Changes in libido and sexual health are among the most common — and least often raised — symptoms women experience in perimenopause and beyond. They are also among the most impactful, affecting relationships, self-perception, and quality of life in meaningful ways.
Libido and sexual response are influenced by multiple systems simultaneously:
Because the causes of low libido are multifactorial, care starts with a thorough evaluation. We do not lead with a single solution. Depending on your history and findings, care may include:
We understand that low libido and sexual health changes can feel personal, private, and difficult to talk about. Here are answers to common questions about hormone-related sexual health changes and personalized care.
Some shift in desire is common with age and life circumstances — but significant, distressing loss of libido is not something you have to simply accept. When low libido causes personal distress or relationship impact, it warrants evaluation. There are often identifiable contributors and effective treatments.
Yes, for the right patient. The strongest evidence supports testosterone therapy for hypoactive sexual desire disorder (HSDD) in postmenopausal women. It is not FDA-approved in a female-specific formulation in the US, but it is used off-label based on an established body of evidence including a major Lancet systematic review. We use physiologic dosing and monitor appropriately.
It is common — not inevitable. And even common does not mean untreatable. If low libido is causing you distress, that is reason enough to seek evaluation and care.
Pain with sex — often caused by vaginal dryness, thinning, and tissue changes from estrogen decline — is one of the most treatable sexual health concerns in perimenopause and menopause. Local vaginal estrogen and non-hormonal vaginal moisturizers are effective options. Pelvic floor therapy is also frequently helpful. We do not consider pain with sex a normal or acceptable outcome of aging.
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