April 8, 2025, 12:36 pm | Read time: 8 minutes

During menopause, a variety of symptoms can affect women’s everyday lives — including a loss of libido. Added to this are complaints such as vaginal dryness, physical changes due to weight gain, hot flashes, or sweating attacks. But this development does not have to be inevitable.

Hormones and Their Role in Libido During Menopause

Attributing a lack of sexual desire solely to hormones is an oversimplified view, regardless of the life circumstances women may be facing. Certainly, increased estrogen levels (around ovulation) can heighten a woman’s sexual desire, yet there are numerous other, and often more significant, factors influencing libido. According to Dr. Bach, loss of libido during menopause is “a multifactorial process.”

“This means that if you only turn one adjusting screw, i.e., with hormone X or supplement Y, you will fall short because a woman’s libido is multifaceted,” explains the gynecologist. The individual life situation of the woman is always important. For example, how high is the stress level due to pubescent children, relatives in need of care, conflicts with a partner, and pressure at work? “If a woman is under a lot of pressure because she is in the rush hour of her life, then this may also be noticeable in a reduced libido — which doesn’t necessarily have to do with her hormone status alone,” emphasizes the expert.

Hormones Only Play a Subordinate Role When It Comes to Loss of Libido During Menopause

For Dr. Widmer, hormones also play a subordinate role, perhaps even no role at all, when it comes to a possible loss of libido during menopause. “Estrogen-progesterone therapy, whether administered internally or through the skin, is effective for hot flashes and a variety of other menopausal symptoms, but not necessarily for libido.” Much more important than insisting on the influence of hormones is the “development and cultivation of a diverse culture around our sex life.”

The sexologist urges: “Let’s not become dependent on our hormones.” At best, testosterone can increase sexual desire. According to Dr. Widmer, this is also sometimes prescribed therapeutically, but she says: “The dosage of testosterone is tricky with possible side effects. It’s better to find out more precisely what puts you in an erotic mood.”

Rediscovering Sex, Sexuality, and Sex Life

To rekindle pleasure and savor pleasurable moments, Dr. Widmer suggests first broadening your personal definition of sex. Sex does not only mean sexual intercourse, but “everything that is sexually arousing and pleasurable”. All forms of sexual exchange are treated equally. Sexual intercourse is just one form of encounter and is equal to other forms of sex, such as “intense kissing or lying together in a tight embrace or even a silent form of lovemaking where the genitals of both partners nestle against each other, petting, caresses with fingers, tongue, toys, penetrative or non-penetrative,” the expert lists.

Libido is often rekindled when we let go of strict definitions of what sex is or should be. “Many women who had intercourse before menopause more for the sake of their partner than for themselves are more likely to lose their desire for this form of sex, unlike women who have always loved intercourse,” adds Dr. Widmer.

Increasing Libido During Menopause Starts in the Mind

Women experiencing a lack of desire should view perimenopause as an opportunity. Now may be the time to “find out what puts you in an erotic mood,” says Dr. Widmer. You should consciously take the time to do this, perhaps “try something completely new, get away from the usual routine, arrange a date night again, always in consultation with your partner,” agrees Dr. Bach. This new discovery can also help women in long-term relationships, in particular, to rediscover sexuality and their libido during menopause.

After all, this is often the reality of life during perimenopause: habit takes the place of lust and passion, and erotic stimulation can provide variety. Another tip from Dr. Bach when it comes to explicitly regaining desire is the use of extracts from the maca plant. “There is a certain amount of data on this,” she explains, “but experience has shown that the most potent means of increasing libido actually starts in our heads.”

Express Your Desires: Communication Is the Be-All and End-All in a Relationship

In addition to sufficient time for relaxed and pleasurable moments, communication is an important tool in relationships and the key to a fulfilling sex life. Women need to talk openly and clearly about their desires first and foremost with their partner (and also about what they don’t like). However, it is also important for women to talk to their girlfriends. The same applies to men in this situation.

“Men also need to engage in this communication, accept requests, and be open to extending foreplay, among other things,” notes Dr. Bach. Men can embark on the same path, “deal with their changing bodies, redefine the concept of masculinity, exchange ideas with men, shed light on the importance of sexual intercourse and open themselves up to new physical, mental and spiritual experiences, for example in a couples’ course, pleasure course or tantra course,” Dr. Widmer also lists the possibilities.

Vulvo-Vaginal Dryness

However, it’s certain that during menopause, the tissue in the vagina and vulva undergoes changes due to the increasing estrogen deficiency. In vulvovaginal atrophy, the thickness and elasticity of the skin in the area of the vaginal epithelium (the uppermost cell layer of the vagina) decrease. The skin in the intimate area therefore becomes “thinner, drier, much more sensitive, can tear and this in turn can cause itching, a burning sensation and discomfort”, describes Dr. Bach. “The local immune defense is also disturbed. This means that the susceptibility to infections is increased due to the disturbed intestinal flora: vaginal infections can occur more easily, as well as mild or recurring bladder infections.”

Pain during sexual intercourse is mainly caused by the skin changes at the vestibule of the vulva and the narrowing of the thin ring of the vaginal entrance, adds Dr. Widmer: “A dry vagina itself does not hurt. It is, therefore, not a question of moisturizing the vagina, but of lubricating or oiling the vaginal entrance and the vestibule.”

Intimate Care and Lubricants

Just as the skin needs more care with age, the same applies to the mucous membranes in the intimate region. They become thinner, drier, and more sensitive over time, and this is particularly noticeable as an accompanying symptom during menopause and as a disturbing factor during sexual intercourse. Dr. Widmer recommends regular intimate care with an oil or plant-based cream, especially if you enjoy penetrative sexual practices.

It is important to use intimate care creams with an acidic pH value so that the immune system is not impaired. Intimate deodorants or vaginal douches should, therefore, also be avoided, and it is best to use plain water without soap for washing, emphasizes Dr. Bach. “If you don’t want to do without a wash lotion, please use an intimate wash solution that is explicitly formulated with the pH value for this area.”

If the female intimate area needs more support despite adequate care, the use of personal lubricants during sex can also help. These are available on different bases as a lubricant gel with hyaluronic acid or aloe, for example, or as a plant-based lubricant oil. Important: without mineral oils.

Estrogen for the Vagina

According to Dr. Widmer, regular intimate hygiene is often enough to maintain sexuality during perimenopause. However, local estrogen administration may also help with atrophy. In this case, estriol (a very weakly effective estrogen) is used exclusively to treat estrogen deficiency in the vaginal epithelium.

“However, this does not mean that estriol can be used to increase libido. But if sex hurts because the skin is cracked, sensitive, and dry, then you don’t even want to think about sex. But if the vaginal epithelium is well supplied with blood, has a reasonable resistance, is elastic, doesn’t tear, and you simply don’t have any pain during intercourse, then of course you will have much more desire again,” explains Dr. Bach.

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Contraceptive Issues and New Freedom

The expert highlights the good news: the ability to orgasm, arousal itself, and lubrication during sexual arousal are not impacted by estrogen deficiency during perimenopause. All of this continues to function perfectly well. Provided the woman is aroused, can get involved in the situation, and has a desire for sex and an appetite for her partner.

Especially in postmenopause, when women no longer have to worry about unplanned pregnancies or contraceptive issues, they can rediscover sexuality. This can also provide a boost to the libido as women focus more freely on their own fulfillment and try out new things.