A lower libido is common in menopause. Approximately half of menopausal women experience it, and impaired sexual function more broadly affects up to 88%. These changes usually have a few different root causes, like vaginal dryness and mood changes.

Let’s explore the connection between menopause and low libido and unpack which treatment pathways your doctor might recommend.

‍

How does menopause affect libido?

Multiple factors can contribute to low libido. The first one worth looking at is declining testosterone. Testosterone impacts areas of the brain that help you experience sexual desire. As you age, the body naturally (and gradually) produces less of it. This can dysregulate and weaken its effects. 

Generally, declining testosterone isn’t the consequence of menopause. It’s usually an expected part of aging. But the impact may become more noticeable in menopause due to the cumulative effect of years of decline. 

Estrogen, which drops quickly in menopause, also affects your sex drive. Researchers think that estrogen may act on brain pathways involved in regulating sexual desire, but this link requires further research. 

Estrogen’s indirect effects are better established. Declining estrogen can cause genitourinary syndrome of menopause (GSM) and vasomotor symptoms (VMS), both of which indirectly affect libido in the following ways. 

Genitourinary syndrome of menopause

GSM represents a collection of genital, sexual, and urinary symptoms—largely driven by declining estrogen levels. That’s because an estrogen deficiency may cause tissues in your urinary and reproductive system to become fragile. 

The GSM symptoms that can indirectly contribute to low libido include vaginal dryness, painful sex, and urinary urgency. 

Vasomotor symptoms 

VMS includes hot flashes and night sweats. An estrogen deficiency can promote dysregulation in brain pathways involved in body temperature regulation. That’s why you may wake up in the night in cold sweats with no clear reason why. Since VMS disrupts sleep, low mood and energy can follow—both affecting libido. 

‍

Nonhormonal causes of low libido

Hormones only represent one part of the bigger picture. Different areas in life can affect libido, including: 

• Medications: Certain medications can reduce libido as a side effect. These include some antidepressant medications like SNRIs and SSRIs. 
• Relational factors: Conflicts with your partner can take a toll on your libido. Couples’ therapy can make a meaningful difference. 
• Illness: Living with emotional or physical pain can naturally affect your desire for intimacy. 
• Caregiving responsibilities: Caring for aging family members demands time and energy. This can leave little room for much else, including intimacy. 

Have an open conversation with your doctor. The more they understand about what you’re navigating, the better they can support you.

‍

Treating low libido in menopause: Key interventions 

Care plans for treating low libido may involve more than one intervention, depending on the root cause. Counselling, lifestyle adjustments, and certain medications can each play a role. 

Counselling 

Your doctor may recommend speaking with a professional who specializes in cognitive behavioral therapy (CBT). This is an evidence-based psychotherapeutic method that helps identify and change unhelpful thoughts and behaviors. 

In a 2025 study from McMaster University, researchers found that CBT provided benefits for the following menopause symptoms: 

• Sexual functioning (including libido)
• Body image
• Relationship satisfaction
• Hot flashes

Couples therapy can be a useful tool, too. Simply speaking with a neutral, trained professional can make what you’re navigating feel a bit less heavy. 

Exercise

Movement can make a noticeable difference. In a 2016 study published in the Iranian Red Crescent Medical Journal, frequent exercise improved vaginal lubrication and orgasmic function. It was also linked to lower odds of reduced libido. 

There are a few reasons for this. One is that exercise may increase sympathetic activity, a system that plays a key role in sexual function. Exercise may also increase endorphin production, chemicals that promote feelings of well-being (also linked to sexual function). 

Medications

Medication is a good option for many women experiencing physical symptoms that lower libido. Prasterone, a vaginal insert that helps restore vaginal tissue health, is FDA-approved for moderate-to-severe dyspareunia (painful sex). Ospemifene is an oral tablet with estrogen-like effects on vaginal tissue, and it’s also FDA-approved for moderate-to-severe dyspareunia and vaginal dryness. 

Your care team may also consider hormone replacement therapy (HRT), a front-line menopause intervention. It works by supplementing the hormones that decline in menopause. In a 2023 article published in the journal Menopause, HRT contributed to a modest improvement in sexual function. But its key benefits may be indirect. 

For example, by helping relieve GSM symptoms, HRT may indirectly support libido. The 2017 REJOICE trial found that HRT:

• Eased dyspareunia
• Restored vaginal tissue cells
• Improved vaginal dryness

These benefits largely stem from estrogen, which is a common active ingredient in HRT formulations. Some HRT regimens can include testosterone. In a 2019 article published in The Lancet Diabetes & Endocrinology, researchers described how testosterone supplementation also meaningfully supported libido.

‍

When should you see a specialist?

There’s no threshold you need to meet to get help. If you’re navigating low libido (regardless of severity or cause), have a conversation with your doctor. The sooner you ask about your options, the faster your care team can help you find relief. 

‍

Experience personalized hormone care with Maven Clinic

Low libido can stem from multiple symptoms and lifestyle changes. At Maven Clinic, we identify the root cause, building care plans around what you actually need—not what’s easiest to prescribe. 

Our patient, Debbie, wrote: "I started using Maven because I was looking for answers and support during perimenopause. What stood out immediately was how understood I felt. The providers didn't dismiss my symptoms. They helped me make sense of the changes happening in my body and gave me practical, personalized support."

This personalized approach is why millions of women trust Maven Clinic with their care. Learn more about Maven Clinic.