Sexual health & libido
Low libido, painful sex, arousal that's gone quiet — sexual symptoms are among the most common and least discussed parts of hormonal change. They have causes, the causes have treatments, and no, you shouldn't just accept it.
See a GP or one of our specialists if:
- sex is painful
- you have bleeding after sex
- changes to your desire or comfort are affecting your relationship or wellbeing
Bleeding after sex should always be checked, even if it happens only once.
Why desire changes at midlife
Libido sits at a crossroads: hormones, tissue comfort, sleep, mood, stress, body image and the relationship itself all feed it — and midlife can disturb every one at once. Falling oestrogen thins genital tissue and makes sex uncomfortable; broken sleep and low mood flatten desire from above; testosterone — which women produce too, and which contributes to desire and arousal — declines gradually with age.
Two clinical points matter before anything else. First, the distinction that decides treatment: desire that is low and distressing to you deserves assessment; there is no “normal” amount of interest you’re obliged to have. Second, order of operations: if sex hurts, treat that first — desire rarely survives pain, and no libido treatment outruns dyspareunia.
Comfort first: treating the physical barriers
Painful sex at midlife is usually genitourinary syndrome of menopause — thinning, drying tissue that responds well to local vaginal oestrogen, with good lubricants alongside and pelvic health physiotherapy where muscles have learned to guard. Restoring comfort is the non-negotiable first step, and for a meaningful number of women it quietly resolves the “libido problem” by itself: desire returns when sex stops hurting.
Alongside comfort, the systemic picture: getting HRT right lifts the floor under everything — sleep, energy, mood — and each of those feeds desire more than any single targeted treatment.
Testosterone for women — the honest version
Where desire remains low and distressing despite comfortable sex and optimised HRT, testosterone is worth considering. Women make testosterone; levels halve between the 20s and menopause. UK specialists can prescribe it off-licence for low sexual desire within established guidance, aiming to restore — not exceed — normal female levels, with blood-level monitoring to keep it there.
The honest version: evidence supports benefit for desire and arousal in the right women; it is not an energy-and-everything tonic, results take a few months to judge, and it isn’t right for everyone. That’s precisely why it’s a specialist decision — covered in detail in our review of what the clinical data actually shows.
The threads hormones can't reach
Sometimes the assessment points elsewhere: a relationship where desire’s disappearance is information; body image in a changing body; the sheer unsexiness of exhaustion, caring loads and midlife logistics; medications (including some antidepressants) with sexual side effects worth reviewing. Psychosexual and psychological support is treatment in its own right here — not a consolation prize — and pretending hormones explain everything serves nobody.
A good specialist assessment holds all the threads at once, then pulls the ones that are actually yours.
Sound familiar?
Our specialists assess and treat sexual health & libido at 8 UK clinics and online.
How we treat it
- Specialist consultation An unhurried, unembarrassable assessment of every thread — hormonal, physical, psychological, relational. About consultations
- Comfort first: local oestrogen Treating GSM so sex stops hurting — the step everything else depends on. About consultations
- Testosterone (where appropriate) For persistent, distressing low desire despite optimised HRT — prescribed and blood-monitored within specialist guidance. About consultations
- Psychology & psychosexual support For the threads hormones can't reach — as treatment, not consolation. About psychotherapy & psychosexual medicine
Specialists in this area
Frequently asked questions
Why is my libido low on HRT?
Worth unpicking rather than accepting: sex may still be uncomfortable (local oestrogen fixes what systemic HRT doesn’t), sleep or mood may still be depleted, a medication may be interfering, or testosterone may be the missing piece. A structured review usually finds a next step.
Can women take testosterone?
Yes — women produce it naturally, levels fall with age, and UK menopause specialists can prescribe it off-licence for persistent, distressing low desire despite optimised HRT. Treatment aims to restore normal female levels, with blood monitoring. It helps the right women; it isn’t a universal fix.
How can I increase libido during menopause?
In order: make sex comfortable (treat GSM), rebuild the foundations (sleep, mood, energy — often via getting HRT right), review medications with sexual side effects, consider testosterone where distressing low desire persists, and take the relationship and psychological threads seriously. The sequence matters more than any single remedy.
Is it normal to lose interest in sex at menopause?
It’s common — hormonal, physical and life factors all converge — but “common” doesn’t mean compulsory or untreatable. The clinical line is distress: if the change bothers you, it deserves assessment and treatment, not acceptance.
Does painful sex cause low libido?
Very reliably — the brain doesn’t sustain desire for something that hurts, and anticipation of pain suppresses arousal in its own right. That’s why comfort is treated first, and why treating it often restores desire without any libido-specific treatment at all.
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