Lost Your Libido in Midlife? You’re Not Broken — and You’re Not Alone

Written By Ann Konkoly

Changes in Desire

If sex feels like the last thing on your to-do list lately, you’re not imagining it — and you’re definitely not alone.

Perimenopause and menopause bring more than hot flashes and sleep disruption. Many women notice changes in sexual desire, arousal, lubrication, and orgasm, often accompanied by frustration, guilt, or worry that something is “wrong.”

Here’s the truth:

Low desire is common in midlife — and it’s treatable.

One of the most studied causes is a condition called Hypoactive Sexual Desire Disorder (HSDD).

What Is HSDD (Low Sexual Desire)?

HSDD is diagnosed when low sexual desire is persistent, causes personal distress, and cannot be explained by another medical or psychological condition alone (Adebisi, 2024; Rowen, 2025).

So what does that mean?

  • This isn’t about how often you have sex

  • It’s about how you feel about your desire

  • And whether the change is bothering you

Research suggests that up to 25% of midlife women experience distressing sexual dysfunction, with low desire being the most common concern (Wang, 2025).

Why Desire Changes in Perimenopause & Menopause

Sexual desire isn’t a switch — it’s the result of multiple systems working together.

1. Hormonal shifts change how sex feels

As estrogen levels fluctuate and decline:

  • Vaginal tissue may become thinner, drier, and more sensitive

  • Lubrication decreases

  • Pain or irritation during sex becomes more common

When sex stops feeling good, the brain learns to avoid it — and desire naturally drops (Paschou et al., 2024; Simon, 2025).

2. Stress, sleep loss, and mental load matter

Midlife is often peak responsibility time: careers, caregiving, parenting, aging parents. Chronic stress and sleep disruption suppress sexual interest even in healthy relationships (Rowen, 2025).

3. Medications and health conditions play a role

Antidepressants, hormonal contraceptives, thyroid disorders, metabolic dysfunction, and mood changes can all contribute to low desire — which is why a thoughtful evaluation matters (Adebisi, 2024).

The Science: A Biopsychosocial Condition

According to the 5th International Consultation on Sexual Medicine (ICSM 2024), HSDD should always be approached through a biopsychosocial lens, meaning:

  • Biology (hormones, pain, medical factors)

  • Psychology (stress, mood, body image)

  • Social & relational context (communication, expectations, life stage)

There is no single cause — and no single fix (American Society for Sexual Medicine, 2025).

What an Evidence-Based Evaluation Looks Like

A comprehensive sexual health evaluation may include:

  • A detailed symptom and sexual history

  • Screening for vaginal dryness, pain, or vulvar conditions

  • Review of medications and mental health

  • Assessment of sleep, stress, and relationship factors

There is no “libido lab test.” Diagnosis is clinical and based on your experience and distress level (Rowen, 2025).

Treatment Options That Actually Help

Step 1: Make sex comfortable again

If dryness or pain is present, treating genitourinary symptoms of menopause is often the foundation. Desire rarely returns when sex hurts (Simon, 2025).

Step 2: Mind-body strategies that work

Cognitive-behavioral and mindfulness-based sex therapies have strong evidence for improving desire and sexual satisfaction by reducing anxiety, pressure, and avoidance patterns (Toledo et al., 2025).

Step 3: Medications — when appropriate

  • Flibanserin (Addyi®)

    • Originally approved for premenopausal women but has recently received expanded FDA approval for postmenopausal women under 65 who experience distressing low sexual desire.

    • A daily oral medication that works on brain neurotransmitters (serotonin, dopamine, and norepinephrine) involved in sexual desire.

    • Designed to increase sexual interest over time, not for immediate effect.

    • Benefits are modest, and side effects can include dizziness, nausea, and fatigue.

    • Originally approved for premenopausal women, but recently received expanded FDA approval for postmenopausal women under 65 who experience distressing low sexual desire.

  • Bremelanotide (Vyleesi®)

    • An as-needed injectable medication used before anticipated sexual activity.

    • Activates melanocortin receptors in the brain involved in sexual motivation and arousal.

    • May help increase sexual desire in the moment, though response varies and side effects (nausea, flushing, injection-site reactions) are common.

Step 4: Testosterone

For some women, low-dose testosterone therapy may improve desire when carefully prescribed and monitored. It is not appropriate for everyone and requires individualized risk–benefit discussion (Simon, 2025; Kling et al., 2025).

What This Means for You

If you’re noticing:

  • Loss of interest in sex that feels distressing

  • Avoidance of intimacy because it’s uncomfortable

  • A disconnect between how you want to feel and how your body responds

…you deserve real answers — not dismissal.

Sexual health is women’s health.

Key Takeaways

  • Low desire in midlife is common and not a personal failure

  • HSDD is a recognized medical condition with evidence-based treatments

  • Addressing pain, hormones, stress, and mindset together works best

  • Care should always be individualized and collaborative

Ready to Feel Like Yourself Again?

At Kultivate Women’s Health, sexual health is part of whole-body midlife care. We offer evidence-based, compassionate support for women navigating changes in desire, comfort, and confidence.

Book a visit at Kultivate Women’s Health today to explore whether hormone support, targeted therapies, or a comprehensive sexual health plan is right for you.

References

Adebisi, O. Y. (2024). Female sexual interest and arousal disorder. In StatPearls. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK603746/

American Society for Sexual Medicine. (2025). Evaluation and management of hypoactive sexual desire disorder in women: Recommendations from the 5th International Consultation on Sexual Medicine (ICSM 2024). Sexual Medicine Reviews. https://academic.oup.com/smr

Kamrul-Hasan, A. B. M., et al. (2024). Role of flibanserin in managing hypoactive sexual desire disorder. Medicine (Baltimore), 103(25), e38174. https://doi.org/10.1097/MD.0000000000038174

Kling, J. M., et al. (2025). Testosterone therapy for women: Clinical considerations and evidence. Menopause, 32(1), 12–22.

Paschou, S. A., et al. (2024). Sexual health and wellbeing in menopause. Maturitas, 176, 1–8. https://doi.org/10.1016/j.maturitas.2024.04.002

Rowen, T. S. (2025). Evaluation and management of hypoactive sexual desire disorder in women. The Journal of Sexual Medicine. https://pubmed.ncbi.nlm.nih.gov/41092352/

Simon, J. A. (2025). State of the art in menopause: Sexual health management. Climacteric. https://pubmed.ncbi.nlm.nih.gov/39928407/

Toledo, R. G., et al. (2025). Female sexual desire, arousal, and orgasmic dysfunctions: A systematic review. The Journal of Sexual Medicine, 22(3), 455–468.

Wang, Y. (2025). Sexual dysfunction in women at midlife: A cross-sectional study. Women’s Health, 21, 1745505724123456.

Ann Konkoly
Previous

Vaginal Estrogen vs Systemic Estrogen: What’s Local, What’s Not, and What Treats What
Next

GLP-1 Medications & HRT in Menopause: Is This a Winning Combo?