What Happened to My Sex Drive?

04/18/2023 | 6 min. read

Written by:

Picture a comic of a couple in bed with a text bubble above the woman that says, “Not tonight, dear. That’s why they call it MEN-O-PAUSE.”

I often include this comic in my talks, and it always gets a laugh, especially from women who have been or are going through the perimenopausal/menopausal transition. Although you can experience a drop in your libido at any age, menopause is a time of life when many women report that their sex drive dramatically decreases.

If you’ve lost that lovin’ feeling, let’s look at the reasons why—and what you can do to bring it back.

Hormones and Women’s Sex Drive

Hormones play an essential role in libido, and natural fluctuations in two hormones have a profound effect on sexual desire:

  • Testosterone may be the quintessential male hormone, but it affects sexual desire in women as well as men. Your ovaries produce testosterone, along with estrogen and progesterone. Testosterone levels peak around age 20. You may long for the sex drive of your 20s, but as testosterone levels decline with age, libido often declines as well.
  • Estrogen also facilitates your sex drive. Have you ever noticed desire and arousal increasing around ovulation? This is when your estrogen level is at its highest.

If you have been pregnant, you may have noted an increase in your sex drive, most often in the second trimester after morning sickness subsides and before the weight of the being growing inside you creates too much discomfort. This, too, is thanks to the estrogen surge that occurs during pregnancy. Conversely, libido often tanks postpartum due to the sudden drop in estrogen, among other factors.

Perimenopause, Menopause, and Decreased Sex Drive in Women

As you enter perimenopause and head into menopause, ovarian production of estrogen starts to diminish and eventually stops. And when age-related declines in testosterone compound this rapid drop-off of estrogen, low sex drive may be all the more evident.

Other symptoms of the menopausal transition can also negatively impact your desire for sex:

  • Vaginal dryness and thinning can lead to decreased lubrication and pain during sex, which obviously has a negative effect on your sex drive.
  • Hot flashes and night sweats interfere with sleep and can literally leave you too tired for sex.
  • Weight gain can make you uncomfortable with your changing body and less desirous of sex.
  • Depression, anxiety, irritability, and mood swings, which are common during this time, affect your interest in sex.

No wonder your libido may be at an all-time low! Although supporting your hormones during this phase of life is important, it is only a piece of your unique arousal puzzle.

What Else Causes Low Sex Drive in Women?

Women’s sex drive is complex and variable. Some women, for example, have a lusty libido while others’ is naturally low. Additional factors also come into play.

Midlife is a time when a woman’s “inner superhero”—balancing work, kids, household demands, etc.—may finally refuse to keep up such an unsustainable pace. In this chronically stressed, exhausted state, the body’s last priority is procreation, so the hormones that facilitate sexual desire often tank.

Certain medications have a dampening effect on libido. SSRIs, the most popular type of antidepressants, may not only reduce interest in sex but also impair arousal and orgasm. Other potentially problematic drugs include benzodiazepines (prescribed for anxiety) and beta blockers (for heart conditions). Illness obviously takes a toll as well.

The health of a sexual relationship often impacts desire, especially for women who need to feel safe, supported, and emotionally intimate. As relationships evolve over time, it takes effort and focus to prioritize communication and to connect and experience intimacy in new ways.

It is also important to recognize that arousal and sexual response change over time. Women’s sex drive isn’t typically as visually enhanced as men’s. A sexy photo doesn’t do the same trick to get us in the mood, nor does simply increasing blood flow to the sexual organs with the help of a little blue pill.

Help for Finding a Lost Sex Drive

If you feel like you’ve lost your sex drive, don’t despair. Let’s look at what you can do to find it again?

Herbal Therapies:

Whether it’s hot flashes, night sweats, sleep problems, mood swings, vaginal dryness, or other menopausal symptoms that are depressing your sex drive, a handful of herbal therapies can help.

  • Ashwagandha is classified as an adaptogen because it helps you adapt to the adverse effects of stress. It has also been shown to improve mood, sleep, and a range of menopausal symptoms. In a recent clinical trial, women who took 600 mg of KSM-66 ashwagandha extract daily had significant reductions in the Menopause Rating Scale (MRS), which measures the severity of symptoms and their impact on quality of life.
  • Fenugreek is another proven herbal therapy that addresses multiple symptoms of menopause. Studies reveal that a daily dose of 500 mg of a proprietary extract resulted in remarkable improvements in the MRS, including vaginal dryness, hot flashes, night sweats, irritability, and more.
  • Black cohosh has an old and solid reputation as a traditional remedy for female disorders. More recently, clinical trials have found a four-fold decrease in hot flashes with this herbal supplement. The suggested daily dose is 100 mg.

Bioidentical Hormones:

Hormone replacement therapy is an option for some women. Estrogen and progesterone helps relieve the entire gamut of menopausal symptoms, including reduced libido, and small doses of testosterone can also boost sex drive. If vaginal dryness and thinning are the main problem, topical estrogen creams or vaginal rings are available. Just make sure to request bioidentical hormones.


No matter what your stage of life, a whole-foods diet, regular exercise, rejuvenating sleep, avoidance of hormone-disrupting toxins, stress management, and a basic daily supplement program are essential for good health. You may not realize it, but a healthy lifestyle also helps balance your hormones.


If loss of interest in sex during menopause or at any other time is a problem, it’s important to communicate with your partner. Couples need to really look at the relationship and address any lack of connection as not just “her issue” but “their issue.” Don’t hesitate to talk to your healthcare provider or a therapist if you can’t work it out on your own.

In Summary

Women’s sex drive is based on an interplay of hormonal, physical, and emotional variables. I like to believe it is because we are incredibly beautiful and complex works of art and all our layers need to be addressed, like the intricate petals of a rose.

As you can see, there are many potential contributors to decreased sexual desire. The good news is that virtually all of them can be addressed.

This may require trying supportive herbs such as ashwagandha, fenugreek, and black cohosh; working with your doctor to find hormonal solutions or rule out underlying problems; taking stock of your physical, mental, and emotional health; and/or communicating with your partner to create and nurture intimacy.

It may take some time and effort to rekindle that spark, but intimacy is a cornerstone of a close and connected relationship. Your efforts will be appreciated.

Dr. Briana Sinatra

Meet Dr. Briana Sinatra

Dr. Briana Sinatra is a board-certified naturopathic doctor with a vibrant practice in the Pacific Northwest. There she focuses on women’s and family health, taking a holistic approach to healthcare by empowering women with the knowledge and tools they need to live their best life now and protect their future wellness by looking at how all the systems in the body work together and how diet, lifestyle, and environment all influence health.

More About Dr. Briana Sinatra