Libido and the Menopause: Why Desire Changes and What Helps

Desire often falls around the menopause: in a US study that followed 3,302 women, desire dropped and pain during sex rose by late perimenopause. The NHS lists HRT as the treatment for menopause-related loss of libido; testosterone can be prescribed by a specialist when HRT alone has not helped, and vaginal oestrogen treats dryness.^{1, 2, 3, 4} Part of the Wellgard libido guide and the Wellgard menopause guide.

Evidence at a glance

• Rests on: NICE NG23 (updated 15 April 2026), six NHS pages, a 2023 Cochrane review (36 HRT trials, 23,299 women) and a 2019 pooled analysis (36 testosterone trials, 8,480 women).^{3, 5, 6, 7}
• Largest single study: 3,302 US women followed through six annual visits.¹
• Strongest measured outcome: testosterone raised desire scores after the menopause (standardised mean difference 0.36, 2019 analysis of 36 trials); acne and hair growth more common.⁷
• Not tested: the long-term safety of testosterone for women beyond the trials.⁷

Sources checked on 14 October 2026.

Why does the menopause affect libido?

"Reduced sex drive (loss of libido)" is on the NHS list of menopause and perimenopause symptoms, and the NHS gives many reasons, "including relationship difficulties, how you feel about yourself, and physical discomfort".^{2, 8} Testosterone also falls at the menopause, "although this happens more gradually" than oestrogen, which the NHS links to tiredness, mood and sex drive.⁴ The best evidence is a US study of 3,302 women aged 42 to 52 followed through six annual visits: after adjusting for age, health and mood, desire fell and pain during sex rose by late perimenopause, while the transition itself was unrelated to arousal, satisfaction or pleasure; health, mood and how much sex mattered to a woman were linked to every outcome, and dryness and relationship change were also associated.¹ Sleep feeds in: perimenopause sleep problems.

Does HRT help libido?

The NHS names HRT as the treatment where the menopause is the cause.³ A 2023 Cochrane review pooled 36 randomised HRT trials in 23,299 women. Oestrogen alone "probably slightly improves" the sexual-function score against placebo or no treatment (standardised mean difference 0.60; nine trials, 1,307 women; moderate certainty), especially lubrication, pain and satisfaction; oestrogen with progestogen was tested in one trial of 104 women, so its effect is uncertain (very low certainty). No trial enrolled only women with sexual difficulties, and 19 of the 36 were commercially funded.⁶ The NHS says that under 60, with menopause symptoms and no high risk of breast cancer or blood clots, "the benefits of HRT are likely to outweigh the risks", and "Talk to a GP, who will help you decide."⁹

What about testosterone for women?

NICE NG23, recommendation 1.5.25 [2015], says to consider testosterone supplementation "for people with low sexual desire associated with menopause if HRT alone is not effective"; NICE notes this was off-label in November 2015, and means testosterone prescribed by a doctor, not a food supplement.⁵ The NHS says testosterone "is not currently licensed to treat symptoms of menopause", but that a specialist doctor "may be able to prescribe it for you", usually only if you are post-menopause, have problems with low sex drive and HRT alone has not helped. Acne, unwanted hair growth and weight gain are possible but "not common"; you wash your hands after use; and "Speak to a GP if you think you might benefit".⁴

A 2019 pooled analysis of 36 randomised trials in 8,480 women, publicly funded in Australia, found that after the menopause testosterone raised desire (standardised mean difference 0.36), added 0.85 satisfying sexual events a month and lowered distress; acne and hair growth were more likely, no serious adverse events were recorded, and tablets, not patches or creams, raised LDL cholesterol. Long-term safety, the authors say, still needs study.⁷ An international consensus endorsed by eleven societies, including the Royal College of Obstetricians and Gynaecologists, says the only evidence-based use is low desire with distress after the menopause.¹⁰

What helps vaginal dryness and painful sex after the menopause?

Lower oestrogen makes dryness more common, and it is treatable at any age. NICE 1.5.5 [2024]: "Offer vaginal oestrogen to people with genitourinary symptoms associated with menopause", including those on systemic HRT. It can be used alone or with non-hormonal moisturisers or lubricants, which are also an option alone (1.5.8, 1.5.9); vaginal prasterone (1.5.10) or oral ospemifene (1.5.11) may be considered where those fail or do not suit.⁵ The NHS says vaginal oestrogen "does not increase the risk of breast cancer, blood clots or other conditions", and moisturisers or lubricants are sold "without a prescription at a pharmacy".^{9, 11} See vaginal health after the menopause and vaginal dryness.

Can therapy or counselling help?

In a 2026 pooled analysis of 16 studies in 1,445 women around the menopause, psychological interventions raised sexual-function scores (standardised mean difference 1.37 across nine randomised trials): education programmes and counselling had large effects; CBT and mindfulness showed little effect where sexual function was a secondary outcome.¹² The NHS lists relationship counselling for relationship problems, and says CBT "can help with a low mood and feelings of anxiety".^{3, 11} Causes at any age: how to increase libido in women.

Do supplements help libido after the menopause?

No supplement is an alternative to HRT, and the NHS advises you to "talk to a doctor before taking herbal supplements or complementary medicines".¹¹ No botanical holds an authorised libido claim in Great Britain; every result below is a trial finding.

Ashwagandha's three menopause trials (100, 60 and 66 women, 8 to 12 weeks; one on an extract its manufacturer supplied) scored a menopause rating scale, not desire, and saffron's one (60 postmenopausal women, six weeks, university grant) scored hot flushes and depression; see ashwagandha for women.^{20, 21, 22, 23} Two women in the ginseng crossover had vaginal bleeding;¹⁴ the NHS says to see a GP for bleeding after the menopause "even if it's only a small amount or it's only happened once".²⁴ More trials are on libido supplements for women and which menopause supplements have evidence.

Does libido come back after the menopause?

For many women desire changes rather than disappears. In the six-year US study, what changed with the transition was desire and pain; satisfaction, pleasure and arousal did not.¹ The NHS routes are those above: dryness and pain, sleep and mood, HRT where it suits; the Cochrane gains were largest in lubrication, pain and satisfaction.^{3, 5, 6}

What we don't know

• The long-term safety of testosterone for women: the trials pooled in 2019 lasted 12 weeks or more.⁷
• No hormone-therapy trial in the Cochrane review enrolled only women with sexual difficulties.⁶
• No supplement trial in menopausal women that measured sexual function enrolled more than 116 women or ran beyond 120 days.^{17, 18, 19}
• Whether the late-perimenopause changes persist or ease years after the final period was not reported in the six-year study.¹

Frequently asked questions

Can you get testosterone on the NHS?

The NHS says a specialist doctor may prescribe it if you are post-menopause, have problems with low sex drive and HRT alone has not helped; it is not licensed for this use. Start with a GP.⁴

Is low libido in perimenopause normal?

It is common: reduced sex drive is on the NHS symptom list, and desire fell by late perimenopause in the 3,302-woman US study.^{1, 2} It is a problem only if it bothers you.

Does vaginal oestrogen help libido?

It treats dryness and pain, which NICE says it should be offered for; in the Cochrane review, oestrogen improved lubrication, pain and satisfaction more than desire.^{5, 6}

Why do I not want to be touched after the menopause?

The NHS names physical discomfort, how you feel about yourself and relationship difficulties among the reasons.⁸ Dryness and pain are treatable; a GP or menopause specialist can help.⁵

Sources

1. Avis 2009. Cohort, 3,302 women, 6 years; US NIH-funded. PubMed 19212271.
2. NHS. Symptoms of menopause and perimenopause. Page last reviewed 19 May 2026. nhs.uk.
3. NHS. Low sex drive (loss of libido). Page last reviewed 26 May 2026. nhs.uk.
4. NHS. Types of HRT. Page last reviewed 9 March 2023 (review overdue). nhs.uk.
5. NICE. Menopause: identification and management (NG23). Published 12 November 2015; updated 15 April 2026. nice.org.uk.
6. Lara 2023. Cochrane systematic review, 36 randomised trials, 23,299 women; 19 commercially funded. PubMed 37619252.
7. Islam 2019. Pooled analysis, 36 randomised trials, 8,480 women; Australian NHMRC-funded. PubMed 31353194.
8. NHS. Treatment for menopause and perimenopause. Page last reviewed 19 May 2026. nhs.uk.
9. NHS. Benefits and risks of HRT. Page last reviewed 8 February 2023 (review overdue). nhs.uk.
10. Davis 2019. Consensus statement, 11 societies. PubMed 31498871.
11. NHS. Things you can do to help menopause symptoms. Page last reviewed 19 May 2026. nhs.uk.
12. Green 2026. Systematic review, 16 studies, 1,445 women; 9 randomised trials pooled. PubMed 41401244.
13. Brooks 2008. Randomised crossover, 14 women, 6 weeks; US NIH grant. PubMed 18784609.
14. Oh 2010. Randomised crossover, 32 women, 8 weeks; funding not checked. PubMed 20141583.
15. Lee 2022. Systematic review, 15 trials; 3 pooled for sexual function, 491 women. PubMed 35691259.
16. Sha'ari 2021. Pooled analysis, 20 studies. PubMed 34638031.
17. de Souza 2016. Randomised trial, 45 women, 120 days; funding not checked. PubMed 27760089.
18. Steels 2017. Randomised trial, 115 women, 12 weeks; funding not checked. PubMed 28707431.
19. Mazaheri Nia 2021. Randomised trial, 116 women; funding not checked. PubMed 34311679.
20. Gopal 2021. Randomised trial, 100 women, 8 weeks; funding not checked. PubMed 34553463.
21. Vani 2026. Randomised trial, 60 women, 8 weeks; no funding declared; extract supplied by its maker, no conflicts declared. PubMed 41561822.
22. Obhrai 2026. Randomised trial, 66 women, 12 weeks; funding not checked. PubMed 42742071.
23. Kashani 2018. Randomised trial, 60 women, 6 weeks; university grant. PubMed 29332222.
24. NHS. Postmenopausal bleeding. Page last reviewed 24 September 2026. nhs.uk.

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