When Desire Fades: Understanding Loss of Sexual Interest in Perimenopause and Beyond
Many women in midlife notice that their sexual desire changes — sometimes gradually, sometimes suddenly. What once felt natural or effortless can start to feel distant or even absent. This experience can lead to frustration, sadness, relationship tension, or confusion, and many women quietly wonder if something is wrong with them. The truth is, loss of sexual desire during perimenopause is common, multifactorial, and completely understandable. It’s not a personal failure or a sign of disconnection — it’s a reflection of the complex changes happening in one’s body, mind, and relationships at this stage of life.
The Science: Why Desire Changes
During perimenopause, levels of estrogen, progesterone, and testosterone fluctuate unpredictably. These hormonal changes can impact everything from mood and energy to vaginal comfort, urinary symptoms, and sleep quality — all of which influence libido.
Physical issues like vaginal dryness, night sweats, weight gain, or fatigue can make intimacy less appealing. Emotional and psychological factors — including stress, mood swings, and body image concerns — often add another layer.
At the same time, midlife can bring unique pressures: caring for ageing parents, navigating teenage children, experiencing an empty nest, career changes, financial worries, or relationship shifts—all of which drain the same physical and emotional energy that supports sexual connection.
Libido isn’t a simple switch controlled solely by hormones; it’s a complex dialogue between your body (hormones, nervous system, gastrointestinal system), brain (emotions), and environment. When one part of that system is strained, desire usually reflects it.
Reclaiming Desire: What Can Help
Loss of sexual interest doesn’t have to mean the end of pleasure or intimacy. Many women find that addressing desire holistically opens doors to renewed comfort and connection. My intention in writing this blog is to direct my patients’ and all readers' attention towards their natural sexuality as a potential tool in the healing of Menopause symptoms. Sexuality and libido are an integral part of human beings and should not be dismissed as unimportant when it comes to Menopause symptoms conversations.
There are many layers to it:
Medical and physical support:
A menopause-informed doctor can review hormonal changes and discuss options such as systemic HRT(MHT), local estrogen therapy, testosterone gel, or vaginal hormones, moisturisers and lubricants.
Addressing sleep, thyroid health, iron levels, weight management, or medication effects can also make a noticeable difference.
Hearing the story of past or present trauma, high allostatic load( chronic accumulative stress) is a vital part of medical assessment at this stage of women's lives.
Emotional and psychological care:
Changes in desire often mirror changes in mood, stress, self-image, general health, disordered eating patterns and relationships. Therapeutic approaches such as CBT, mindfulness, somatic therapy or psychosexual therapy can help reconnect body and mind.
Rebuilding communication and emotional intimacy in relationships can gently restore a sense of safety and curiosity around touch and closeness.
Lifestyle and relational factors:
Exercise, food, rest, and time for self-nurturing all support hormonal balance and vitality.
Redefining intimacy beyond performance — through curious affection, touch, and laughter — can reawaken comfort and connection without pressure.
A Deeper Reflection: Desire as a Portal to Healing
Although many women prioritise other symptoms over changes in sexual desire when seeking professional help—which is quite understandable given that some symptoms may seem more immediate—I believe that addressing issues like mood swings, heat intolerance, insomnia, body aches, brain fog, or weight gain separately from decreased libido can overlook an important aspect of health and miss an opportunity to help with other symptoms by addressing intimacy and desire. I often regard sexuality as a vital symptom in its own right and as a potential gateway to deeper healing. When we start examining the role of libido in our overall health, we’re not just talking about sex. We’re exploring layers of self-connection, comfort, emotional safety, and body awareness. Perimenopause often presents a prime opportunity for women to reconnect with their true selves and to forge a new relationship with themselves and with their partners—whether existing or new.
I sometimes describe this stage transition as "befriending renewed self-sexuality” before rebuilding an intimate relationship with a partner. What that means is learning to reconnect with your own changing body, emotions, thoughts, sensuality, curiosity, and pleasure, either before or alongside sharing that with another person. For many women, it's a new concept that requires curiosity and patience to begin exploring. This self-connection can become a powerful tool in somatic therapy, helping to rebalance the nervous system—particularly the relationship between the parasympathetic (“rest and restore”) and sympathetic (“alert and active”) systems, which can be disrupted during perimenopause. I often talk to my patients about the need to engage more parasympathetic restorative movements and practices in their daily lives to manage their hyperaroused nervous system, which usually presents as anxiety. We frequently run out of time to even start the conversation about libido and self-sexuality as a potential tool for this parasympathetic engagement and nervous system recalibration. Opening our minds and tapping into our natural curiosity by exploring this possibility can be a valuable and safe way to support lifestyle readjustment towards better symptom control and health during the perimenopause transition.
From this perspective, sexuality shouldn't be viewed in isolation, only after addressing other symptoms, or solely through the lens of testosterone supplements — it’s an integral part of the whole. There has been considerable focus on the role of testosterone supplementation recently, particularly on social media and within medical circles. While it can occasionally be a helpful addition to restoring libido, it should never be regarded as the only solution. Still, scientific understanding of the true role and benefits of testosterone supplements for female libido during perimenopause and Menopause remains limited. The lack of reliable measuring tools further complicates assessing testosterone's effectiveness as a treatment for declining libido in Menopause. Relying exclusively on medication—regardless of the type—without reviewing and adjusting lifestyle is never a fully holistic approach to any human condition or symptom. Emphasising the development or deepening of internal body awareness (interoception), monitoring and befriending the nervous system (neuroception), and nurturing the relational connection between self and others can become vital components in healing, supporting mood, sleep, energy, and vitality for the years ahead.
Take Home Message
Loss of sexual desire during perimenopause is common, and it doesn’t have to be permanent or shameful. It can serve as an invitation to slow down, listen to your body and mind, and reimagine what intimacy and pleasure mean at this new stage of life. It may look very different from how it did in earlier decades of a woman's life. With the right support — medical, emotional, and relational — many women rediscover desire and develop a deeper connection to themselves and others. Sometimes, what starts as a symptom can become a pathway to growth, healing, and a renewed sense of vitality. Addressing a loss of libido holistically and patiently can open a new door to managing many other menopause symptoms and embracing healthier ageing in the years ahead.
