Understanding Low Libido in Perimenopause and Menopause

The reality is that a reduced sex drive is often multifactorial—and importantly, there is a great deal that can be done to help.

Start with the Relationship

The first and most important question is not hormonal—it’s relational.

How is your relationship?

Do you still feel attracted to your partner?

Are you making time for each other, or has life simply become too busy and exhausting?

For many women, especially during midlife, competing demands such as work, family, and general fatigue can leave little energy for intimacy. If the emotional connection has diminished, it is unlikely that libido will feel strong.

This is why we always encourage women to reflect on relationship dynamics first. Rebuilding connection—through communication, shared time, or even something as simple as regular date nights—can make a meaningful difference.

Vaginal Dryness and Discomfort

A very common and often under-recognised cause of low libido is vaginal dryness and soreness.

As oestrogen levels decline, the vaginal tissues can become thinner, drier, and more sensitive. This can make intimacy uncomfortable or even painful, understandably reducing desire.

The good news is that this is highly treatable.

Local vaginal oestrogen can be transformative, significantly improving dryness and discomfort for the majority of women. It is suitable for most, including many women who have had hormone-sensitive breast cancer, although this is always an individual decision made in consultation with a menopause specialist.

In addition, vaginal moisturisers can be very helpful. Products such as those from the YES range—available in water-based, and coconut- oil-based formulations—offer a natural and effective way to improve comfort.

Hormonal Balance

Once relationship factors and physical discomfort have been addressed, the next step is to consider hormonal balance.

For women experiencing menopausal symptoms or oestrogen deficiency, hormone replacement therapy (HRT)—using oestrogen and progesterone—can be an important foundation. Restoring these hormones often improves overall wellbeing, energy levels, and, for some women, libido.

However, libido does not always fully return with HRT alone.

The Role of Testosterone

If low libido persists, testosterone can be a valuable option.

Testosterone plays an important role in sexual desire in women, but accessing appropriate treatment can be challenging. In the UK, there are currently no testosterone products specifically licensed for women on the NHS. This means that male formulations are often used in very small doses, which can make achieving the correct balance difficult.

At The Women’s Hormone Clinic, we are able to prescribe compounded testosterone that is tailored to the individual. These made-to-measure treatments can be highly effective in improving libido and overall vitality.

There is hope that this will change in the near future. A product called Androfeme, currently available in Australia, is anticipated to be licensed in the UK—hopefully during 2026. If approved, this could significantly improve access to appropriate testosterone treatment for women through the NHS.

At present, however, NHS access remains variable, with prescribing often depending on individual clinicians—resulting in what many describe as a “postcode lottery.”

You Don’t Have to Suffer in Silence

If you are struggling with low libido during perimenopause or menopause, it’s important to know that you are not alone—and that help is available.

Whether through your GP, practice nurse, or by speaking to us at The Women’s Hormone Clinic, there are a range of effective options that can be tailored to your individual needs.

Low libido is not something you simply have to put up with. With the right support and a holistic approach, it can be addressed—and often significantly improved.

Click here to book an appointment to talk to one of our experts about any of the issues raised in Dr Rockwell's blog.