What's actually happening.
A drop in libido during perimenopause and menopause has multiple contributors: declining oestrogen and testosterone, vaginal dryness making sex painful, sleep deprivation and fatigue, mood changes, and the wider emotional landscape of midlife. Treating it requires looking at the whole picture.
It is also one of the most under-discussed symptoms in primary care. Women report being told it is normal for your age, or that there is nothing to be done. That is not accurate. There is a lot that can be done, and a proper conversation is the starting point.
Common signs
- · Loss of spontaneous desire
- · Discomfort or pain during sex
- · Reduced response to physical intimacy
- · Loss of interest in closeness more generally
- · Concerns about impact on a partner relationship
How I approach this.
I take a careful history covering hormonal, physical, mental health, and relational factors. Where vaginal dryness or pain is contributing, vaginal oestrogen often makes a transformational difference within a few weeks.
For some women, optimised systemic HRT is enough. For others, testosterone is worth discussing. Testosterone in women is prescribed in the UK on a named-patient basis for low libido and requires careful monitoring; it is not a casual prescription.
Where the picture suggests a relational or mental health contribution, I am happy to discuss this and signpost onward to therapy if helpful. The aim is a plan that addresses what is actually happening, not just what is easy to prescribe.
Ready for a proper conversation about this?
A 45-minute menopause consultation includes full assessment, a written plan, and an HRT prescription if appropriate.