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Private guide · 5 min read
Desire, Hormones & Medications
Low desire is common in midlife, rarely discussed, and usually has more than one cause.
By Julie Murphy, FNP-BC, PMHNP-BC, MSCP
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Low desire is one of the most common concerns in midlife and one of the least talked about. It is rarely just "in your head" and rarely just a relationship problem. Most of the time, several things are stacking up at once.
What can lower desire
- Hormonal: falling estrogen can cause vaginal dryness and thinning tissue, which makes sex uncomfortable or painful. Testosterone also declines gradually with age.
- Medications: SSRIs and SNRIs commonly reduce desire, arousal, or orgasm. Some blood pressure medicines and hormonal contraceptives can too.
- Exhaustion, stress, poor sleep, and low mood
- Body changes and how you feel about them
- Relationship dynamics and context
What helps
- Address pain first. Vaginal moisturizers and lubricants help, and low-dose vaginal estrogen is very effective with minimal absorption into the rest of the body.
- Pelvic floor physical therapy for pain or tension
- Systemic hormone therapy can help some women
- Testosterone: international guidelines support a trial for postmenopausal women with low desire that causes distress, though there is no FDA-approved product for women in the U.S.
- If an antidepressant is the cause, there are options to discuss with your prescriber, such as adjusting or switching
- Sex therapy or mindfulness-based approaches, alone or with a partner
Questions to ask your clinician
- Could any of my medications be affecting my desire?
- Is low-dose vaginal estrogen right for me?
- Am I a candidate for testosterone therapy?
- Would pelvic floor physical therapy help?
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