As if the brain fog, night sweats, and inexplicably itchy ears weren’t enough to look forward to, the hormone changes of perimenopause can also radically decrease your sex drive. Research has shown that hormone therapy, whether it’s estrogen, progesterone, testosterone, or a combination of all three, can be an effective way to ease symptoms in most women. Yet, it’s often not prescribed. In 2002, after researchers overseeing a study on post-menopausal women taking oral estrogen saw a small uptick in breast cancer, blood clots, and strokes among participants, the treatment fell out of favor. While those findings are now considered flawed, the damage was lasting, and less than 5 percent of women in the U.S. who could benefit from hormone therapy are actually on it. Doctors are finally coming back around to the treatment, which research has shown can slightly improve a low sex drive and vaginal dryness. (The Menopause Society specifically recommends testosterone therapy for low libidos, though the U.S. Food and Drug Administration hasn’t yet approved it for use by women).
But what’s it like to take hormone therapy, and does it really help improve libido? Below, four women (the names of some of whom have been changed) discuss how the treatment affected their sex lives, from making them as horny as teenagers to bringing back their ability to orgasm (or having no effect at all).
“I feel like Samantha in the Sex and the City movie when she runs out of her meds and there’s a rugby team at the pool and she’s like, I feel nothing.”
I started noticing symptoms of perimenopause around 35. I felt suicidal the same time every month, my sleep was garbage, the texture of my hair went from straight to curly, and my periods fell out of whack; I went from fairly regular to very light — I could wear one tampon for three to four days and had to remind myself to change it out. I also put on thirty pounds. I’m a fitness instructor who teaches ten to thirteen classes a week, but no matter what I did, I couldn’t lose it. I went on Ozempic three times. I lost the 20 pounds I’d put on, but I gained it back after I went off the drug. When I tried going back on it after that, I didn’t lose anything. I don’t have kids, and after a hormone test suggested I was probably in perimenopause, my doctor said that if my boyfriend and I wanted to have children, we would have to discuss IVF. I was 38 at the time.
Before perimenopause, I had a healthy sex drive. An ex of mine used to tell me he had to tap out because mine was higher than his, and I would masturbate whenever I had the time. But in the past two years I’ve had zero sex drive. Sex sounds like a chore, and I don’t want to masturbate. I see good-looking men at the Equinox where I work all the time, and I’m like, right, whatever. I feel like Samantha in the Sex and the City movie when she runs out of her meds and there’s a rugby team at the pool and she’s like, I feel nothing.
When I used to bring up my symptoms to past doctors, they would say I was too young. My current doctor, the one who did the hormone test, told me my testosterone is low, which would explain my low libido and fatigue. First, she put me on a testosterone cream, but after two months, I didn’t feel any changes. Then she added in an estradiol patch and a progesterone pill, and I’ve been on all three since September. I might be able to weightlift a smidge heavier, but my energy has not changed. On a scale of one to ten, my libido has moved from a zero to a one. I’m having dreams that are more sexual in nature, so it’s flickering and not completely dead. My boyfriend is understanding and supportive, but his love language is physical touch. I’m taking HRT for a few reasons: to shed some of this weight and improve my energy levels, but also because I want to fix my sex drive for him. If we weren’t together, I wouldn’t care. I feel like a 60-year-old woman who was recently widowed and no longer wants to deal with the male population. I have a sneaking suspicion I’ll have to take heavier doses. —Winona, 39, Austin, Texas
“I thought about sex all the time and literally had to carry around my vibrator.”
I didn’t even know perimenopause was a thing before I started to experience it at 36. At the time, I had a lot of bodily pain and couldn’t run the half-marathons I always used to. Long walks took me out, and I thought I had fibromyalgia and osteoporosis. I also wasn’t sleeping, which I didn’t realize was a symptom, and would wake up four to six times a night thinking, this is just what busy adults do. I also had no libido. It fell off gradually. First, you’re tired, then you realize it’s been a couple of weeks, and you still don’t want to.
Before perimenopause, sex was a cornerstone for me and my husband. If everything was going poorly, at least sex was good. So when it wasn’t good, it felt like everything was falling apart. I thought, my marriage is crap, he’s not romantic enough, we need to go to couples therapy. We went and worked through some issues, which was good, but no matter what, my body wouldn’t turn on. I bought lingerie and drank wine. It sucked that I had to get drunk to have sex.
For two years, we tried everything. Around the time I turned 39, I went for a gynecology exam and learned I had a prolapsed uterus. I had a partial hysterectomy and kept my ovaries. My doctor said the next ten years would be blissful — no periods, no hormone changes. But my body felt a thousand times worse, and I spiraled into a deep depression and was unable to get out of bed. My gyno checked my hormones and said I was in normal range, but what’s devastating is women in normal range so often feel like shit. So many doctors tell you, that’s normal, you’re just getting old.
I was looking into antidepressants when my friend told me I needed to get hormones and sent me to a medspa — it’s hard to find a place to find help with perimenopause. There, I told a hormone specialist my symptoms. She said, we can help with that. I remember thinking: where have you been all this time? Why are you in a medspa?! She put me on testosterone pellets and told me it could increase my facial hair and possibly lower my voice. After my first dose, I slept through the night for the first time in years and my body wasn’t hurting anymore. Still, I had no libido. My husband is a good guy, but it felt so blah and I could only conclude I didn’t love him. I told him we were done and went to my parents for a bit. I went home and after a week of not seeing him (I’d gotten my second dose by then) he came through the door and my whole body came alive in a way I didn’t think was possible after 14 years of marriage. No one cared that there were dishes in the sink or laundry to be done. It was like, just take my pants off! Let’s go! Throw-you-up-against-a-wall kind of wanting. I thought about sex all the time and literally had to carry around my vibrator.
To me, perimenopause feels like puberty. Everyone’s looking for a test to know, am I in it? But there’s no test for puberty. Are you 40? You’re probably in it! I’ve been on testosterone for two years now, and my libido is really good. I enjoy having a daily orgasm. —Marcella Hill, 44, Utah
“What provoked me to seek treatment was an abrupt inability to orgasm.”
I entered perimenopause in my late thirties. The initial symptom was migraines, but I never really associated that with hormonal issues. That was the first big indicator, and then it was a gradual lessening of libido over time. I’ve always been a very sexual person, and my interest diminished until I had fewer thoughts about it. But what provoked me to seek treatment was an abrupt inability to orgasm.
Because it happened when the pandemic hit, I wasn’t really going into doctors’ offices. That first year I tried going off my birth control to see if that would help. Then I did a mail-order test to check my hormone levels. The results showed I didn’t have enough progesterone and had too much estrogen, which is common in perimenopause. After I got vaccinated, I found a doctor who did extensive blood tests and checked for any other problems that may have contributed, like thyroid issues. She ended up prescribing me a testosterone cream. It helped with my libido and I was able to orgasm again, but I could feel when it would drop off at the end of the day and I would start feeling agitated and getting mood swings. I could feel it leaving my system.
My provider recommended pellets for a more consistent stream of testosterone. It’s inconvenient to have a pellet inserted under your skin, but the benefits made it worthwhile. My migraines went away and it helped my mood and anxiety a lot. You’re supposed to get a pellet every six months, but I feel the beneficial effects, like higher libido levels and the ability to orgasm, fading after three. I’m married to a man ten years older than me and I’m usually the one who’s more interested in sex, so the waning effects haven’t been a problem for us.
My first provider was responsive: I’d tell her my libido was dropping and my migraines were returning and she’d schedule me in. But she recently left for another job, and my new provider is less responsive to my concerns. Like a lot of doctors, she’s cautious about the masculinizing side effects of pellets, and seems unwilling to consider that different women may need different doses to see the same benefits. I’ve grown some additional facial hair and can no longer sing soprano, but I’m not bothered by that. —Charlene, 43, Houston, Texas
“My husband doesn’t grasp the hormonal changes.”
I started hormone therapy not long after I experienced my first perimenopause symptoms around age 40. I had intense insomnia, anxiety, and night sweats. My doctor started me on a low dose of progesterone, which was amazing. It helped those symptoms a lot.
But the further I get into perimenopause, even with the progesterone — I’ve gone from one-hundred milligrams to two-hundred — I have a lack of desire for sex. When I am interested, it’s cycle-dependent, about ten days before my period. For a while, I didn’t even see the changes as related to perimenopause. I’d heard your sex drive was supposed to go up when you get to this age, maybe in a last-ditch biological effort to have a baby. Personally, the lack of libido has been fine for me. But it’s been hard on my husband. Before perimenopause, we had a pretty healthy sexual relationship and had sex a few times a week. We’ve had some conversations about it, but he definitely doesn’t understand. The concept of not wanting to is foreign to him, and even when I explain, it’s not that I don’t find you attractive or anything, it’s that my body doesn’t want to, that genuinely sounds even worse to him. It’s a touchy subject.
I no longer have a women’s health doctor since the practice I went to recently disbanded; I just see a regular doctor now who prescribes me the progesterone. I want to try out estrogen and see how that works in combination with the progesterone, but it’s difficult to find another provider since I’d seen my last one for ten years. One of my friends who is also going through this is an executive at a healthcare company, but even she couldn’t find an in-network doctor willing to explore hormone therapy, so she ended up paying out of pocket. I’ve been on the same treatment for seven years and need to update it to what’s right for me now, but I’m at a stalemate until I find a practitioner again. A higher sex drive is an ideal goal, but my anxiety is also up a bit and I’m feeling really down when I’m down. I’m looking for help with the slumps. —Tiffany, 47, San Diego, California
