35 Symptoms of Perimenopause: Loss of Libido

by Magnolia on January 11, 2010

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As if perimenopause doesn’t cause enough grief, it can also kill your sex drive. It seems awfully cruel too, especially if you’ve enjoyed a healthy and satisfying sex life until then.

I remember panicking when I realized that my desire for sex would diminish – or at least, that’s what I was expecting to happen.  I had heard this happened to women during menopause, and I wasn’t particularly thrilled about it either.

I am happy to report though, that it doesn’t have to be a long term and permanent condition. For me, it never completely went away, but it did diminish considerably. However, like most everything during menopause, sexuality and libido may require a redefinition for the years to come.

Chances are, if you had a low sex drive before perimenopause, you probably won’t suddenly develop a higher one during perimenopause. In addition, if you also had difficulties in your relationships with sex prior to perimenopause, chances are those difficulties will not only remain, but perhaps even worsen.

I hate to be the bearer of bad news, ladies.  But, unfortunately, perimenopause is not known to solve problems.  In fact, it usually exacerbates them.

Hormonal Causes

One of the primary reasons for loss of libido in women during perimenopause is a drop in progesterone, which is linked to ovulation.  Most women, barring any physical issues, experience a surge in sexual desire around the time of ovulation because of a rise in progesterone.

However, during perimenopause, ovulation is not consistent. In fact, anovulatory cycles (cycles where you experience blood loss but no ovulation) are one of the hallmarks of perimenopause. So, it doesn’t take rocket science to make the connection: No ovulation.  No rising progesterone levels.  Diminished sexual desire and libido.

Estrogen also plays an important role in our sexual function. Without healthy estrogen levels women often experience vaginal dryness, thinning of vaginal walls, and vaginal atrophy; all of which can make vaginal intercourse very painful.  And let’s face it.  Who wants sex when it’s painful?

Estrogen is also necessary for normal sexual response and orgasm. So, in addition to vaginal dryness, atrophy, and the thinning of vaginal walls, the ability to physically respond and reach actual orgasm can also be significantly diminished as well.

In addition to fluctuating estrogen and progesterone levels, a woman’s testosterone levels  can become imbalanced as well during perimenopause.  Given that testosterone has a powerful influence in one’s sex drive, any drop in testosterone can have a certain negative affect on libido.

Emotional Causes

Sexual response in women is far more complicated than a simple physical response. If we are having a bad day, if we are tired, depressed, or coping with mood swings during perimenopause, it is very unlikely we are going to be “in the mood” for sex.

Taking into consideration all of the components which make up a woman’s sexual response, and how easily it can become disrupted, it’s enough to make most women want to throw in the towel.  But, don’t.  If you’re not ready to give up your sex life, you don’t have to. There really are plenty of things you can do.

Bioidentical Hormones

One very obvious solution for a lagging libido is to put back that which is lost.  Re-balancing estrogen and progesterone levels can help restore sexual desire and response.

Since the release of the Women’s Health Initiative study in 2001, the debate about hormone replacement therapy and the safety of it has taken many twists and turns.  In 2012, many physicians are giving synthetic hormone therapy new consideration and are beginning prescribe it again for perimenopausal women.

While I cannot offer a medical opinion on the matter, I can give you my personal opinion based on my own research and study, and that is, I believe bioidentical hormones are a healthier solution to hormone imbalance than synthetic hormones.

I am not alone in my opinion either, as many physicians prefer prescribing bioidenticals as well.  Of course, the choice is ultimately yours, but if you are looking for suggestions, bioidentical hormones would be it.

Testosterone Therapy

According to a  Mayo Clinic article, there have not been enough studies done on the benefits of testosterone therapy for perimenopausal and menopausal women, for there to be a consensus among physicians as to it’s usefulness.

However, there have also been studies which suggest testosterone is the missing link in hormone therapy, and that women who have testosterone as a part of their “hormonal cocktail” if you will, not only tolerate additional estrogen and progesterone during hormone therapy better, but they also experience a surge in sexual desire and overall feelings of well being.

I have personally used testosterone pellets (you can read a post I wrote about it here) and I can tell you with absolute certainty that it increased my sex drive considerably. Testosterone is also a substrate for the production of estrogen in your body.

Many physicians believe that testosterone therapy alone is all that is needed to help balance hormones during perimenopause. It is a therapy which is gaining traction as more studies are being done.  So it might be worth your while to inquire about it with your physician.

Personal Lubricants

In a previous post, I addressed dietary changes which help increase vaginal moisture.  You can find that article here.

Personal lubricants are quite helpful as well. Fortunately, there are plenty to choose from.  K-Y, which has long held a solid position in the personal lubricant market, has a product called K-Y Intense Arousal Gel For Her.

I have not personally used it, but from what I’ve read, the results are good.  It not only provides much needed lubrication, but is said to enhance orgasm as well.  Another popular choice is Durex Play Utopia Female Arousal Gel.

Sex or No Sex:  It’s a Personal Decision

Though I do not want to say that sex is not necessary, the truth is, many couples find that they can redefine their relationship to include other types of emotional bonding and intimacy, and are quite content without sex or with less sex. If both parties are happy with the arrangement, then there really is no right or wrong way to approach it.

However, if you wish to continue in a healthy sexual relationship, there is no reason that you shouldn’t. It may require a little more effort, but it can certainly be done.

By the time women reach menopause, most of us have figured out that we no longer seek the approval of others for our life choices.  Our sexual health and well-being should certainly be no exception.  So decide what works for you in your marriage, and be well.

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{ 18 comments… read them below or add one }

PaulaS January 11, 2010 at 10:48 am

Yes, I agree that the the loss of our sex drive is a difficult pill to swallow in addition to all the other things that happen to us as we age. I know a few ladies who have tried bio-identical hormones and one had a lot of success with them and the other one didn’t really feel like it made much difference so I guess we are all different when it comes to our body’s responses. This is a great article.


Magnolia January 11, 2010 at 11:07 am

Hello Paula,

thank you for stopping by. I agree. We are all very different which makes for difficulties when trying to help women with perimenopause symptoms. What works splendidly for one, barely makes a dent for someone else.

To me, this is what made it all so frustrating for me. I wanted answers and it seemed it was just a hit and miss game with supplements, hormones and the like.

Thankfully though, I’ve survived thus far and it looks like better days are ahead.

Thanks again for commenting.



DeAnn February 15, 2011 at 7:25 pm

I just visited the MD last week for a complete hormonal makeover. I had a partial hysterectomy 2 yrs ago (ovaries intact, everything else gone) and in the last 8 months thought I was going crazy… all the symptoms of this perimenapause monster are showing up, especially the lack in libido. I am almost 45 and know something is wrong, but didn’t know what to do. My husband also has noticed, but keeps to himself rather than face my rage and fustration. The MD has suggested testosterone injections, seems scary to me, but I’m willing to try almost anything. Any thoughts or stories of succes with the injections?


Magnolia February 18, 2011 at 12:22 pm

Hello DeAnn,

I’m sorry for taking so long to get back to your questions. I’ve known some women who have used testosterone suppositories and creams with roaring success. :)

However, I have not known anyone nor do I have any knowledge on the safety or success of injections.

I would be a bit concerned too. Anytime we put hormones in our body we are playing hormone roulette. You just never know how your body is going to respond.

I would strongly suggest you educate yourself and maybe do some searches on bioidentical testosterone. You can check out both Dr. Hotze and Dr. Ericka Schwartz for information on the web if you are interestedl There sites can be located at:


Please let me know if I can help you with anything else.



DeAnna April 13, 2011 at 12:43 pm

Does the fact that a woman has had a complete hysterectomy have any barring the symptoms a woman can experience during menopause? If so can it explain why I have No desire for sex at all, and don’t think about it, unless I see it on T.V., or it comes up in a conversation? I also have some serious mood swings, my legs hurt a lot, trouble sleeping, or I sleep to much, etc. etc., How can I get Me back, or can I if Doctors won’t give you Hormone replacements, as I feel I need? Please Reply. Thanks


Magnolia April 13, 2011 at 12:55 pm

Hello DeAnna,

Yes. A complete hysterectomy will have a bearing on your libido and many other hormone directed bodily issues. If you have had a complete hysterectomy, I’m surprised you were not offered hormone replacement therapy of some kind. How old are you if you don’t mind me asking?

I would recommend that you do some serious reading on the subject. SERIOUS READING. Educate yourself. Unfortunately, we cannot rely on the medical community to be our all in all and we certainly can’t count on them to really “get” everything that is wrong with us. “You” understand how you feel better than anyone. So, the more you read and educate yourself, the better your chances are of finding the kind of help you need.

Please check out Dr. Steven Hotze’s site: http://www.drhotze.com for some excellent resources on bio-identical hormones. You should be able to at least use some bio-identical progesterone (possibly some estrogens), and a testosterone which will definitely rev your libido back up. (trust me on that one)

And I would look around for another doctor. Please check the website of Women in Balance here: http://www.womeninbalance.org/

There is a search function in the top right corner of the page. Plug in your zipcode to find bioidentical hormone physicians in your area. And by all means, if you have anymore questions, please check back.



DeAnna April 15, 2011 at 3:22 am

No I don’t mind telling my age, I am 54 come this November. I had my hysterectomy in 1991, all except one, ovary that is. I was almost 34, the Dr. told me at that time, that when I go through menopause, my symptoms may be more sever as a result. My husband and I have always had a great sex life. Until about 2 years ago. It was so abrupt, major depression, weight gain, leg hurt, sweats, hot flashes, and I think about sex when I’m feeling guilty about never thinking about sex. It’s like I am a completely different person. Like so many others my age insurance is a problem recently. But I have been to the Dr.’s, explained what I was going through, and requested hormone replacement, and was denied. They said to eat soy products, and take supplements. I hate to bend your ear, however, I felt such a relief when reading about the type of depression you experienced, I thought perhaps, all of a sudden I was bi-polar, or something. I have tried supplements, and from what I understand, after having a complete hysterectomy, you no-longer have the organs to produce the “reduced/lower amounts of hormones” that most women deal with. Supplements, are an addition to what you already have, but if I have none, how is that going to help?
Thank you so much for your response, just having something that states this isn’t just moodiness, and I am not being lazy, or unfeeling, matters.


Magnolia April 15, 2011 at 8:26 am

Hello DeAnna,

I’m 54 too. I just turned 54 last month. And you’re not bending my ear. This is why I blog about this. I really care about this subject and I’m very passionate about it. I want very much to be of some help to women who are going through this. I had such a tough time when I was in the thick of it and I just wanted somebody to listen to me and help me understand what was happening to me. Unfortunately no one did and I made up my mind that I was going to give women a voice who are suffering with this stuff.

It’s real, it’s difficult and in some cases can be entirely debilitating. So, no, you’re not bothering me AT ALL.

I’m glad to know your husband is supportive. It’s even more difficult when they are not. I didn’t have much support or understanding and it compounded everything I was going through ten fold. It’s bad enough when you feel like your entire body is falling apart and your world as you once knew it is imploding from the inside out. But, add on top of that an insensitive or uncaring spouse and you’ve got a very special kind of hell.

Yes, you are correct in your understanding of what happens during a hysterectomy – or those that include the removal of ovaries. If your body does not have the capacity to make the necessary hormones, then it only makes sense that you would need to put something back in there to replace what has been lost.

Soy products are good for hot flashes and night sweats. I recommend them often here at The Perimenopause Blog. Soy milk was my friend for many years. :)

Of course, you realize everything I say here, DeAnna is merely my experience and different things I’ve learned in studying perimenopause. I am not a physician and cannot dispense medical advice. I’m sure you know that (as do all my readers) but I have to say that to make sure it is understood.

I can’t suggest strongly enough that you find another physician who is versed bioidentical hormone therapy. If there is not one in your area, please check out the websites I’ve recommended. You can get a lot of help by taking the initiative. Unfortunately, when it comes to perimenopause, that is exactly what so many women have to do. It’s just not wise to be apathetic about your hormone health. You’ve already learned (as I did) that most physicians are not going to jump on a bandwagon for you. They have their ideas about what is wrong with women in perimenopause and unfortunately, most of them are just wrong. They are simply following the pack of those who taught them in medical school.

Check out Dr. Hotze’s site: http://www.drhotze.com
Check out Dr. Erika Schwartz: http://www.drerika.com
Check out Virginia Hopkins Health Watch (one of my favorite sites) for tests and great information: http://www.virginiahopkinstestkits.com/

And please feel free to come by and “bend my ear” as much as you like.



DeAnna April 15, 2011 at 6:29 pm

Thank You Magnolia, it’s hard to take all of this in without crying, I’ve already began checking the websites you’ve recommended.


Magnolia April 15, 2011 at 6:58 pm


I know when you’re in the middle of these symptoms, it feels so hopeless and you can feel powerless. But, you are not. I am very glad to know your husband is supportive. Lean on him as much as you can. Push yourself through the tough days as much as you can and keep reaching for answers and help.

I wish I could snap my fingers and fix it for you. I remember the feelings of despair when I felt I was being swallowed up by my symptoms. The good news is, they passed. There is so much you can do, you are just going to have to take the bull by the horns and don’t give up.

If I can offer anything else for you, please ask.



DeAnna April 16, 2011 at 2:57 am

Thanks for your kind words, it feels good to finally have some of what I’ve been going through actually validated. I have 6 sisters, but none of them have gone through such severe and numerous symptoms. My husband has been very supportive, but I think this is the first time he actually believes that the depression is really related to menopause. He worries when I can’t get out of bed, and my sister, is quick to explain that this type of behavior is a deal breaker for most marriages, and I should learn to embrace menopause, except this time in my life, etc….. My youngest daughter, (31 years ) lives with us, and she says, she just has to stay out of the way, she See’s it coming, and feels helpless to do anything. This is going to sound strange but even my dog, Cha whom I’ve had for 8 years, knows when I am having a big time, which tends to happen more often now a days. Except unlike my daughter, Cha will stay right by my side. I really was unaware that there are so many type of resources out there. I am starting to see that perhaps, having no medical insurance may not be as big an issue as I thought. Makes sense, a lot of people our age are now finding themselves without insurance.
In a strange way, just knowing that I didn’t develop some mental illness mid way through life, is uplifting. Let’s see where it takes me. Thank You


Magnolia April 16, 2011 at 8:27 am

Hi DeAnna,

Yes, like most everything else, people can be incredibly unhelpful and insensitive until it is *them* that is experiencing something. And the truth is, I number myself among them before I became menopausal.

Perimenopause scared me. I had never had any issues with my menstrual cycles, fertility or anything else when it came to my reproductive organs. Everything worked like it was supposed to and I just couldn’t understand the experience of women who did. I was like your sisters and said that those women who had menstrual problems should just “get a grip”. Looking back and seeing what kind of attitude I had, I feel ashamed.

Yes, menopause does make marriages difficult. But, it seems to me that when we get married we say for “better or for worse” and through “sickness and in health”. So, why is when women start going through menopause and it begins to affect their health that all of a sudden it becomes our burden to bear alone?

I don’t believe that is right. I am certain that if your husband began to struggle with something that was beyond his ability to control you wouldn’t abandon him. Yet, women are told they have to embrace this because it’s their own burden to bear? That does nothing but increase guilt, shame and powerlessness if you ask me.

It doesn’t sound strange that your dog stays close to you during your difficult days. Dogs are very perceptive to mood changes in humans. My little Jack Russell stays close to me at all times anyway. But, if I’m having a difficult day (and I still get hormone blues occasionally) she becomes particularly sweet and affectionate towards me. She climbs up next to me and places her little head on my chest and looks at me with great affection. It’s quite touching and frankly, if I didn’t have her in my life I would feel pretty darn lonely. So, no, having a dog that “gets you” :) is pretty grand if you ask me.

And listen, don’t let a lack of insurance stop you. Most insurance plans won’t cover the cost of bioidentical hormones and supplements anyway. They will cover the cost of going to a bioidentical hormone doctor though, so use what you have to find a good physician and then do like the rest of us do and buy what you can out of pocket.

I would strongly recommend a bioidentical progesterone and testosterone right off the bat. If you want a good progesterone, I recommend Oasis Serene that I sell on my blog here. I use it and have had excellent results with it.

You know, complex carbohydrates and protein help with depression. And so does a good brisk walk EVERY DAY!! in the sunshine. I know when you are in the clutches of it though you can hardly move. Oh, I hate that feeling and I know exactly how it affects you. It’s like sludge running through your veins. But, I promise you if you push your way through it, no matter how you feel, just keep pushing through it, you will get through this.

You have not developed mental illness. Though it does drive you crazy! :)



Helen rhodes December 29, 2013 at 2:12 am

Hiya im going through exactly the same its horrible and scary when it starts,mine started when i was 38 when i was trying for my son and and i had great difficulty getting pregnant, it took me nearly 1yr to fall pregnant which was not like me. Anyway after i had him i was very ill and had alot of strange symptoms that i couldn’t explain , i had many tests done and soon found out that i was going through the menopause. I had my tubes done and in the end i had to have the nova sure op done as my periods wer so very heavy and long, since having it done my periods have gone completely. My gyno has now put me on oestrogen gel to help with all the other symptoms, i have totally lost my sex drive and have found out that i cant have an orgasm which i now find very hard to deal with, it is now putting a strain on my marriage as my husband doesn’t seem to be as understanding as he did at the infact he seems to be putting more pressure on me and i feel so alone. Can anyone help have you been in this position.


Magnolia December 30, 2013 at 9:24 pm


Have you tried to testosterone? It helps with libido and orgasm.



Heidi June 22, 2013 at 12:49 pm

Is there anything I can buy or take that would give me back my desire to have sex again? I have a wonderful man who is not happy that I do not want to have sex anymore. I just have no desire, whatsoever, to have sex. I am 48 years old, my man is 62, but he still NEEDS to have an active sex life. I love him tons and am willing to try anything to get that MOOD back. I don’t have insurance, therefore going to the doctor is out of the question. Please help


Magnolia June 22, 2013 at 11:08 pm


I am not familiar with anything to increase libido without seeing a doctor. Bioidentical testosterone and estrogen can both help restore libido. Some physicians will see you without insurance. So perhaps you can find a physician who will? I have used both testosterone and estrogen, and I can assure you, it will help. A lot. :)

The estrogen will help with vaginal dryness, and the testosterone will boost your desire. The estrogen also helps with desire as well.



Katy July 24, 2013 at 1:05 am

As a young woman, I had a somewhat average sex drive. Now that I am coming into menopause, my sex drive is nonexistent. I am happy, healthy, and active, and frankly, welcome the change. Since sex stopped being front and center in my mind — more or less giving me tunnel vision — I find my perspective has opened up in so many interesting ways.

I am constantly amazed at how much our culture glorifies sex and pathologizes the entirely natural decline in a woman’s libido as she ages. Come on, people. Sex drive is largely hormonal, and the hormones which control it decline steeply at menopause. Bearing in mind that sex is nature’s way of ensuring reproduction, is it really so surprising that as we leave our reproductive years, our sex drive falls? For heaven’s sake, it would be strange if it didn’t!

If you want to fight this natural process with hormone therapy, far be it for me to stand in your way. (Just as I won’t judge you for coloring your grey hair, or botoxing your wrinkles, or doing any of the other myriad things our culture encourages us to do to deny the normal aging process.) But please, please STOP assuming that there is something inherently wrong with not wanting sex.

Why do I care, you ask? Because my husband reads this nonsense and is urging me to go “get my hormones checked.” Thank you ever so much, medical profession, for creating this new medical “problem.” Now we have men assuming that if their 50 year old wives aren’t still tigers in the sack, something is horribly wrong.

Why aren’t we pathologizing those 50 year old men who still — like teenagers — prioritize their penises over just about everything else, rather than their 50 year old wives, who have moved on to other interests?


Magnolia July 25, 2013 at 7:26 am


Not every woman needs or wants to continue a sex life later in life. But, others do. I’m not particularly interested in it. But, I’m also recently divorced and have no inclination to find a man just for sex.

But, if a woman wants to continue her sex life, there is certainly nothing wrong with replacing hormones so that she can. I happen to believe that the sexual relationship is far more than just an act for procreation. It is an expression of love as well. And for men, they need it to feel connected to their wives. So, I can understand why they begin to panic when their wives are no longer interested.

I do agree, however, that sometimes it becomes an obsession, but then there is that saying….”sex is not that important until it’s not there…..” And I suppose that could be said about a lot of things.

I haven’t read this post in a while, so I don’t recall if I suggested there was something wrong if a woman no longer wanted to have sex. I can’t imagine that I did, because I don’t think there is anything wrong with not wanting it.

Anyway, it’s only an issue if it is important to the individual. Otherwise, I say be happy and content with whatever your choice is.



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