Sexual changes in perimenopause and menopause

Written by the Progyny Editorial Team. Reviewed by the Progyny Clinical Team — July 2026.

Sexual wellness means something different to everyone – before, during, and after menopause. What matters is how happy and satisfied you feel with your sex life.

Peri/menopause (perimenopause and menopause) doesn’t affect sexual wellness for all people. But it is common for changes to happen. This could be due to physical reasons, low libido, or other changes during this time.

If changes are bothering you or affecting your sex life, you have options to consider. Your healthcare provider and other specialists are available for help.

What causes sexual changes during peri/menopause?

Estrogen plays an important role with vaginal health. It helps with lubrication, blood flow, and the thickness and elasticity of vaginal tissue.

With lower estrogen, sex may become uncomfortable or even painful. A drop in estrogen may lead to:

• Lower sex drive
• Issues with arousal and orgasm
• Vaginal dryness and less lubrication during sex
• Thinning vaginal tissue
• Vulvar dryness (the outer genital area)
• Irritation and burning
• Frequent or urgent urination

Peri/menopause may also cause other symptoms that influence your sex drive or sex life, like:

• Poor sleep
• Anxiety
• Hot flashes and/or night sweats

In addition, other factors may play a role during this complex phase of life. Sexual health may be affected by things like:

• Stress
• Health issues
• Concerns about aging or self-image
• Relationship changes

What can I do for relief?

Whatever you may be going through, you’re not alone. For support, you may wish to start with your gynecologist or menopause specialist. They may recommend other specialists as well.

You and your team can discuss a personalized plan that feels right for you. Here are a few options people consider.

Menopause hormone therapy

Menopause hormone therapy (MHT) is a common, effective treatment. It’s not right for everyone, so ask your healthcare provider what’s recommended for you.

Many people try local vaginal estrogen therapy for vaginal and sexual symptoms. It has a lower dose of estrogen and almost no side effects, and is available in different forms:

• Tablet or suppository inserted into the vagina
• Cream applied to the walls of the lower part of the vagina
• Vaginal ring (typically in place for 3 months)

Systemic therapy (which affects your whole body) can also help vaginal and sexual symptoms. Sometimes people use local vaginal estrogen therapy along with systemic therapy.

Some studies have shown that testosterone may improve libido. The best use of testosterone is for someone in postmenopause with low libido and no other issues. But we don’t have long-term data on its health risks, and it is not FDA-approved for women or for peri/menopause symptoms.

Non-hormonal medicine options

You can try non-prescription moisturizers or lubricants to help vaginal dryness and painful sex.

• Vaginal moisturizers are typically applied every few days to help with vaginal dryness. There are internal moisturizers for the vagina and external moisturizers for the vulva.
• Lubricants may help with painful sex when used beforehand. Either water-based or silicone-based types are good. Many people in postmenopause prefer silicone lubricants due to their longer-lasting quality. You may use lubricants along with a vaginal moisturizer.

Other forms of support

Since sexual health may be influenced by many areas, your provider may refer you to another specialist for additional support.

• Sex therapists can provide therapy for individuals or couples in a non-judgmental setting
• Professional counselors, including relationship counselors, may help address your well-being, relationships, and sex life
• Pelvic floor therapists teach exercises that can help restore the muscles involved in sex and orgasm

Communicating with your partner

If you’re in a relationship, share your feelings and the changes you’re going through with your partner. Together, you can explore how you’d like to be intimate and what you want your sex life to look like in the years ahead.

Regular sexual activity (if it’s something that you want) may help vaginal symptoms by increasing blood flow. There are many ways to remain close and intimate, sexually and otherwise.

Seeking support

Talking about a sensitive subject like your sex life can be challenging. You could bring it up with your provider by saying something direct and simple like, “I wanted to talk with you about changes I’ve noticed in my sex life.”

Use the words that feel right for you, and know that your provider has had this conversation before. They are ready to help you.

For help getting started or sorting through options, reach out to your Progyny Care Advocate. We are here to support you.

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.

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