Have you noticed changes in your sexual desire during midlife? You’re not alone. In my work with women in this stage of life, I often see how hormonal fluctuations during perimenopause and menopause can have a real effect on their libido.
That’s why understanding why and how these changes happen in your body can empower you to take control of your sexual health. In this blog, we’ll explore how hormones affect libido, the role of neurotransmitters, and actionable steps to manage these changes.
Key Hormonal Changes
Hormones play a central role in regulating sexual desire, and midlife brings significant shifts that can affect libido. Here’s a breakdown of the most important hormonal changes:
1. Oestrogen’s Role
Oestrogen is often referred to as the “female hormone” because it supports reproductive health, vaginal health, and sexual function. During perimenopause—the years leading up to menopause—oestrogen levels become unpredictable, fluctuating between sudden highs and precipitous lows (1). These hormonal roller-coaster fluctuations can contribute to irregular menstrual cycles, mood swings, and shifts in libido.
As perimenopause moves into menopause, oestrogen levels drop and then stay consistently low after menopause. This long-term drop can affect the body in several ways:
Vaginal Dryness
Oestrogen normally helps keep the vaginal tissues healthy and well-lubricated by increasing blood flow. When oestrogen drops, those tissues become thinner, drier, and more fragile, which can cause discomfort or pain during sex (2).
Reduced Arousal and Desire
Oestrogen also affects how the brain processes motivation and pleasure by supporting the action of a brain chemical called dopamine.
Dopamine is involved in feelings of reward and motivation. It plays a role in helping people feel interest and enjoyment—whether that’s about food, music, achievement, or intimacy. Oestrogen helps the brain respond to dopamine more effectively. It does this by making dopamine receptors in the brain more sensitive in key areas involved in emotion and motivation, including the prefrontal cortex and the amygdala.
When oestrogen levels are high and stable, the brain is more responsive to pleasurable experiences, increasing interest in sex. During perimenopause and menopause, declining oestrogen weakens dopamine signaling in reward pathways, reducing sexual motivation and desire (3).
In short, the drop in oestrogen during midlife doesn’t just affect the body—it also affects how the brain responds to intimacy and connection. This helps explain why many women experience a shift in sexual motivation during this time. It is not simply emotional or relational but rooted in real biological changes.
2. Testosterone Dynamics
Testosterone isn’t just a “male hormone.” Testosterone is the most abundant biologically active sex steroid in women throughout their lifespan, and you may be surprised to know that levels exceed estradiol by up to 10-fold. Testosterone levels peak during a woman’s 20s but gradually decline by approximately 50% by the time she reaches her 40s (4)(5). By menopause, testosterone levels are about one-quarter of their peak levels (6).
It plays a vital role in female sexual desire by enhancing motivation and arousal. It regulates sexual motivation, arousal, and mood via dopamine pathways in the brain’s reward system (7). Research shows that testosterone therapy may improve libido in some women, but its use should be carefully monitored due to potential side effects (8).
3. DHEA’s Subtle Impact
Dehydroepiandrosterone (DHEA) is a precursor hormone that helps produce both oestrogen and testosterone. While DHEA supplementation has shown modest benefits for improving libido in postmenopausal women, results vary widely depending on individual factors (9). Some studies suggest DHEA may improve sexual satisfaction and mood (10), but others report limited effects when used alone (11).
Symptoms You Might Notice
Hormonal changes during perimenopause and menopause don’t just affect libido—they can also cause physical discomfort or emotional challenges that impact intimacy. Common symptoms include:
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- Vaginal dryness or pain during intercourse due to reduced oestrogen levels (12).
- Decreased genital blood flow leading to reduced sensitivity and arousal (13).
- Mood swings or irritability caused by fluctuating hormone levels (14).
These symptoms are common but manageable with appropriate treatment options.
What You Can Do
Managing libido changes during midlife involves addressing both physical symptoms and emotional well-being. Here are some practical steps you can take:
1. Focus on Lifestyle Changes
Lifestyle adjustments can support hormonal health and improve overall well-being:
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- Regular exercise (as explored in our blog Let’s Move It: Maintaining Your Healthy Body in Midlife) boosts blood flow and improves mood through endorphin release (15).
- Stress management techniques like yoga (read our blog to learn what benefits you can get from yoga in midlife) or meditation can help regulate cortisol levels that interfere with libido (16).
- A 2021 randomised clinical trial in postmenopausal women with low zinc levels found that zinc supplementation (30 mg/day for 12 weeks) significantly increased testosterone levels and improved sexual function (desire, arousal, orgasm, satisfaction).Total FSFI (Female Sexual Function Index) scores improved by 67% compared to controls (17). Zinc-rich foods include oysters, red meat, poultry, beans and nuts. Supplementation may be particularly beneficial for individuals with marginal or severe zinc deficiency but should be approached cautiously to avoid toxicity. In Australia, the tolerable upper intake level (UL) for zinc is 40 mg/day for adults as exceeding this limit may lead to adverse effects such as copper deficiency, immune suppression, and reduced HDL cholesterol levels (18) (19).
2. Consider Hormone Therapy
Hormone therapy can help restore balance by supplementing oestrogen or testosterone levels.
Options include:
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- Topical oestrogen creams for vaginal dryness (20).
- Low-dose testosterone gel for improving libido under medical supervision (21) (22).
3. Strengthen Emotional Intimacy
Open communication with your partner about changes in your body can foster emotional connection and improve physical intimacy.
Final Thoughts
Navigating the shifts in libido during midlife can feel confusing, but you’re not imagining it—your body is going through real, measurable changes. Speaking with an expert in midlife health and wellness, along with understanding how hormones like oestrogen, testosterone, and DHEA influence your sexual health, can give you the clarity and confidence to make informed decisions about your well-being.
This chapter of life doesn’t mean letting go of desire or connection. With the right knowledge, support, and care, there are many ways to feel more in tune with your body again—whether that’s through lifestyle changes (as explored in our Living Vibrantly: Nourishing Your Mind, Body, and Soul blog), hormone therapy, or simply acknowledging what you need emotionally and physically.
Looking to feel more prepared for that next doctor’s visit? Download our free brochure: Questions to ask your healthcare provider about hormone therapy options.
It’s designed to help you advocate for your health with clarity and confidence.
References
[1] Davis, S. R., et al. (2005). Circulating androgen levels and self-reported sexual function in women. JAMA, 294(1), 91–96.
[2] Santoro, N., et al. (2016). Vaginal estrogen for genitourinary syndrome of menopause. Menopause, 23(3), 243–253.
[3] Davison, S. L., et al. (2005). Androgen levels in adult females: Changes with age, menopause, and oophorectomy. Journal of Clinical Endocrinology & Metabolism, 90(7), 3847–3853.
[4] Santoro, N., et al. (2021). Menopause and the brain: Estrogen’s role in cognition and mood. Menopause, 28(6), 691–699.
[5] Australasian Menopause Society. (2024). Testosterone and women.
[6] Zumoff, B., et al. (1995). Subnormal plasma testosterone levels in women over 40. Journal of Clinical Endocrinology & Metabolism, 80(2), 703–706.
[7] Del Río, J. P., Alliende, M. I., Molina, N., Serrano, F. G., Molina, S., & Vigil, P. (2018). Steroid Hormones and Their Action in Women’s Brains: The Importance of Hormonal Balance. Frontiers in public health, 6, 141.
[8] Yang, J., et al. (2024). Estrogen receptor density in the female brain: Associations with sexual motivation during menopause. Scientific Reports, 14(1), 6789.
[9] Davis, S. R. (2020). Testosterone in women—the clinical significance. The Lancet Diabetes & Endocrinology, 8(12), 980–990. (15)00284-3
[10] https://www.healthline.com/health/womens-health/low-estrogen-symptoms
[11] https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause
[12] Santoro, N., et al. (2016). Vaginal estrogen for genitourinary syndrome of menopause. Menopause, 23(3), 243–253.
[13] Leiblum, S., et al. (2001). Decreased circulating levels of estrogen alter vaginal and clitoral blood flow in postmenopausal women. Journal of Sexual Medicine, 38(5), 483–490.
[14] Freeman, E. W., et al. (2004). Hormones and mood during the menopausal transition: Findings from the Penn Ovarian Aging Study. Archives of General Psychiatry, 61(4), 372–380.
[15] The Effect of Exercise on Cerebral Blood Flow and Executive Function. (2023). Frontiers in Human Neuroscience, 17(315), 1–10.
[16] Yoga, Meditation, and Mind-Body Health: Increased BDNF, Cortisol Regulation, and Stress Resilience. (2017). Frontiers in Human Neuroscience, 11(315), 1–12.
[17] Mazaheri Nia, L., Iravani, M., Abedi, P., & Cheraghian, B. (2021). Effect of Zinc on Testosterone Levels and Sexual Function of Postmenopausal Women: A Randomized Controlled Trial. Journal of sex & marital therapy, 47(8), 804–813.
[18] National Health and Medical Research Council (NHMRC). (2006). Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes.
[19] Eat for Health – Zinc Fact Sheet. (2024). Australian Government Department of Health.
[20] Simon, J., et al. (2018). A randomized, multicenter, double-blind study to evaluate the efficacy of low-dose estradiol vaginal cream for vulvovaginal atrophy symptoms. Menopause, 25(3), 301–307.
[21] Davis, S. R., et al. (2019). Global consensus position statement on testosterone therapy for women. The Lancet Diabetes & Endocrinology, 7(10), 754–766.
[22] Kingsberg, S., et al. (2014). Testosterone therapy improves sexual function in postmenopausal women with HSDD: A randomized controlled trial. Journal of Clinical Endocrinology & Metabolism, 99(9), E1893–E1900.
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