Key takeaways
- Low libido during menopause has multiple causes: declining oestrogen, falling testosterone, vaginal changes that make sex uncomfortable, and psychological factors including fatigue, mood changes, and body image. Most women experience a combination.
- Testosterone is the treatment most women with low libido during menopause are never told about. NICE guideline NG23 recommends that specialists consider it when HRT alone is not effective.
- Effective non-hormonal options exist, including CBT and pelvic floor training, and a personalised plan that addresses the specific causes driving your symptoms will produce better outcomes than a generic approach.
Introduction
Loss of sexual desire during menopause is one of the most common symptoms women experience and one of the least likely to be raised in a clinical setting. Many women feel embarrassed to mention it. Others have mentioned it and been told it is normal, as if "normal" and "nothing can be done" mean the same thing. They do not.
A systematic review and meta-analysis published in Health Science Reports (Hosseinabadi et al., 2025) found that sexual dysfunction in postmenopausal women is both widespread and frequently neglected, with common manifestations left unaddressed in clinical practice. The research confirms what many women already know from lived experience: this is a real, recognised, and underserved symptom.
If your desire for sex has changed during perimenopause or menopause, this article is for you. It explains why it happens, covers the full range of treatment options including some that most content on this topic never mentions, and describes what a specialist-led approach actually looks like.
Is low libido during menopause normal?
Yes, in the sense that it is very common. No, in the sense that you should not simply accept it as an inevitable part of ageing with no path forward.
Research consistently shows that sexual desire declines across the menopausal transition, with studies suggesting that somewhere between 40% and 55% of postmenopausal women experience low libido as a significant concern. Hosseinabadi et al. (2025) confirm that sexual health in postmenopausal women is multifactorial and frequently neglected, both by healthcare systems and by women themselves, who often normalise the experience rather than seeking support.
When low libido causes personal distress or affects relationships and quality of life, it meets the clinical criteria for hypoactive sexual desire disorder (HSDD): a recognised condition that warrants clinical attention, not reassurance that everyone goes through it.
The experience of being dismissed is common. Women describe GPs telling them it is "just your age", offering antidepressants, or moving quickly past the topic. If that has been your experience, your concern was legitimate and your desire for proper support is reasonable.
93% of Voy members reported improvement in overall quality of life after starting treatment, data presented at The Menopause Society 2025 and forthcoming in Climacteric. Sexual wellbeing is a meaningful part of that picture.
Why does menopause affect your sex drive?
Several hormonal changes happen simultaneously during the menopausal transition, and each contributes to reduced sexual desire in a different way.
Oestrogen decline:
Oestrogen supports vaginal tissue health, natural lubrication, and the physiological arousal response. As oestrogen falls, vaginal tissue becomes thinner and drier (a condition called genitourinary syndrome of menopause, or GSM), natural lubrication reduces, and arousal takes longer or becomes less reliable. For many women, sex that was previously comfortable becomes uncomfortable or painful. Pain during sex is itself one of the most significant drivers of reduced desire: the anticipation of discomfort is a powerful inhibitor of wanting sex at all.
Testosterone decline:
Testosterone is the hormone most directly responsible for sexual desire in women, yet it is rarely discussed in menopause consultations. Testosterone levels fall substantially across the menopausal transition. Unlike oestrogen, which has a relatively defined decline curve, testosterone can begin falling from a woman's 30s, reaching significantly lower levels by the time she reaches perimenopause. Low testosterone in women is specifically associated with reduced libido, diminished arousal, and a general loss of the spontaneous interest in sex that many women previously took for granted.
Progesterone decline:
Progesterone also falls during the transition. Lower progesterone is associated with disrupted sleep and increased anxiety, both of which compound the other hormonal drivers of reduced desire.
A systematic review and meta-analysis published in Menopause (Lara et al., 2023) analysed 36 trials covering 23,299 women and found that hormone therapy significantly improved overall sexual function in perimenopausal and recently postmenopausal women, including desire, arousal, lubrication, and pain outcomes. The effect was strongest in women whose symptoms were primarily oestrogen-related.
It is not just hormones: the psychological side of low libido
“Hormones set the physiological conditions for sexual desire, but they do not tell the whole story. Psychological factors play a significant and independent role, and for many women they are the primary driver or a major compounding factor.”
Fatigue:
Menopause-related exhaustion, whether from disrupted sleep, direct hormonal effects on energy, or the cumulative load of managing multiple symptoms, directly suppresses desire. When physical and mental resources are depleted, sex moves down the list of priorities without any conscious decision to put it there.
Mood changes:
Anxiety, low mood, and emotional volatility are common during the menopausal transition. Both anxiety and depression independently reduce sexual desire, and the relationship is bidirectional: low libido can worsen mood, which further reduces desire.
Body image:
Changes in weight distribution, skin, and physical energy during menopause can affect how women feel about themselves and their bodies. Feeling disconnected from or critical of your body is a well-evidenced barrier to sexual desire.
Relationship dynamics:
Long-term relationships bring their own dynamics, and menopause often arrives at a point in life when other stressors (careers, children, caring responsibilities, health concerns in partners) are simultaneously demanding. Desire is responsive to context, not just physiology.
Hosseinabadi et al. (2025) confirm that hormonal, psychological, and relational factors all significantly contribute to sexual dysfunction in postmenopausal women, and that addressing only one dimension is unlikely to produce full recovery.
83% of Voy members reported improved mood and emotional symptoms after starting treatment, data presented at The Menopause Society 2025 and forthcoming in Climacteric. When the mood and emotional burden of menopause is addressed, the psychological conditions for sexual desire improve alongside it.
What actually helps: treatment options explained
HRT
Systemic HRT (hormone replacement therapy) addresses the oestrogen deficiency that underlies vaginal dryness, reduced arousal, and the physiological dimension of low desire. Lara et al. (2023) found that HRT improved sexual desire, arousal, lubrication, and pain outcomes across a large, well-designed evidence base. For women whose low libido is primarily oestrogen-related, HRT is often the most direct and effective intervention.
HRT does not suit everyone, and suitability depends on individual health history. If you have concerns about HRT safety, including questions about breast cancer risk, a 45-minute consultation with a BMS-trained menopause specialist is the right place to explore your individual risk-benefit picture. Blanket reassurances in either direction are not clinically helpful; your history matters.
Vaginal oestrogen
Vaginal oestrogen (available as a cream, pessary, or ring) is a topical treatment that directly restores vaginal tissue health, increasing thickness, elasticity, and natural lubrication. It is absorbed locally rather than systemically, which means it carries a different risk profile from systemic HRT and is appropriate for many women who cannot or do not wish to use systemic hormone therapy.
For women whose low libido is substantially driven by pain or discomfort during sex, vaginal oestrogen can produce meaningful improvement, often within a few weeks. Removing pain as a factor in sexual experience frequently restores desire that the anticipation of discomfort had suppressed. Vaginal oestrogen is distinct from systemic HRT and can be used alongside it or independently.
NICE guideline NG23 recommends vaginal oestrogen for genitourinary symptoms associated with menopause, including vaginal dryness and discomfort.
CBT
Cognitive Behavioural Therapy is an evidence-based psychological treatment with a growing evidence base specifically for sexual concerns during menopause. A pilot study published in The Journal of Sexual Medicine (Green et al., 2025) found that a four-session CBT protocol delivered to 32 peri- and postmenopausal women significantly improved sexual functioning including desire, arousal, pain, and satisfaction, alongside improvements in body image, relationship satisfaction, and reductions in anxiety and depression. All participants reported high treatment satisfaction.
This is early research from a pilot trial, and a larger controlled trial is needed to establish the findings more definitively. It sits alongside Hunter's (2021) review in Climacteric confirming that CBT is an evidence-based, brief (4–6 session) intervention effective for menopause symptoms including mood, sleep, and quality of life. NICE NG23 recommends CBT as a non-hormonal option for women managing menopause symptoms.
CBT is available through Voy as part of a comprehensive menopause treatment plan.
Pelvic floor training
A meta-analysis published in The Journal of Sexual Medicine (García-Laria et al., 2025) found that pelvic floor muscle training had beneficial effects on sexual function in postmenopausal women, including pain reduction and improved satisfaction. The evidence base is still developing, but pelvic floor training is a low-risk, accessible option that can support the physical dimensions of sexual function, particularly where discomfort is a factor.
Lifestyle
Exercise, adequate sleep, and a diet that supports blood sugar stability all contribute to the hormonal and psychological conditions that underpin sexual desire. The connection between improving general menopause symptom burden (particularly fatigue and mood) and improvements in libido is well-established. Addressing the wider symptom picture, rather than targeting libido in isolation, tends to produce more durable results.
What about testosterone? A note on what it is and who it is for
Testosterone is the treatment most women with low libido during menopause are never told about. This is one of the most significant gaps in current menopause care, and it matters.
Testosterone is often thought of as a male hormone, but it is produced by women's ovaries and adrenal glands throughout their reproductive lives and plays a central role in sexual desire. It is the hormone most directly associated with libido: with spontaneous desire, with arousal, and with the motivation to seek and enjoy sex. When testosterone levels fall during the menopausal transition, reduced libido is a predictable and direct consequence.
A systematic review and meta-analysis published in The Lancet Diabetes and Endocrinology (Islam et al., 2019) analysed randomised controlled trial data and found that transdermal testosterone significantly improved sexual desire, arousal, pleasure, orgasm, and frequency of satisfying sexual events in women. This is the foundational dataset that now informs clinical guidance globally.
NICE guideline NG23 (updated 2024) states: "Consider testosterone supplementation for people with low sexual desire associated with menopause if HRT alone is not effective." This is not a fringe recommendation; it is national clinical guidance from the UK's healthcare regulator.
One important context: testosterone does not currently hold a UK marketing licence for use in women. This means it is prescribed off-label, which is a legal and common clinical practice where a medicine is used outside its licensed indication based on clinical evidence and specialist judgement. BMS-trained menopause specialists regularly prescribe testosterone for women in this context. At Voy, testosterone is available as Testogel, Androfeme, or Voy's Testosterone cream, as part of an individually assessed treatment plan. A testosterone blood test within the last three months is required before a prescription can be issued.
Voy members treated with testosterone reported a 65% improvement in libido at 12 months, data published in The Journal of Sexual Medicine (2025). This is not a vague improvement; it is a meaningful, measured outcome over a clinically significant timeframe.
If you have tried HRT and still experience low desire, or if you have not yet been offered a testosterone assessment, it is worth raising with a specialist. The conversation many women have not been able to have with their GP is one that a 45-minute specialist consultation is specifically designed to make possible.
When to speak to a specialist, and what to expect
If low libido is affecting your quality of life, your relationship, or your sense of yourself, it is worth seeking specialist support. This is not a minor complaint to manage alone with lifestyle tips. It is a recognised clinical symptom with recognised clinical treatments.
A GP appointment is often not the right setting. Time is limited, the topic is easy to sidestep, and many GPs have limited training in prescribing testosterone for women or in the more nuanced aspects of menopause sexual health. Women consistently report feeling dismissed, hurried, or redirected toward antidepressants when they raise sexual symptoms in a standard appointment.
A 45-minute consultation with a BMS-trained menopause specialist is a different kind of conversation. It is long enough to map the full picture: which causes are most likely driving your symptoms, whether HRT is appropriate and in what form, whether vaginal oestrogen would help, whether testosterone is worth assessing, and whether CBT or other psychological support is relevant to your situation. Treatment is built around your specific circumstances, not a standard protocol.
Voy is rated 4.7 out of 5 on Trustpilot, based on more than 7,000 reviews. An initial consultation costs £99, compared to £295 at many private clinics.
