Better Sex in Peri/menopause? Yes Please.

Medically reviewed by Dr. Louann Brizendine MD

Remember sex? You know, that thing that used to feel so amazing? The thing you used to look forward to? Make time for? Get caught doing in unexpected places?

Yeah, that was some good stuff. What happened to it?

Like so many things in your life lately, peri/menopause came along and put its hormone-deprived stamp on it. Now for some, this stamp comes in a unicorns-and-rainbows design. Especially for those not currently in a relationship. Less interest in sex can free up your thoughts and energies for other passions. It can dissolve sexual tensions that used to muddy up work or social situations. It can wash away insecurities and replace them with unprecedented self-confidence. Plus, it’s nice not to have to change the sheets so often.

“I never realized how much of my behavior and self-image were kind of held hostage by my desire to be desired. Once menopause made sex unimportant to me, all of my interactions with men became much easier and more relaxed.” - Shelly 56

For others, the stamp is more of a cactus-in-a-desert motif. Prickly, arid, and maybe a little lonely. If you’re in a relationship now and your libido has deserted you, feelings of frustration, depression, guilt, insecurity, shame, or resentment may surface. Not to mention physical pain.

“I love my partner and miss our playfulness and intimacy. Sex was always so great for us. But now I absolutely dread it. At best, it’s unsatisfying. At worst, it’s excruciating. What if he gets tired of me saying ‘no?’” - Michelle, 49

No matter how you view your loss of libido, there are plenty of reasons to fire up the ol’ sex drive in peri/menopause. And there are a lot of ways to get your heart and vagina back in the swing, either with your partner(s) or on your own. More on this in a bit. But first...

What’s Going On Down There?

The same phenomenon that suddenly turned your libido on in puberty, can start to shut it down in perimenopause: hormones. In puberty, they were surging. In perimenopause, they’re slowing to a drizzle. At the same time, some other perimenopause symptoms can make sex unpleasant, like vaginal dryness or thinning of the vaginal tissues. Or prolapse, which is when the muscles in your pelvic floor cause your uterus or bladder to drop lower into your pelvis. So they’re more susceptible to the jousting and jostling of sex. Poor sleep caused by night sweats or multiple midnight potty runs can leave you feeling too fatigued for sex. And mood changes can sap your motivation for just about anything, and especially a roll in the hay.

“I just don’t feel sexy or desirable any more. But that may be more a function of having put on weight. I used to be an insatiable sex queen, but she has been de throned. I can be cajoled, but it takes being nice to me for a couple of days, lots of preparation, foreplay, and a special toy to get the happy button to work.” - Tonya, 54

The tricky bit is that your dwindling (or absent) sex drive could actually have nothing to do with your body, but everything to do with your feelings toward your sex partner. Some say the brain is a woman’s most important erogenous zone. If your brain’s not in it, your vagina probably won’t be, either.

There aren’t studies that describe what “normal sexual functioning” should be as women age. (Are we surprised? No, we are not.) It might make some sense, anthropologically, that we start to lose interest in sex as we exit our childbearing years. But we all know there’s more to sex than conception. And there’s no reason we should be denied that pleasure just because we’re not pumping out a baby 9 months down the road. And there’s one big one reason why we should keep grabbing all the pleasure we can: regular vaginal sexual activity helps keep those tissues thick and moist, and maintains the vagina’s length and width. Who knew sex was so good for us?

For those of us in the very early stages of perimenopause, there’s even more motivation. Some researchers in England are seeing a link between infrequent sex and early menopause, though their findings are still inconclusive. It could be a chicken-and-egg thing: are women having more sex because they still have hormones, or do they still have hormones because they’re having more sex? But if it does turn out you can trick your ovaries into pumping out estrogen longer by having more frequent orgasms, we say, by all means, have the orgasms!

How To Get Your Groove Back

The good news is that there are several ways to jump-start your libido, depending on what caused it to take a hike in the first place. You may have to try a few of them before figuring out the cause and its best treatment.

Hormone Therapy

If you’re not experiencing any pain during sex, and you absolutely adore your sex partner, replacing estrogen and progesterone via Hormone Therapy (HRT) can get at the root of the problem. Depending on whether you’re still having periods or have hit the 1-year anniversary of your last menstrual cycle, the form of HRT prescribed for you will be different (e.g.: pills, patches, or creams). But prudently prescribed, HRT is a great option for women who have no history of breast cancer or blood clots.

If sex is painful due to vaginal dryness, estrogen delivered locally to your vagina via a tiny pill, cream, or ring can put that complaint to bed. It should have you feeling supple and dewy again in a couple of weeks. This form of HRT is safe for just about any woman, regardless of breast cancer or blood clot history. It can help increase tone and elasticity of the tissues in your urinary tract, easing mild stress incontinence.

Recently, some studies have shown that low-dose testosterone therapy can be helpful for women who are post-menopause and have hypoactive sexual desire disorder (HSDD). This is characterized by a persistent lack of sexual fantasies and desire for sex that causes distress to a woman or her partner. A statement published in The Journal of Clinical Endocrinology & Metabolism recommends treating HSDD with testosterone in the form of topical creams and gels for the right women. Other forms (injectables, pellets) can deliver too much testosterone and cause irreversible side effects like hair loss, facial hair growth, and a deepening voice. At The Cusp, we recommend first ruling out other causes and treatments for low libido before considering testosterone therapy.

Other Medical Interventions

Two other prescription meds are available that treat HSDD: One is called Addyi, a pill you take daily to stimulate the parts of your brain that control sexual desire. The other is called Vyleesi. This is an injection you can give yourself 45 minutes prior to sex.

If you’re feeling pain deeper inside you during sex, this could be an indication of prolapse. There are some exercises that you can do to strengthen these muscles. We recommend working with a gynecologic physical therapist to learn to do them the right way. Doing them the wrong way could make matters worse. Another option is to have surgery to secure the wayward organs back in place. So definitely start with physical therapy.

You can also treat sleep-depriving night sweats with very low doses of prescription drugs like Gabapentin or SSRIs (e.g.: Paxil, Prozac, Zoloft, Celexa, etc.).

Botanical Treatments

There is some evidence that ginkgo biloba and maca may improve female libido. We always recommend speaking with your doctor before adding a botanical supplement, to rule out any adverse interactions.


If your feelings toward your sex partner are impacting your libido, speaking with a marriage and family therapist and/or sex therapist could help you both get to a better place emotionally and sexually.

Lifestyle Adjustments

Regular exercise can actually solve for some of this. It can lift your mood, make you sleep better and help with weight management. On average, women gain 1.5 pounds per year in midlife. As it adds up, your self-image and self-confidence can take a hit, and so can your enthusiasm for sex. Taking back control of your body can help make you feel sexy again. For more weight management tips, read our article, How To Lose The Meno 10.

Non-medical interventions

There are some great toys and lubricants out there that can help push your “happy button.” You have to experiment to find the ones that work best for you. But some of our favorites are The Womanizer which allows you or someone of your choosing to stimulate your clitoris…without direct contact! And two THC-based lubes: Foria Pleasure and Quim Night Moves Intimate Oil. One important note about the lubes: they need time to activate, so you have to apply them about 20 minutes before business time.

Future Interventions 

Emerging studies are showing that treatments with radio frequency, light, and laser devices may help improve the tone and elasticity of vaginal tissues. We’re eagerly awaiting FDA approval of this exciting technology for these indications. 

The last thing we want any of our readers to think is that women owe anybody sex, at any point in our lives. Sex is something that we believe is best when shared with mutual enthusiasm and enjoyment. Our aim with this article is to help women regain that enthusiasm and enjoyment if they’re missing it. And to inspire those who don’t miss it to at least consider some regular, therapeutic self-love. Because you just never know when that spark might be reignited.

About Us

The Cusp provides personalized menopause care. Our doctors have deep expertise and a broad treatment toolkit, offering natural and medical therapies to help you feel better.