Medically reviewed by Dr. Tamara Neuhaus MD

Libido and Perimenopause - 4 Tips to Help Get Your Groove Back

It’s not that I miss sex. It’s that I miss missing sex! I miss feeling like a sexual being. -Wanda, 53

What is it?

You may actively not want to have sex (as in, I’d rather clean my bathroom grout than have sex with my partner). Or it just might not be on your radar anymore. Either way, there’s probably a whole lotta nothin’ goin’ on down south.

Why does it happen?

The same mechanism that suddenly turned your libido on in puberty, can start to shut it down in peri/menopause: hormones. In puberty, they were surging. In perimenopause, they’re slowing to a drizzle. Alternatively, your dwindling (or absent) sex drive could also be a reaction to other perimenopause symptoms that make sex unpleasant, like vaginal dryness (exactly what it sounds like) or prolapse (when the muscles in your pelvic floor cause your uterus or bladder to drop lower into your pelvis, where they’re more susceptible to the jousting and jostling of sex). The tricky bit is that it could also have nothing to do with your body, but everything to do with your feelings toward your sex partner. Or a bit of both. 

What can you do about it?

You have a few options here, depending on what caused your libido to take a hike. And 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,  Hormone Therapy (HRT), delivered systemically via pills, patches, or creams, can get at the root of the problem by replacing your lost hormones. Depending on whether you’re still having periods or have hit your 1-year anniversary of your last menstrual cycle, the form of HRT prescribed for you will be different. 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 will 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.

Other Medical Interventions

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. Your other option is to have surgery to secure the wayward organs back in place. So definitely start with physical therapy.


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


Interestingly, the less you have sex, the less you tend to want it. And the less comfortable it can become. Try masturbating regularly, either with your partner or solo, to get your body and mind back in the groove. It may also relieve the stress your lack of libido has caused, making you more relaxed and open to sex again. 

If you’re in the very early stages of perimenopause, there’s even more motivation to stay sexually active. 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!

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At The Cusp, we provide expert menopause care. We are a comprehensive, convenient virtual healthcare service dedicated to help you feel better.