Menopause and Hypoactive Sexual Desire Disorder

Women's Health | | Natasha Weiss
5 min read

It’s important to point out that most, if not all, research around menopause and HSDD focused on cis-women. We wanted to acknowledge that other people including trans-men and non-binary folks also undergo menopause, but unfortunately, the research doesn’t reflect that yet. When possible, we aim to use gender-neutral language.

Menopause is like a right of passage of sorts. You’ve made it through your reproductive years, have completed the cycles of crimson tides and cramps, you’re now older and wiser. 

With all of that, you’ve probably noticed some big changes in your body. Some expected, and others not so much.

Some of those changes may revolve around your vagina and your sex drive. As in, it may be way lower than what you’re used to. Much to your dismay.

What is Hypoactive Sexual Desire Disorder?

Menopause and hypo-what? Whew, that’s a mouthful!

But when you break it down, it’s easy to understand just what this disorder is all about.

Hypo means low or below normal. Sexual desire, well you can figure that one out for yourself.

Hypoactive Sexual Desire Disorder, or HSDD, is marked by the deficiency or absence of sexual desire and sexual fantasies. Unlike people who identify as a-sexual, this absence of desire creates distress and possible interpersonal difficulties – especially with sexual or romantic partners. 

All of this can wear down on a person’s self-confidence, physical and emotional satisfaction, and overall happiness. 

HSDD may occur in up to one-third of adult women in the U.S. A lot of different hormonal factors can contribute to someone developing HSDD like the use of hormonal birth control, pregnancy and postpartum, undergoing a hysterectomy, and you guessed it – menopause.  

Low Sex Drive After Menopause

Having a low sex drive is one of the most commonly known side effects of menopause. HSDD isn’t just a low sex drive. It’s when your lack of sexual desire negatively impacts different areas of your life.

So what does that have to do with menopause?

Menopause occurs when a menstruating person stops having their period. Someone is officially post-menopausal after they’ve gone a full year without a period.

As people age, their hormone levels change, this is one of the factors that leads to menopause. The hormone in question is estrogen, which you probably know as “the female hormone”.

This decrease in estrogen can make the vagina less sensitive thanks to lower blood flow which can make vaginal tissues thinner. Lower estrogen levels can also impact vaginal lubrication, and just make someone less sensitive overall. Sex may even become uncomfortable or painful for people after menopause. Mental health changes and stress during menopause may also lower someone’s sex drive and arousal. 

These factors build up, making someone want sex less and less, which leads to HSDD.

People who have more significant symptoms related to menopause like hot flashes, fatigue, and trouble sleeping, may be more likely to have a lower sex drive and develop HSDD.

One study found that while HSDD was present in 26.7% of premenopausal women sampled, that statistic rose to 52.4% of women who were naturally menopausal. The chances of someone developing menopausal HSDD may increase if menopause was induced via surgery

Not only that but distress amongst surgically menopause women with HSDD was about twice of their counterparts. This could be in part due to compounding stress from medical issues that led to the surgery, that they went through menopause earlier in life than they had expected, or that menopause came on much faster than if they had gone through it naturally. 

Those rates are just reflective of women diagnosed with HSDD, the actual prevalence of lowered libido amongst post-menopausal women may be closer to 68 to 86.5% of women.

What to Do About Post-Menopausal HSDD

If you suspect you may have HSDD after menopause, there are steps you can take to start enjoying your sex life again. 

These are some of the ways postmenopausal HSDD is treated: 

Hormone Therapy

Hormone therapy is commonly used as a way to counteract the uncomfortable side effects of menopause. 

There are two main types of hormone therapy – topical and ingestable.

Topical estrogen is typically applied directly to the vagina to treat vaginal changes and discomfort. These come in creams and vaginal rings.

Other people choose to take estrogen pills as a form of hormone replacement therapy, which can help increase libido as well as negate other uncomfortable parts of menopause like hot flashes and mood changes.


While therapy may not be able to help with physical vaginal changes, it can help with the mental health changes that can impact your libido.

Therapy can be done as a couple or as an individual. You may even consider seeing a sex therapist who specializes in issues like HSDD.

Lifestyle and Sexual Changes

Steps like switching up your diet and getting more physical activity may help you increase your sexual desire. 

It can be hard to get the engine started when the spark just isn’t there, but if you’re able to get in the mood or practice a little bit, you can try switching up your sex life by using toys in the bedroom, practising masturbation, and going on a sex staycation or vacation.

See a Doctor

A medical professional can help you rule out any other factors that may be affecting your sexual desire, as well as give your practical tips to help you increase it.

Other reproductive health disorders like endometriosis and uterine prolapse may be contributing to your HSDD. A medical professional can help you get to the bottom of it.  

All these changes can be difficult to cope with. Hypoactive Sexual Desire Disorder may make you feel like you’re not yourself anymore. It may take a little time to figure out what works for you, but there is hope. Before you know it, you’ll once again be having a thriving sex life – maybe even better than before!

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