Low Sex Drive After Menopause: When It's a Problem, and When It Isn't

Wanting sex less often after menopause is common. Being bothered by it is a separate question, and it’s the one doctors ask.

The share who minded went the other way:

Women with low desire who were distressed by it1	Europe	US
Age 20 to 29	65%	67%
Age 60 to 70	22%	37%

Because more women had low desire but fewer were upset about it, the share with the disorder stayed about the same at every age: 6% to 13% in Europe and 12% to 19% in the US.¹

How doctors draw the line

• Distress is part of the definition. ACOG² describes female sexual dysfunction as conditions marked by “reported personal distress” in desire, arousal, orgasm or pain.² Hypoactive sexual desire disorder (HSDD) is diagnosed only when low desire and distress come together.¹
• About 10% of adult women have HSDD, according to the International Society for the Study of Women’s Sexual Health.³
• Problems are more common than distress. In a US survey of 31,581 women, 43.1% reported a sexual problem, 22.2% reported distress about sex, and 12.0% had both. That figure peaked at 14.8% in women aged 45 to 64 and fell to 8.9% after 65.⁴

What these surveys can’t tell you

• They’re snapshots, so they can’t show how one woman’s desire changes over time.¹⁴
• The US survey counted all sexual problems together, not low desire alone.⁴
• The international study only included women in sexual relationships.¹

If it bothers you

The distress can be your own, or it can be friction with a partner. The flibanserin label counts both “marked distress” and “interpersonal difficulty.”⁵

• Raise it yourself. ACOG² notes that women rarely bring it up unless asked.²
• Start with what can change. Distressing sexual problems were linked with depression, anxiety, thyroid conditions and urinary leaks.⁴ Medicines count too: see antidepressant side effects and what helps. Pain or dryness can dampen desire, so see why sex hurts.
• Sex therapy comes before pills in the expert pathway. It includes behavior therapy, cognitive behavioral therapy and mindfulness.³
• Medicines are for distressing low desire with no other cause. Flibanserin is now approved for women under 65 with HSDD that isn’t due to another medical or psychiatric condition, relationship problems or a medicine.⁵ See our flibanserin label checks. Testosterone after menopause is supported by data but not FDA-approved for women.³ See testosterone review questions.

Try: “My interest in sex has dropped since menopause, and it bothers me. Before we talk about treatment, can we look at my medicines, my mood, my thyroid and any pain?”

Down There, Decoded answers this in Chapter 9, “Where Did My Desire Go?”, with one sorting question: does this bother you? Its Down-There Log keeps three notes for each change: what changed, when it changed, and what you’ve tried. See the book.