Why Has My Libido Changed? Understanding Low Sexual Desire in Midlife Women
Hormonal Changes, Vaginal Dryness, and Other Causes of Low Libido in Midlife Women
With Valentine's day approaching, if you're a midlife woman who doesn’t feel interested in intimacy when you previously did, there may be a hormonal reason for that.
Sexual dysfunction is the term used for distress caused by sexual concerns. The key is distress. If you aren't sexually active or interested in intercourse and that's not bothersome to you, that is not dysfunction. Distress is a required criteria of dysfunction.
There can be many reasons for sexual dysfunction, including interpersonal and social factors, here we will focus on hormonal causes.
Patients often report the following symptoms:
• Low libido (even women who have never experienced this)
• Vaginal dryness
• Painful intercourse (often due to vaginal dryness)
• Difficulty having orgasm
The Hormonal Changes That Affect Libido in Midlife
With menopause comes a decline in our most potent estrogen, estradiol (E2). Testosterone also decreases, though not on the same scale.
While typically considered a "male hormone”, testosterone is crucial to the sexual function of women, though our levels differ from males. It's responsible for interest and arousal.
Estrogen helps vaginal lubrication and sexual responsiveness.
High levels of cortisol, our stress hormone, can decrease sexual interest.
Vaginal Dryness & Genitourinary Syndrome of Menopause
The decline in estrogen affects vaginal and vulvar tissues by decreasing tissue elasticity, collagen, and moisture.
This means the skin down there becomes thinner, more dry and inflexible, often leading to discomfort.
Medications That Can Decrease Libido
Medications can also contribute to low libido. These include but aren’t limited to:
• Birth control pills
• SSRI (anti-depressant and anti-anxiety medications)
• GnRH antagonists like Lupin or Orilissa
Others are less studied in women.
Why can birth control pills decrease libido?
Birth control pills increase Sex Hormone Binding Globulin (SHBG), which binds up testosterone. Testosterone is a hormone that can float around freely, which is hormonally active, or bound which is inactive. With more testosterone bound and therefore inactive, it can decrease sexual interest for some people.
What Helps: Evidence-Based Treatment Options
Testosterone
While there isn't an FDA-approved testosterone product for women, this is evidence-based for hypoactive sexual desire disorder
Women with HSDD taking testosterone have shown improved:
Libido
Arousal
Orgasm
Satisfying events
Non-hormonal moisturizers
Ingredients matter, just like our other self-care and hygiene products
Organic, paraben-free, water-based options can be found here
Another great option is HyaloGYN found here (Use code RELIEF2025 for $5 off)
Vaginal Estrogen
This needs prescribed and can be pill, cream, ointment, or ring
It delivers estrogen directly to the vaginal tissues, though some can increase systemic levels of estrogen (levels throughout the body)
This is overall a great option, but it's important to talk with a doctor/menopause specialist
Vaginal DHEA
DHEA is a hormone that gets turned into other hormones: testosterone and estrogen in our tissues
Addyi
This was recently FDA-approved for post-menopausal women (previously only pre-menopausal women)
This is a non-hormonal medication to be taken daily that can increase satisfying events
Vyleesi
This is another non-hormonal option to increase libido that comes as an injection to be used prior to intercourse
Explore Non-Toxic & Hormone-Friendly Intimate Care
Struggling with vaginal dryness, low libido, or discomfort during intimacy? Discover our Non-Toxic & Hormone-Friendly Intimate Care collection—carefully curated for midlife women. From gentle lubricants to soothing moisturizers, every product is crafted to support comfort, wellness, and pleasure, without harmful chemicals.
Opt-in now to get exclusive access, tips, and product recommendations for maintaining intimacy and confidence at any age.
Resources:
https://menopause.org/wp-content/uploads/for-women/Menonote-Menopause-and-Sexual-Function.pdf
https://www.goodrx.com/drugs/side-effects/these-drugs-may-be-affecting-your-sex-life?srsltid=AfmBOoqe9zRP5r_S3YZ5VeTYMrUJe4y4ZtzcQawWODoj8ycnET5GKw7E
https://chicagoobgyn.com/libido-and-hormonal-changes-understanding-and-managing-changes-in-sexual-desire/