If menopause has reduced your sex drive, you’re not alone. As many as half of women experience lower libido during or after the menopause transition.

Thankfully, there are things that can help to increase your sex drive again, including a variety of prescription medications and natural supplements.

As well as exploring these options, we’ll look at how changing hormone levels, and other symptoms such as vaginal atrophy, can affect your libido during menopause.

We’ll also consider whether your sex drive could come back in future, and why some women actually have a higher sex drive during menopause.

For help with a whole range of menopause symptoms – including those like vaginal dryness and inflammation that can impact your sex drive – try The Better Gut probiotic supplements.

To get 10% off your first order, visit The Better Gut and use the discount code WELCOME10.

How does menopause affect sex drive and sexual health?

In the years leading up to menopause – known as perimenopause – your levels of reproductive hormones like oestrogen fluctuate and begin to drop. As you reach menopause – the point 12 months after your last period – your oestrogen levels settle at their lowest.

Although there’s not necessarily a direct link between lower levels of oestrogen and reduced sex drive at this time, having less oestrogen can cause other physical and psychological changes that can affect your confidence and your libido and make the prospect of sex less appealing.

These include:

• vaginal atrophy, the thinning of the vaginal walls, which can lead to
  • dryness
  • inflammation and soreness
  • discomfort or pain during sex
  • blood spotting after sex
  • a burning pain when urinating
  • more frequent urinary tract infections
  • bladder control issues
• hot flushes/night sweats
• sleep problems
• anxiety and low mood
• weight gain
• thinning hair

Oestrogen is not the only reproductive hormone that can affect your libido – low levels of testosterone can also be a factor in reduced sexual desire.

Although many people think of testosterone as a male hormone, it’s also key to sex drive in women. While low testosterone is not a direct result of menopause – your levels gradually reduce as you get older – it could start to have an impact at around the same time.

Reduced testosterone in women can contribute to:

• low sex drive
• less pleasurable sexual sensations
• trouble reaching orgasm

Along with the symptoms of hormonal changes, menopause may also coincide with a time in your life when you’re facing increased life stresses. Depending on your situation, difficulties with work and responsibilities for both children and older parents could hamper your sex drive.

Increased sex drive during menopause

Although most women whose libido is affected during menopause find their sex drive goes down, for some it can increase.

While the complex interactions between different reproductive hormones are not fully understood, it’s thought that in some cases a relative reduction in oestrogen compared with testosterone could increase the effects of testosterone in menopausal women, leading to a higher sex drive.

For some women, changing circumstances can also be a factor. Children having left home, along with reduced anxiety about getting pregnant, can contribute to a feeling of increased liberation when it comes to sex.

However, it’s important to be aware that although you may have lower fertility as you approach menopause, it’s still possible to get pregnant until your periods have completely stopped.

Does sex drive return after menopause?

During the menopause transition, your levels of both oestrogen and testosterone go down, but oestrogen drops at a much faster rate than testosterone.

In the years after menopause, both of these hormones stabilise – but with testosterone at a much higher level relative to oestrogen than before menopause.

As we’ve discussed, it’s possible that for a small number of women this proportional increase in testosterone could contribute to an increased sex drive.

Interestingly, studies have reported that more women are troubled by a low sex drive in middle-age – the years when perimenopause and the transition to menopause tend to take place – than they are as they get older.

And while it’s unclear whether the two are related, women’s levels of both testosterone and a form of oestrogen called estrone start to increase again after the age of 70.

Medications for menopause sex drive and vaginal health

If you have low sex drive due to menopause, your doctor can help you to decide which medications might be suitable for you.

This could depend on your symptoms, your health status, what you’ve tried before and what’s available where you live.

HRT and testosterone

Hormone replacement therapy (HRT) can treat a wide range of common menopause symptoms, including hot flushes, anxiety and vaginal dryness.

It replaces hormones like oestrogen and progesterone via tablets, skin patches, gels, implants or a coil/intrauterine system (IUS).

If this kind of HRT doesn’t improve your sex drive, you may be offered testosterone as well. Testosterone tends to be more effective at increasing your libido when taken alongside oestrogen.

Flibanserin

Known by the brand name Addyi, flibanserin is a non-hormonal treatment that comes in tablet form. It’s approved for use in the US by the Food and Drug Administration (FDA) but is not available in the UK, partly due to safety concerns.

In the US, it’s only intended for women who are have not reached menopause but in Canada it can also be taken by postmenopausal women aged 60 or under.

Addyi works by rebalancing the neurotransmitters dopamine and norepinephrine – chemical messengers involved in sexual arousal – while lowering levels of serotonin, which can reduce libido.

In clinical trials, Addyi increased both sex drive and the number of satisfying sexual events. While the improvements were generally small, they were still enough to make a significant difference for some women.

The most common side effects of Addyi include dizziness, sleep problems, nausea, fatigue and dry mouth.

Vaginal oestrogen therapy

Vaginal oestrogen therapy is another type of HRT. By directly replenishing the oestrogen in your vagina, it treats the dryness and irritation that can lead to uncomfortable or painful sex.

Vaginal oestrogen products are all inserted into the vagina but come in a number of different forms with different brand names:

• Tablets (Gina, Vagifem, Vagirux)
• Pessaries (Imvaggis)
• Rings, that can be used for up to 3 months (Estring)
• Gels (Blissel)
• Creams (Ovestin)

Many of these are available in both the UK, US and other countries.

Ospemifene

Ospemifene is known in the UK as Senshio and in the US as Osphena. It’s an oral tablet designed for postmenopausal women with vaginal atrophy and dryness who aren’t able to use vaginal oestrogen therapy.

Ospemifene acts like oestrogen by affecting oestrogen receptors. It improves the health of your vaginal walls and increases the number of moisture-producing cells. This can help to reduce vaginal dryness and pain during sex.

Senshio is available by prescription on the NHS.

Supplements for menopause sex drive

Here we’ll look at some herbal remedies and other natural supplements that may help to improve your sex drive, vaginal health or both.

The plants in this section all contain compounds called phytoestrogens, which may mimic some of the functions of oestrogen.

It’s worth bearing in mind that although the results of many of the studies discussed are promising, they are mostly quite small so more research may be needed.

Red ginseng (Panax ginseng)

The root of the red ginseng plant, also known as Korean or Chinese ginseng, is a traditional Asian medicine with a reputation for improving libido.

Several scientific studies have looked at the effects of red ginseng on sexual health in menopausal women.

In one study, participants who took 500 milligram (mg) ginseng supplements twice a day for four weeks saw improvements in areas including sex drive, lubrication, pain and reaching orgasm.

Another study saw significant increases in sexual arousal in menopausal women who took a total of 3 grams (g) of red ginseng each day, compared with those who took a placebo.

Fennel (Foeniculum vulgare)

You probably know fennel and its seeds as culinary ingredients. But supplements containing extracts of fennel have shown positive results when it comes to sexual issues during menopause.

In one trial, postmenopausal women used either a vaginal moisturising cream containing extracts of fennel seeds, or a placebo cream with no added ingredient, every night for 8 weeks.

At the start and end of the study, they completed questionnaires covering levels of sex drive and arousal, sexual satisfaction, lubrication and pain during sex.

While overall scores in both groups improved, they were significantly higher for the women who used the fennel cream.  

In another very small 8-week study, women who took two 100 mg capsules of fennel extract per day saw improvements in a range of menopause symptoms including sexual issues, as well as in their overall quality of life.

Bindii (Tribulus terrestris)

Bindii is a spiny flowering plant that was used in ancient Greek, Chinese and Indian medicine. Then, it was better known as a remedy for impotence and low libido in men but studies today suggest it can improve sex drive in postmenopausal women.

In one study, women who took 750 mg per day of bindii extract for 3 months reported increased libido, lubrication and ability to orgasm, while there were no improvements in a placebo group. Other studies have shown similar results.

Interestingly, the women who took the bindii also had significantly raised levels of testosterone, one of the key hormones involved in female sex drive.

Maca (Lepidium meyenii)

Maca root, also known as Peruvian ginseng, grows at high altitudes in the Andean region of Peru. Like ginseng, it’s thought to have aphrodisiac properties.

Maca has been shown in several studies to improve menopause symptoms as a whole. Although not much research has focused on maca’s impact on sexual health, one very small study involving postmenopausal women had encouraging results.

Before the study, participants scored their symptoms in a range of areas. For the next 6 weeks they took daily supplements containing 3.5 grams (g) of powdered maca root. At the end of the study, scores relating to both sexual dysfunction and anxiety were significantly reduced.

Red clover (Trifolium pratense)

Red clover is a flowering plant from the legume family, the same that includes beans and pulses. It’s promoted as a remedy for a range of menopause symptoms but results of studies have been inconclusive.

One study looked at the effects of red clover on sex drive and vaginal health in postmenopausal women. Participants who took 80 mg of red clover extract every day for 3 months improved their vaginal health, reduced dryness and pain and almost halved problems with libido.

Another similar study found no change in a number of measures of sexual satisfaction. However, participants in this trial took only 40 mg of red clover per day, so it’s possible the smaller dosage contributed to the conflicting results.

Probiotics

Probiotics are friendly bacteria that can improve the balance and health of your gut microbiome. That includes your estrobolome, the group of microorganisms responsible for processing and recirculating oestrogen around your body.

The Better Gut probiotic menopause supplements contain specific strains of probiotic bacteria that have been shown in studies to improve overall vaginal health, reduce dryness and inflammation and help prevent vaginal and urinary tract infections.

To find out more, visit The Better Gut.

Other ways to improve your sex drive

• A healthy lifestyle: Try to get regular exercise, eat a balanced diet – including a wide variety of plants – and stick to good sleep habits. This can boost your overall health, your mood and your self-confidence, which could help you feel more positive about sex. For tips on exercising, eating and sleeping to improve menopausal symptoms, see the sections at the bottom of this article.
• Moisturisers and lubricants: There are plenty of vaginal moisturisers and lubricants that you can buy over the counter. They don’t contain oestrogen but can still help to relieve dryness. Lubricants can reduce pain and discomfort during sex. Water-based lubricants are a good choice as they don’t stain sheets or weaken the latex in condoms like oil-based options.
• Strengthen your pelvic floor: Your pelvic floor is the name for the muscles that hold your vagina, uterus, bladder and bowels in place. Strong pelvic floor muscles can help prevent urine leaking out and can improve sex. The NHS has some tips on how to exercise these muscles.
• Take your time: Try spending more time on foreplay or experimenting with self-pleasure. These can both lead to increased arousal and better sex, but are also enjoyable in themselves.
• Plan your sex: Scheduling a time for sex can sometimes be easier than trying to be spontaneous and can give you more time to think about it and get in the mood.

Summary

Declining levels of oestrogen during menopause may reduce your sex drive and cause other symptoms like vaginal atrophy, hot flushes and anxiety that can make the prospect of sex less appealing.

Lower levels of testosterone at this time of life can also contribute to a lower libido.

For some women, menopause can actually lead to an increased sex drive. This may be due to the changing relationship between levels of testosterone and oestrogen.

Medications that may help to increase your sex drive or improve vaginal health during perimenopause or after menopause include:

• HRT, including testosterone replacement
• flibanserin, although this is not available in the UK
• vaginal oestrogen therapy
• ospemifene

Natural supplements that may help include:

• red ginseng
• fennel extract
• bindii (Tribulus terrestris)
• maca root
• red clover
• targeted probiotics

The Better Gut probiotic supplements contain strains of friendly bacteria that can help with a whole range of perimenopause and menopause symptoms, including those that can affect your sex drive, like vaginal dryness and inflammation, hot flushes and anxiety.

Visit The Better Gut to find out more, and get 10% off your first order with the discount code WELCOME10.

Additional sources

Menopause – Understanding the impact on women and their partners. Post Reproductive Health. (2019). https://journals.sagepub.com/doi/10.1177/2053369119895413