Low libido

A lower interest in sex than you used to have, or none at all. Doctors call it low libido or low sexual desire.

The Pakistan Menopause Society lists reduced libido, together with difficulty becoming aroused and reaching orgasm, among the symptoms of the years after menopause (Table 1). It also defines a more lasting form, hypoactive sexual desire disorder: a persistent lack of desire that causes real distress, and that nothing else explains (section 1.5.3).

It is not rare. The European Menopause and Andropause Society (EMAS) says around one in two women have sexual problems of some kind, and that they lower quality of life and affect relationships.

Not thinking about sex at all, for weeks. Feeling nothing when you used to feel something. Going along with it and feeling flat afterwards. Guilt, mostly. And often a worry, unspoken, about what he thinks it means.

The NHS website lists lower hormone levels as you get older, particularly during the menopause, among the main causes of a low sex drive.

It is rarely only that. The same page lists relationship problems, stress, anxiety and depression, vaginal dryness, some medicines (including some for blood pressure and some antidepressants), hormonal contraception, alcohol, and conditions such as diabetes, heart disease and an underactive thyroid. At this stage of life, several of those can arrive at once, along with broken sleep and hot flushes.

EMAS names one more: a partner's own sexual problems, such as difficulty with erections. It lists them among the causes of sexual problems after the menopause, and asks doctors to include them when they assess a woman.

Pain matters too. Women's Health Concern says painful sex can contribute to a loss of desire, and that relieving the symptoms often brings an increase in desire and arousal. See pain during sex.

The NHS website matches each cause to a possible treatment:

• relationship problems: relationship counselling
• vaginal dryness: treatments such as vaginal lubricants
• menopause: HRT
• depression: antidepressants or CBT
• a medicine or contraception: a change to a different one

It says treatment depends on the cause, and a GP can advise.

NICE NG23 sets out one line on testosterone: "Consider testosterone supplementation for people with low sexual desire associated with menopause if HRT alone is not effective." (1.5.25) NICE notes that when it was written, this was an off-label use.

The Pakistan Menopause Society takes the same order. Its recommendations advise starting standard hormone therapy and making sure estrogen is adequate, especially in the vagina, before considering testosterone for persistent low desire (section 5.9).

The Menopause Society, the North American menopause body, is plain about what HRT itself can do. Its 2022 statement says HRT generally does not lift desire, arousal or orgasm beyond what it does for vaginal dryness and discomfort, and rates that evidence as strong. Where desire is a concern, it says estrogen through the skin, as a patch or gel, may be a better choice than tablets, because it has little effect on the body's free testosterone. It rates that evidence as limited.

Whether any of this is right for you is your doctor's call, made with your history in front of them.

The NHS website says to see a GP if you are worried about your sex drive, or if you think a medicine or hormonal contraception is affecting it.

The Pakistan Menopause Society notes that many Pakistani women may not mention sexual symptoms unless a doctor asks respectfully and in private (section 2.2). That means you may need to be the one who brings it up. Jinsi khwahish mein kami is a plain, respectable way to say it.

Low desire is a symptom, not a verdict on you as a wife. It shifts with hormones, with sleep, with grief, with a house full of people.

At home, a husband may take less interest as rejection. The Pakistan Menopause Society names a husband's support as important, including honest talk about hormonal changes and respect for sexual health and personal space (section 4.2.6). Telling him this is a symptom, with a name and with options, can take the weight off both of you. Partner and family support has more on that conversation.