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Menopause and Sex: How to Reignite Your Passion!

Just Because You Are Going Through Menopause Does Not Mean That Your Sex Life is Over!

Menopause and sex CAN go together with ease, despite what you might have heard. After all, it’s no wonder that women can lose their sex drive when hormones start to decline! Mental and physical changes can be unpleasant, and those can cause you to lose your desire for sex.

It’s easy to fall into the trap of feeling hopeless about your sex life, which may cause you to lose the vitality that you once had. Sex isn’t just about physical pleasure. It’s also a special way to experience emotional and physical intimacy with your partner. When you are having intimate sex, the feel-good hormones are released into your system such as dopamine and oxytocin.

These are good for your health and well-being. Sex also benefits your cardiovascular system. We understand that it’s not all about sex. It’s also the way you FEEL as you’re going through this time of your life. Many women, just like yourself, may feel like the “old” you are gone, but that’s not the case! Mid-life can be a beautiful time and give you more wisdom and confidence than you’ve ever had before. Not only that, but you can also feel more comfortable with your sex life than ever!
asian middle aged couple

The “Change”

As you enter mid-life, hormone levels begin to fluctuate and decline. This can affect the quality of your sex life along with other aspects of your health and well-being. Fortunately, times have changed considerably! You have a lot more options including bioidentical hormone replacement therapy.

Depending on your age, you may remember your mother or grandmother talking about “the change” and how old it made them feel. This is not the case anymore!

You might be wondering how you know that you are in menopause. It is more of a process than a one-time event. For example, “menopause” is defined as the cessation of menses. You are technically menopausal one year after you had your last menstrual cycle.

However, this process of hormonal changes can take some time. The time frame leading up to menopause is referred to as perimenopause and it’s a natural form of aging.

Perimenopause can happen over a period of just a few years for some, or it can take several years, each person is different. In general, the hormones that will decline are estrogen, progesterone, and testosterone.

Other Factors Can Hasten Onset of Symptoms

While the process of perimenopause to menopause is generally gradual, there are some factors that can bring on symptoms more suddenly including:

  • Smoking
  • Obesity
  • Diabetes and other chronic health conditions
  • Insulin Resistance
  • Family history of earlier menopause
  • Cancer – some cancer drugs cause the ovaries to stop producing hormones.
  • Hysterectomy – A hysterectomy will cause you to experience full-on menopausal symptoms just weeks after your surgery (especially if you have had your ovaries removed).

How Hormones Affect Your Sex Life

Hormones affect your overall health and mental state. You may feel like you no longer desire your partner or even dislike them. Please know that it is the decline in hormones that is causing you to feel that way. We want to reassure you that you are not crazy, even though you may feel that way at times!

There is hope and relief available for you at our clinic in Austin. Our providers are all expertly trained in bioidentical hormone therapy. They can look at your hormone levels and symptoms and help you get your vitality back…including your sex life!

What Causes Hormones to Decline?

  • Age
  • Lifestyle
  • Diet
  • Illness
  • Stress levels

Hormone Balancing

Women only need a small amount of testosterone supplementation compared to men. Most report feeling like their old selves again after just a few weeks with increased mood and motivation. Other hormonal shifts occur in the perimenopause and menopausal stages of life such as decreased progesterone and estrogen. All hormone levels should be tested for optimal health and well-being.

Symptoms of Perimenopause/Menopause Can Include:

  • Loss of the desire to have sex (libido)
  • Painful sex
  • Less frequent or weaker orgasms
  • Loss of muscle mass
  • Irregular or heavier periods
  • Brain fog
  • Irritability
  • Hot flashes and night sweats
  • Anxiety and/or depression
  • Weight gain
  • Loss of muscle mass
  • Decreased ability to handle stress
  • Insomnia
  • Excessive hair growth in unwanted places
  • Loss of energy
  • Hair loss
  • Heart palpitations
  • Changes in skin texture


While estrogen is the “primary” female hormone, progesterone and testosterone are equally important. All the cells in the vagina have both estrogen and progesterone receptors.  Estrogen is the hormone that keeps the vagina elastic, moisturized, and well-supplied with blood flow.

Estrogen levels start to fluctuate and decline during perimenopause. These fluctuations can happen in an irregular manner. This is why you may start to experience irregular or heavier periods during perimenopause.

Lower estrogen levels can cause the internal environment in the vagina to change. You are likely to experience symptoms such as vaginal dryness, atrophy, itchiness, burning, and painful sex. Sex may not be as pleasurable since dryness and atrophy can cause it to be painful.


Estrogen and progesterone complement each other. Starting in perimenopause, progesterone levels can wane before estrogen. When you don’t have enough progesterone, estrogen dominates. A lot of women do not realize that estrogen dominance is the cause of symptoms such as:

  • Low sex drive
  • Vaginal dryness
  • Depression/mood swings
  • Heavy bleeding
  • Irregular periods
  • Insomnia

As progesterone levels fall in perimenopause, estrogen can start to spike. This can cause additional issues such as thickening of the uterine lining, creating fibroids, or even causing endometriosis. Estrogen dominance can also cause periods to become much heavier with clotting.


Testosterone is a hormone that is directly related to libido. It’s a myth that only men have testosterone; women produce it too, just at much lower levels. Unlike progesterone and estrogen which fluctuate and decrease during perimenopause, testosterone is a more gradual decline.

For both men and women, testosterone usually peaks in the late twenties to early thirties and then gradually starts to wane. On average, women’s testosterone levels at age 50 will be about half of what they were in their twenties.

If a woman has had a hysterectomy, that can contribute to low testosterone (especially if the ovaries are removed). If you’ve had a hysterectomy, chances are that you have been thrown into full-blown menopause within a very short time and your symptoms are going to be much more severe.

Current research shows that testosterone supplementation can drastically affect how women feel overall. Most women noted an increased sex drive/libido.

They also see better results when exercising because muscle mass will increase, and body fat will decrease when testosterone is in balance. Studies also report that women see an overall change in mood and are more motivated and energized.

The Symphony of Hormones

menopause and sex

Hormones act in a synergistic manner with each other. If one is out of balance, others are likely to be as well. These signals “tell your body what to do and when to do it.” Proper hormone levels are essential for your health.

There are some providers out there who advertise that they can help you feel better with hormone replacement therapy. But, beware! Not all hormone replacement therapy is the same.

At Hormones by Design by Forum Health in Austin, we only use bioidentical hormones. These hormones are the same chemical structure as the hormones your body makes.  You won’t find Hormones by Design using formulas like Premarin (made from pregnant horse urine) that the female body cannot utilize properly.

Our philosophy

We understand that lab results don’t always give us the full picture. Your diagnostic testing may show that you are in the “normal” range, but you are still not feeling good. We always listen to you and what symptoms you are experiencing before we start treatment. We offer our services in a warm, compassionate, and safe environment…and we want to help YOU.

Our office in Austin, Texas is now accepting new patients. We want to help you cruise through perimenopause and menopause without the misery your mother and grandmother felt. Call us today!


Picture of  Dr. Melissa Miskell
Dr. Melissa Miskell

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