Menopause can cause an increase in sex drive or a decrease as hormone levels fluctuate, but very often it’s the symptoms of menopause — mood swings, weight gain, hot flashes and vaginal dryness — that can leave you uninterested in sex.

Published: July 26, 2022 | Updated: August 10, 2022

Menopause can cause an increase in sex drive or a decrease as hormone levels fluctuate, but very often it’s the symptoms of menopause — mood swings, weight gain, hot flashes and vaginal dryness — that can leave you uninterested in sex.

Lower estrogen levels can lead to vaginal dryness as blood supply to the vagina drops, thinning the vaginal wall and causing a general tightness. The result can be penetrative sex that’s uncomfortable or even painful (dyspareunia).

To understand your condition, your gynecologist will collect your health and sexual history, perform a pelvic exam and may order blood tests to check hormone levels and any disorders with the thyroid or liver and to look for diabetes and high cholesterol.

Hormone therapy such as estrogen can address changes to the vagina. Testosterone in women is not approved by the Food and Drug Administration (FDA) and can have significant detrimental side effects.

“Keep in mind that if a partner is using medication for erectile dysfunction, they could be adding to the discomfort. A more robust erection is not a good combination with vaginal atrophy and the thinner, dryer and inflamed vaginal walls that come with it,” said Amy E. Farrell, M.D., a gynecologist with Norton Women’s Health.

“If vaginal dryness is an issue, you may use a daily moisturizer that is safe for the vaginal area. Lubricants may also be used with intercourse to decrease friction and improve sensation,” Dr. Farrell said.

Counseling also can help with sexual conditions and low sex drive. Counseling typically will cover understanding sexual response and techniques. Addressing relationship issues may also help increase feelings of intimacy and desire.

Hypoactive sexual desire disorder

If the condition is a total loss of interest in sex — hypoactive sexual desire disorder — there are some new medications available.

Two new drugs include bremelanotide (Vyleesi) and flibanserin (Addyi). Vylessi was approved by the FDA in 2019 and is taken as an injection 45 minutes before anticipated sexual activity. It has been shown through clinical trials to increase desire and satisfaction. Addyi was approved in 2015 and targets serotonin receptors. It’s a daily pill that will interact with alcohol and can cause sleepiness and fainting.