Sexuality in Menopause

by Christiane Northrup, M.D.

Sex & Sexuality

Do you remember the first time you fell in love? Chances are, you thought you had discovered the moon and the stars. The lyrics to songs seemed to be written about you. And you probably didn’t even think about eating or sleeping. When a woman falls in love, she experiences an almost-overwhelming influx of energy, filling her with exhilaration, benevolence, vigor creativity, and often insatiable sexual desire.

This first-love feeling can be experienced at any life-stage or age when we are able to connect at a deeply emotional and spiritual level with another person. But at midlife, the challenge for most women is to be able to access that in-love feeling in ways other than looking to another person for fulfillment and gratification. In other words, if you think of sexual energy in the largest possible context — as life force, or Source energy — then it is easy to see that the health and vitality of our sexuality is inexorably linked to the health and vitality of our lives.

Listen to Your Body

It is a common misconception that sexual desire and activity inevitably decrease at menopause. Although this is true for some women, it certainly doesn’t have to be the truth for all. What we believe about sexuality at menopause has a lot to do with our sexual expectations and experience. And many women who are in the process of negotiating how to tap into their source energy at midlife notice a decrease in sexual desire. In one study 86 percent of women reported some form of sexual dysfunction, usually in the form of loss of sexual desire, often associated with vaginal dryness, dyspareunia (pain during intercourse), vaginismus (painful spasms in the vaginal muscles), loss of clitoral sensation, and touch sensation impairment. Whitehead1

Determining the cause of sexual problems can be difficult. Sometimes, menopause-related hormone deficiency is to blame. But sexual function is a complex, integrated phenomenon that reflects the physical health of not only the ovaries and hormone balance, but also the cardiovascular system, the brain, the spinal cord and the peripheral nerves. In addition, there are almost always underlying psychological, sociocultural, interpersonal and biological influences that affect individual sexual function. Interestingly, of the 14 percent of women in the study who reported no sexual problems, one-third admitted they had previously had sexual problems but that the problems had been resolved when they found new sex partners.

It is also important to note that health conditions and medications may also interfere with sexual functioning. Women suffering from gynecological problems, hypertension (high blood pressure), diabetes, chronic pain, alcoholism, drug use (including cigarette smoking), thyroid deficiency, or depression, as well as those who use anti-hypertensive medications, tranquilizers or sedatives, ulcer medications, glucocorticosteroids, antihistamines, or antidepressants may suffer some sexual dysfunction.

What Causes This

Are you worried about perimenopause and how it will affect your sex life? Many of the following midlife changes in sexual function have been associated with normal perimenopause:

  • Increased sexual desire
  • Change in sexual orientation
  • Decreased sexual activity
  • Vaginal dryness and loss of vaginal elasticity
  • Pain or burning with intercourse
  • Decreased clitoral sensitivity
  • Increased clitoral sensitivity
  • Decreased responsiveness
  • Increased responsiveness
  • Fewer orgasms, decreased depth or orgasm increase in orgasms, sexual awakening.

As you can see by this list, change itself, and not the nature of the change, is the common theme. It’s important to remember that during the perimenopausal transition, with all of its changes, a woman’s libido may go underground for a while as she reprioritizes her life and the manner in which she uses her energy. This is perfectly normal and can yield great dividends. But, it is only temporary. There is no reason for diminished sex drive to become permanent after menopause. And, while some women truly do notice a decline in libido at menopause, others actually experience heightened sexual desire and activity after menopause.

Spiritual and Holistic Options

Here’s how to keep your libido high after menopause:

  1. Overcome cultural barriers.
  2. Update your relationship. Communicating with your partner is the key to maintaining a healthy sexual relationship. While you may have a good relationship, it may be time to renegotiate some of the terms. Question what is no longer viable in your relationship and work with your partner on rekindling your passion together.
  3. Make time for yourself and your partner. It can be hard to make the transition from caring for everyone else to taking care of yourself. When you make time for yourself, and allow some time to connect with your partner, your passion for each other will return.
  4. Get your hormone levels checked. Androgens are the hormones associated with libido; however, declining levels of estradiol (E2) can also affect a woman’s potential for sexual arousal. Having a baseline panel is ideal; it may help you to know what your hormones levels are when your sex drive is normal for you, so that if and when you notice a change, you can test your hormones again to see if anything has changed.
  5. Try progesterone cream. A little progesterone cream is often all you need to restore your libido. As a precursor to estrogen and testosterone, progesterone is important in maintaining sufficiently high levels of the other hormones for optimal sexual pleasure. A normal balance of progesterone also acts as a mood stabilizer and supports normal thyroid function.
  6. Use over-the-counter lubricants. Regular intercourse, itself, helps keep the vaginal tissue strong and well-vascularized. However, some women experience uncomfortable vaginal dryness during menopause, even though their libido is fine. There are plenty of treatments that can help with this problem, including over-the-counter lubricants. Other solutions to vaginal dryness include estriol vaginal cream, or herbal remedies taken systemically, such as black cohosh, wild yam, Dong Quai or chasteberry. Vitamin E suppositories are also helpful.
  7. Exercise. There is hardly a menopausal symptom that exercise cannot help, including low libido.
  8. Tell the truth about your sexuality. All humans are sexual by nature. How you choose to express your sexuality depends upon many factors including your upbringing, your hormones levels, your general overall health, and your level of satisfaction with your current partner, if you have one.
  9. Read Hot Monogamy, by Dr. Patricia Love. Dr. Love has identified nine factors that can help sustain libido and cultivate a sensual relationship with your partner and yourself.


  1. Sarrel, P. & Whitehead, M.I. (1985). Sex and menopause: Defining the issues. Maturitas, 7 (3), 217–224.

Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Ronna
    10 months ago

    Can you recommend a good natural lubricant for a new relationship?

    1. Esperança Melo
      2 months ago

      Coconut oil works wonders and it´s an edible product so it doesn´t contain all the chemicals found in specialized products, and it´s a lot cheaper!

  2. Kay
    1 year ago

    I haven’t had a period for over a year and a half. I am 55 and decided that I can’t get pregnant at my age so now my husband and I use no means of birth control.
    Is this ok?

  3. Deb Robbins-Madone
    2 years ago

    No mention of circumcision of the male partner as the primary cause of painful burning intercourse! You need to check this out–with an intact partner there is no discomfort during sex!

  4. Paula
    2 years ago

    I want an organic and safe herb or supplement to help with an extremely low libido. I don’t want to take any hormones as they really scare me to death. How do I research my options?

  5. Cheryl
    2 years ago

    From HayHouse radio program, I thought I heard you promote a product for male sexual health. I believe it was called Thor? Where would I find it?

  6. Susan Cook
    2 years ago

    Hello. I have been an admirer of yours for years. Thank you for sharing your knowledge. How do you pick a progesterone cream? There are SO may on the market. I want help with my libido. I am 55 years old and post-menopausal. thank you very much, Susan Cook

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