How to Increase Libido During Perimenopause: Causes, Natural Remedies, and Treatments

If you’ve noticed that your sex drive has gone MIA in your forties, you may take some comfort in knowing that you’re not alone, and it’s completely normal. Many women experience changes in libido during perimenopause (the years leading up to menopause) thanks to a mix of hormonal, emotional, and physical changes. 

Fluctuating hormone levels, vaginal dryness, mood swings, fatigue, and stress are hardly a turn-on. The good news is that entering perimenopause doesn’t mean saying goodbye to a satisfying sex life. It might take some getting used to, but there are natural remedies and medical treatments that can help you find your libido again. Keep reading to learn how to increase libido during perimenopause.

Why does libido change during perimenopause?

Perimenopause is the transitional phase before menopause, often beginning in the late 30s or 40s, when hormones like estrogen, progesterone, and testosterone start to fluctuate and decline. These hormonal shifts can affect everything from vaginal comfort to mood and sleep, all factors closely tied to sexual desire.

But hormones aren’t the whole story. Physical symptoms, emotional well-being, and relationship factors also influence libido. For some, stress or fatigue may be the bigger culprit than hormone levels themselves.

Sexual dysfunction (when someone experiences challenges with any part of their sex life — like desire, sexual arousal, pleasure, or reaching orgasm) is pretty common in perimenopause. Around 40-55% of perimenopausal women report low sexual desire. This change can be attributed to a mix of physical and emotional factors. Here’s a brief overview of why sexual desire may decrease during perimenopause:

• Declining estrogen levels can lead to reduced blood flow and lubrication in vaginal tissues, resulting in dryness and painful sex.
• Fluctuations in testosterone levels can affect sexual desire and arousal.
• Changes in progesterone and estrogen may contribute to fatigue due to poor sleep, as well as hot flashes and night sweats.
• Factors such as stress, relationship issues, or low self-esteem can also play a role.
• Certain medications (like antidepressants) and chronic health conditions may further impact sexual desire.

Sex drive changes during perimenopause are quite normal and can vary from person to person. It’s all about how different factors come together, making this experience unique for everyone.

Natural ways to increase libido during perimenopause

Addressing low libido in perimenopause often starts with lifestyle and self-care. While medications can be incredibly effective for managing perimenopause symptoms like hot flashes and vaginal discomfort, most doctors also encourage lifestyle strategies alongside treatment. 

Exercise, stress management, quality sleep, and a nutrient-rich diet not only support overall health but can enhance the effectiveness of medical therapies. Taking a holistic approach by addressing both body and mind often leads to the best results, helping women feel more energized, comfortable, and connected in their sexual and everyday lives.

Exercise 

Exercise is one of the most powerful libido boosters: it increases blood flow, which enhances arousal, and also releases endorphins that improve energy and mood. Resistance training can help preserve muscle mass as estrogen declines, while aerobic exercise supports heart health and stamina. Even activities like yoga or pilates may help by improving pelvic floor strength, which can make sex feel more pleasurable. Importantly, exercise also supports confidence in your body — an often-overlooked driver of desire.

Stress management 

Stress is a well-known sex drive dampener. High cortisol levels can interfere with hormone balance and make it harder to feel desire. Emerging evidence suggests that mindfulness can be helpful in improving sexual well-being. One goal of mindfulness is to enhance awareness, which may reduce distraction — a factor that can negatively affect sexual function, mood, and self-esteem. Practices like meditation, journaling, or simply taking a mindful nightly walk with your partner give your nervous system a chance to reset. Relaxation also strengthens emotional connection, helping intimacy feel more present and enjoyable.

If stress or anxiety feels overwhelming, therapy or counseling (whether with a couple’s therapist or sex therapist) can provide deeper support and help reframe negative thought patterns around sex.

Sleep and energy levels

Sleep disruptions like night sweats, hot flashes, or insomnia are notorious in perimenopause and can leave you too tired for intimacy. Quality sleep helps regulate sex hormones, boosts mood, and restores energy. Create a sleep-friendly environment: keep your bedroom cool, reduce caffeine and alcohol, and try relaxation rituals like reading or a warm bath before bed. If sleep issues persist, talk with your healthcare provider about options like cognitive behavioral therapy for insomnia (CBT-I) or targeted treatments for night sweats.

Nutrition and hydration

Your diet directly impacts hormones, energy, and even vaginal health. Aim for nutrient-dense foods like leafy greens, omega-3-rich fish, nuts, and whole grains to boost your mood and keep your blood sugar steady. Staying hydrated is super important, too, since not drinking enough can lead to dryness and tiredness. Cutting back on alcohol can help you sleep better, feel better, and improve circulation, which are all key to sexual health.

Intimacy and relationship practices

Desire isn’t only physical, it’s deeply emotional. Open communication about your needs, preferences, and any discomfort can reduce performance pressure and make intimacy more fulfilling. Explore new ways of being close, like prioritizing foreplay, massage, or non-penetrative touch, which can rebuild sexual desire and pleasure. Scheduling sex might sound unsexy, but for many couples, it helps keep intimacy a priority. If challenges persist, couples therapy or sex therapy can offer tools to deepen closeness.

Vaginal moisturizers and lubricants

Vaginal dryness occurs when there's a decrease in estrogen levels, which leads to the thinning and drying of the vaginal tissues. As a result, many women experience discomfort, pain, and even bleeding during sex.

If you're experiencing vaginal dryness, over-the-counter lubricants and vaginal moisturizers, like Evvy’s Hyaluronic Acid Suppositories, can really make a difference. These moisturizers are perfect for daily use and help keep things hydrated, while lube offers short-term relief during sex (realistically, everyone can benefit from using lube!).

Can lifestyle changes really improve perimenopausal libido?

Yes, research suggests that lifestyle adjustments — especially regular exercise, stress management, and improved sleep — can make a real difference in sex drive during perimenopause. Physical activity has been linked to better body image and increased sexual function, while stress reduction techniques help lower cortisol levels that interfere with desire. Adequate rest not only reduces fatigue but also balances mood-regulating hormones.

That said, improvements are often gradual and may be modest. For some women, addressing lifestyle alone won’t fully resolve low libido, especially if vaginal dryness or hormonal changes are the main drivers. In these cases, natural strategies work best as part of a broader plan that may include medical treatments. The key takeaway is that small, consistent changes can improve overall well-being, and that often translates into a healthier, more satisfying sex life.

Medical treatments for low libido during perimenopause

If lifestyle changes aren’t enough, medical treatments can help. The right option depends on whether discomfort, hormones, or mood are the main barriers.

Vaginal estrogen for dryness and pain

Localized estrogen therapy (such as creams, tablets, or rings) works directly on vaginal tissues to restore elasticity, thickness, and vaginal lubrication. By easing dryness and pain during sex, vaginal estrogen can reduce the anxiety that dampens desire for sex and help intimacy feel pleasurable again. Research shows that estrogen therapy can improve sexual desire, arousal, and sexual satisfaction. Because it delivers low doses directly to the tissues, it has fewer systemic effects than hormone replacement therapy.

Other medical options include:

• Hormone replacement therapy (HRT): Hormone replacement therapy can help address low libido in perimenopause by stabilizing fluctuating estrogen and testosterone levels, reducing vaginal dryness and discomfort, and supporting mood and energy.
• Androgen therapy: Off-label testosterone prescriptions may be used for hypoactive sexual desire disorder (HSDD), though not FDA-approved for women in the U.S.
• Non-estrogen medications: Vaginal DHEA (Prasterone) and ospemifene are approved for genitourinary symptoms that affect sex.
• HSDD medications: Flibanserin (Addyi) and bremelanotide (Vyleesi) are FDA-approved for premenopausal women but not typically used during perimenopause.

Treatment should be individualized and closely monitored by a healthcare provider, because perimenopause affects every woman differently. Not everyone experiences the same symptoms or hormone shifts, and factors like age, medical history, and personal preferences all influence the best approach. Some women can’t take hormone-based therapies due to conditions like certain cancers, blood clot risks, or heart disease. In these cases, non-hormonal strategies — including lifestyle changes, vaginal moisturizers, or targeted medications — can be particularly important. A personalized plan ensures that perimenopause symptoms are managed safely and effectively, while supporting overall sexual health and wellbeing.

Key facts about libido during perimenopause

• Low libido is very common during perimenopause, affecting up to half of women.
• Desire changes are largely driven by hormonal shifts, but stress, fatigue, and self-image also play big roles.
• Vaginal dryness and discomfort are leading physical barriers to sexual pleasure.
• Lifestyle changes (exercise, nutrition, stress reduction) can help improve sexual wellbeing.
• Medical options exist, from vaginal estrogen to hormone therapy, for those needing more support.
• The vaginal microbiome may influence comfort, infections, and inflammation, which in turn affect sex drive.
• Decreased libido during perimenopause doesn’t mean it’s permanent, and many women regain desire after adjusting to this new phase.

Supporting your sexual health with Evvy

At Evvy, we believe sexual wellbeing is an important part of overall health. During perimenopause, the vaginal microbiome often shifts, including a decline in Lactobacilli, which can lead to increased dryness, irritation, or infections — all factors that directly impact comfort and desire. 

Testing with Evvy’s Vaginal Health Test gives you insight into the makeup of your microbiome and may help explain symptoms you’re experiencing. Evvy also offers targeted solutions, including probiotics to support healthy bacteria, Hyaluronic Acid Suppositories to improve vaginal lubrication, and Soothing Vulva Cream to ease external dryness and irritation. Together, these tools can make intimacy more comfortable and enjoyable during this transitional phase.

Whether you’re navigating hormonal changes, dryness, or shifts in libido, Evvy offers solutions to help you understand your body better. Knowledge is power pleasure.

FAQs about libido and perimenopause

What is the best natural female libido enhancer?

There isn’t one single “magic” natural enhancer, but a combination of healthy habits is often the answer. Regular exercise, balanced nutrition, and stress reduction techniques all help by supporting hormone balance, energy levels, and mood — all necessary components of a happy sex life. Vaginal moisturizers and lubricants can address vaginal dryness, while mindfulness practices and counseling can reduce mental barriers like anxiety, depression, and body image issues. Ultimately, the best natural enhancer is whatever makes you feel physically comfortable, emotionally connected, and confident in your own skin.

Will my libido come back after perimenopause?

For many women, yes. It’s normal for libido to ebb and flow at any point in life, and it’s especially common for it to fluctuate during the menopausal transition, but it doesn’t disappear permanently. Once hormone levels stabilize after menopause, symptoms like hot flashes and sleep disturbances often improve, which can restore energy and desire. Addressing vaginal dryness with moisturizers, lubricants, or localized estrogen also makes intimacy more comfortable, which can reignite your interest in sex. If low libido continues, medical treatments or therapy can provide additional support.

Can you have a higher libido during perimenopause?

Absolutely. While declining estrogen and testosterone often reduce sexual desire, not every woman experiences this. Some find that as fertility concerns fade, stress about an unplanned pregnancy goes away, making intimacy more enjoyable. Others feel more confident and liberated in midlife, especially if they’ve grown more comfortable with their bodies and sexual preferences. It’s a reminder that libido is highly individual, and while perimenopause may lower it for some, it boosts it for others.