

These hormonal shifts can bring about a lot of changes in your body: 

• Irregular periods: Your cycles may become shorter, longer, heavier, or lighter. Basically, they’re all over the place. Irregular periods are often the first sign of perimenopause. 
• Hot flashes and night sweats: Increased body temperature and excessive sweating can disrupt daily life and sleep.
• Mood swings: Anxiety, irritability, and depression can sometimes surface.
• Vaginal dryness: Decreased estrogen can cause thinning of the vaginal lining, leading to dryness and discomfort during penetrative sex.
• Sleep disturbances: Insomnia or restless sleep can result from hormonal changes.

These symptoms are all part of your body’s adjustment process as it transitions to menopause. Perimenopause affects everyone differently, so you may experience only a couple of these symptoms. Nevertheless, understanding these changes is the first step toward addressing their impact on your life, including your sexual health.

How does perimenopause affect libido?

Libido is another word for sexual desire. It’s shaped by a mix of biological, psychological, and social influences. Hormones (like estrogen, progesterone, and testosterone) and neurotransmitters (like dopamine) are key players in how our libido functions. Our emotional health, physical well-being, and the quality of our relationships also have a big impact on how we feel.

Many women experience changes in their libido during perimenopause. As many as 40-55% of women report a decline in sexual desire in the lead-up to menopause, and the reasons are both physiological (physical) and psychological (emotional): 

• Hormonal fluctuations: Estrogen helps maintain vaginal lubrication and elasticity. Its decline can lead to dryness and pain during sex, which can diminish your desire (because it’s hard to want sex if it always hurts). Testosterone, which plays a role in sexual arousal, also tends to decrease during perimenopause.
• Poor sleep: The quantity and quality of sleep can take a dip due to night sweats or insomnia can leave you feeling fatigued and less interested in sex. Research has shown that poor sleep can affect sexual desire. 
• Stress: Perimenopause often coincides with big life events, like having to take care of aging parents, divorce, children leaving home, etc. Navigating those changes while also dealing with perimenopausal symptoms mean sex is often the last thing on your mind. 
• Emotional and psychological factors: Mood swings, anxiety, and body image changes can affect your confidence and desire for intimacy.
• Relationship dynamics: If you’re navigating life changes alongside your partner, stress and communication issues may contribute to decreased sexual interest.

That said, perimenopause doesn’t have to be a metaphorical nail in the coffin for your sex life. Some research states that only 10-15% of perimenopausal women report no sexual desire, so there really is no one-size-fits-all. 

While many people notice a dip in their libido during this time, fluctuating estrogen and progesterone can actually increase sensitivity to other hormones (notably, testosterone), which might boost their libido instead. Although testosterone levels also drop in perimenopause, the balance between testosterone and the other hormones gets a bit out of whack. This means that testosterone can become relatively more prominent and actually increase your sex drive. 

But should perimenopause put a damper on your sex life, there are several things you can do. 

Reigniting your libido

While changes in libido during perimenopause are normal, there are many ways to address them and improve your sexual wellness.

Every woman experiences peri- or postmenopausal sexual dysfunction differently, so there's no one-size-fits-all treatment. It's important to take a thorough look at both physical and psychological factors that might be influencing your sexual desire. This way, you can find the most suitable approach tailored to your individual needs.

Hormone therapy

Hormone therapy (HT) is a widely recognized treatment for addressing the symptoms of perimenopause, including low libido. It works by:

1. Minimizing hormonal fluctuations: Fluctuating estrogen and testosterone levels can significantly impact sexual desire. HT helps stabilize these hormones, addressing the root cause of libido changes.
2. Alleviating physical symptoms: By improving vaginal dryness and thinning of the vaginal lining, and helping with pelvic floor problems, HT reduces discomfort during sex, making intimacy more enjoyable. 
3. Enhancing mood and energy: Drastic hormonal fluctuations can contribute to mood swings, fatigue, and depression, all of which affect libido. HT can help stabilize mood and boost energy, indirectly improving sexual desire.

Some research found that women using estrogen therapy reported improved sexual function, including desire, arousal, and satisfaction. Another study indicated that testosterone supplementation, when used alongside estrogen therapy, could lead to a noticeable increase in sexual desire and frequency of sexual activity.

While hormone therapy can be helpful for many, it’s not without risks. It’s crucial to consult with a healthcare provider to determine the right type, dosage, and duration of hormone therapy for your individual needs.

Over-the-counter solutions

Over-the-counter vaginal moisturizers and lubricants can ease dryness and discomfort during sex.

Vaginal moisturizers (usually made with hyaluronic acid) can be used daily to restore hydration and elasticity to the vaginal mucosa, providing relief from vaginal dryness and irritation. 

Lubricants, on the other hand, should be used during sex. Really and truly, everyone should be using lube — regardless of whether you’re perimenopausal or not! But lube is especially beneficial during perimenopause and menopause as it can reduce friction caused by vaginal dryness, making penetration more pleasurable. 

Look for a water-based option like Vella’s Intimate Elixir, formulated especially as a menopause lubricant for women with low estrogen. Intimate Elixir harnesses the powers of hyaluronic acid, chasteberry extract, and aloe vera to supplement the body's natural lubrication.

Lifestyle adjustments

Making certain lifestyle changes might not prevent perimenopausal symptoms entirely, but they can make them a lot more manageable — and stop them from getting in the way of your sexual well-being. 

• Exercise: Regular physical activity boosts endorphins, improves mood, and makes you . feel more confident in your body. 
• Diet: A diet rich in whole grains, lean proteins, healthy fats, and phytoestrogen-rich foods like soy (such as the Mediterranean Diet) can support hormone balance. 
• Sleep: Prioritize good sleep hygiene by establishing a bedtime routine, reducing screen time, and managing stress.
• Sexual wellness practices: Regular sexual activity, either with a partner or solo, can increase blood flow to the genital area and maintain vaginal health. We know it’s easier said than done when your libido seems to be at an all-time low, so make time for yourself and schedule a date night with your partner to experiment with new forms of intimacy or focus on non-sexual affection to foster closeness. Take it easy and don’t put too much pressure on yourself: the key is to enjoy yourself. 

Emotional and psychological support

Perimenopause can be a unique journey that affects not just your body, but also your emotions and mental well-being. Hormonal fluctuations, particularly a decrease in estrogen and progesterone, can impact mood, stress levels, and overall emotional health. This can lead to anxiety, depression, and reduced self-esteem — all of which can affect sexual desire and satisfaction.

Therapy and counseling can be highly effective for managing the emotional and psychological aspects of low libido during perimenopause. By addressing underlying psychological issues, improving communication with partners, and offering strategies for stress reduction, therapy can help individuals regain intimacy and improve sexual health.

Some forms of therapy that may be helpful include:

• Cognitive behavioral therapy (CBT): CBT helps individuals identify and challenge negative thought patterns that may contribute to low libido. For instance, if someone struggles with thoughts like "I’m not attractive anymore" or "I’m too old for this," a therapist can assist in reframing these beliefs.
• Mindfulness and relaxation therapy: Practicing mindfulness allows individuals to stay present and connected to their bodies, which can enhance arousal and desire. Techniques such as progressive muscle relaxation, guided imagery, and meditation can also reduce stress and improve overall emotional well-being.
• Sex therapy: Specialized sex therapists can work with individuals or couples to explore sexual issues and develop techniques to enhance desire and satisfaction. They can address physical aspects like pain during intercourse or low libido and provide education on managing symptoms and expectations.
• Couples counseling: This type of therapy helps partners navigate changes in intimacy and learn how to support each other. It offers a structured environment to discuss desires, fears, and the changes each partner is experiencing without judgment.

Perimenopause is a natural part of life, and while it comes with challenges, it’s also an opportunity to embrace self-care and prioritize your well-being. Remember that there’s also no such thing as “normal” when it comes to libido. It’s normal for your sexual desire to wax and wane, so low libido is only an issue if it’s causing you distress. If low libido is affecting your quality of life or your relationship, remember that you have options and support. 

FAQ

Do you lose your libido in perimenopause?

During perimenopause, it’s common for many people to notice changes in their libido, often due to shifts in hormones like estrogen, progesterone, and testosterone. These hormonal changes can bring about some physical discomfort, such as vaginal dryness, which might make intimacy a bit less enjoyable. On top of that, emotional factors like anxiety, stress, and mood swings can also influence desire. That said, everyone’s experience is unique. While some may feel a noticeable dip in their libido, others might find that it stays the same or even grows. As people become more in tune with their bodies and begin to prioritize different aspects of life, their sexual desire can shift in unexpected ways. It’s important to remember that stress, overall health, relationship dynamics, and self-esteem can all play significant roles in how someone feels during this time. If low libido becomes worrisome, seeking support through therapy or counseling can help in addressing the emotional and psychological aspects of it.