Menopause Libido, HRT And Sex Drive

increased sex drive in perimenopause
From the sex surge of the pre-perimenopause years to the libido lows of menopause, take a closer look at your patterns of desire.

I recently turned 44 and the small signs of perimenopause changes in my body are becoming increasingly obvious. I was expecting many of them, but one thing I wasn’t expecting: an increased sex drive in perimenopause. When it came to menopause libido, I was prepared for a loss of libido rather than an increased interest in sex.

Does menopause affect libido was something I had wondered. Yes, but not in the ways I thought it would.

The symptoms I was expecting are predictable enough. My PMS and mood swings, which were previously manageable by eating chocolate (and keeping my online comments to myself), have increased in intensity and length. My menstrual cycles are changing and my hair is not growing back as quickly as in the past. And my most intense sexual desire is no longer near ovulation, as it once was. Now, it’s closer to the end of my cycle.

READ MORE What are the 34 menopause symptoms?

Many of these are symptoms that we already associate with perimenopause and peri-perimenopause (the years before perimenopause where we may have hormonal changes but they are almost unnoticeable). There’s also the anger, the changes to our cycle and the shifts in how we see ourself and the world.

Loss of libido was something that the Hylda medical experts write about – and I was waiting for it, but no sign so far.

Does menopause cause low libido?

“If you’ve noticed that your sex drive isn’t what it was, please don’t worry, as you’re not alone – it’s something we hear a lot,” says the team at My Menopause Centre, Hylda’s women’s health partner. “The truth is that most women (and indeed men) have less desire to have sex as they get older.

“In a survey by the British Menopause Society, over a third of the women interviewed reported a loss of sex drive but fewer than a third sought help even though it’s something that can cause distress and unhappiness.

“Oestrogen levels play a big role in female sex drive. The natural loss of oestrogen during menopause affects mood and energy levels and our libido too. The physical effects of falling oestrogen levels, like hot flushes and night sweats, and vaginal dryness, can also have an adverse effect on your sex life. Testosterone may also be a factor in women as well as men.”

READ MORE How to have an orgasm after menopause.

How do you treat loss of libido in menopause? 

The My Menopause Centre team has some suggestions of things that you can try: 

  • Lubricants and vaginal moisturisers – non-scented, water-based lubricants are best. Lubricants for menopause can be oil-, water- or silicone-based. The oil-based ones can be better, as they last longer, but watch out if you use condoms for contraception as the oil can make them less effective.
  • Vibrators – they can work wonders and can be ordered from the privacy of home. The extra sensation can help orgasm, either with your partner or by yourself. You’ll find a good selection of vibrators here.
  • Masturbation – don’t put pressure on yourself (any kind of pressure is a killer to sex drive), but a little self-pleasure can make you feel good and help you relax.

READ MORE How to book a private menopause appointment.

My unexpected libido boost

I had heard about all of the above, but there was one thing I wasn’t prepared for because I’d never heard of it: A surge in my menopause libido in the peri-perimenopause phase. I’m talking about a libido so high I felt like stereotypical 20 year-old man, looking to have sex with anyone I found attractive, at any time. I called it the ‘Sex Surge®’ because it felt very much like an electrical surge, a sudden burst of sexual energy in my system that sometimes threatened to blow my circuits. Ringing any bells with anyone?

Increased sex drive in perimenopause

I understand that the desire for a lot of sex sounds like something crazy when we’re talking about perimenopause, but it does happen.

For some women, there is a slight shift upwards in testosterone, to the point that they want sex much more frequently than they have in the past. For me, this first started around ovulation. I wanted sex 10 times more than I ever had before, but only around ovulation.

READ MORE All about better sex and the menopause.

Over time though, my libido grew to be a constant factor in my life. At the most intense point, I would wake up, have about three minutes of peace, and then begin thinking about and desiring sex until I went to sleep at the end of the day. It was exciting – in many ways I really enjoyed thinking and feeling sexy things all day long – but it was also exhausting.

As I began to write on my blog, about this new level of libido at midlife, 100s of women emailed me with similar stories. So many were afraid something was wrong with them, or that they had a brain tumour (which speaks to how different this level of libido can make a woman feel; she feels so different about herself and her behaviour that she’s worried she has a brain tumour).

Most women spoke of how this phase has helped them feel great; confident, sexy, creative, focused, driven. These are the neuro-chemical gifts of testosterone. Many women also discussed the difficulties of having a high sex drive; partners who can’t keep up or refuse them outright, their desire for extra-marital affairs, how the highly-distractive sexual thoughts made it hard to work, feeling like their body was sexually on fire and not knowing how to deal with it.

Most of all, women described not having safe places to talk about these symptoms and be believed, a frustration shared by so many midlife women.

The Sex Surge is personal

Over the last eight years I have researched the Sex Surge and listened to many women and their stories of increased sex drive in perimenopause.

What I know is that each woman has to walk the path of the Sex Surge in her own way. For some this means big changes in their lives; getting divorced, trying an open marriage, performing in burlesque shows, living on their own for a while. For others, it has meant small changes; increasing the frequency of sex in their already happy relationship, wearing sexier clothes on a daily basis, flirting with the local barista a bit more.

Exploring the energy and finding ways to express it are key to handling the Sex Surge well, but what that looks like is unique to each woman, her life, and her needs.

Like any hormonal phase, the Sex Surge does come to an end. For most women it ends with small hormonal shifts that are steps on the path to perimenopause: the circuitry quietly returns to its normal supply.

READ MORE Menopause, sex drive – and dating tips!

In rare cases, the end of the Sex Surge is as if someone shut off the power entirely; confidence, libido, and a sense of self crash into the dark. Most women report relief when the Sex Surge ends, even if it was great fun or allowed them to choose an amazing new life for themselves. They are glad to not think about or desire sex all the time.

The Sex Surge is not something that happens to every woman, but it is an important and life-changing phase for those who experience it. It is my hope that, with greater awareness, the Sex Surge will be considered a normal aspect of the peri-perimenopause phase and women will no longer feel afraid or alone when they find themselves in the midst of it.

Can HRT help with libido?

So what about those women who have experienced a drop in libido around perimenopause and menopause?

“Firstly, don’t be embarrassed about talking to your doctor,” says Dr Goodwin. “They see these kinds of problems frequently, understand their impact and can advise on the many forms of available treatment from HRT to vaginal estrogen and other lubricants which is available in many forms.”

For many women, hormone replacement therapy can help. Declining levels of oestrogen and testosterone can affect a woman’s sexual desire. “Testosterone deficiency affects a lot of women after the menopause,” confirms Dr Goodwin. “Testosterone Replacement Therapy can be very helpful for women who have got lack of libido as part of their menopausal symptoms.”

READ MORE Here’s what you need to know about testosterone for women.

How long does HRT take to increase libido?

So what about those women who have experienced a drop in libido around perimenopause and menopause?

Hormonal Replacement Therapy isn’t just good for hot flushes, it can help improve your sex drive too,” says the My Menopause Centre team. “There is also evidence that testosterone helps some women with desire and arousal. Unfortunately, there is no licensed testosterone preparation specifically for women in the UK, but tiny amounts of male testosterone can be prescribed.”

READ MORE Read more about My Menopause Centre and how to book a private menopause specialist appointment here.


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