Hi, I'm Dr. Bianca!


I’m a menopausal woman. I write about what it's like to get through the hormonal transition we’ve come to know as menopause. My intent is to help us all age together in the best and healthiest way possible. Let’s not suffer in silence. Let’s normalize the conversation. 


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Sex drive and menopause. The desire for sexual activity at midlife

Often fun when we are young and vibrant but combine sex drive and menopause, and we might find ourselves having some sexual difficulties.

I treat many menopausal women in my office weekly. 

Most of us with plunging hormone levels. 

Sex isn't a common topic of discussion for most but an important one nonetheless.

Physical changes, loss of libido, and menopausal symptoms all damper a woman's active sex life.

Sex Drive and Menopause: Midlife Effects on Desire & Libido

Menopause was always so far from my mind. Until now. 

At 15 years old, I remember my mother coming home from work and throwing her head into the freezer to cool down.

In the dead of winter, she would keep the heat on so low I had to wear a snowsuit in the house to offset the arctic chill. 

She would break down into tears or fits of rage like she was Sybil. She would forget words, trip on herself, and never sleep. 

Poor woman.

Mom was of the June Cleaver era. She never talked about what she was going through; she just went through it. 

She came out the other side, but not without some PTSD for herself or me.

Hormonal Changes in The Midlife Woman

Menopause is stamped as a definite moment in time for women.

It is precisely 12 months after the date of your last menstrual cycle

The menopause transition, however, can potentially span up to 10 years or more for some. Therefore, women in their 40s can begin having symptoms and may not even be aware of them. 

Some of which include:

  • weakness of the pelvic floor muscles and urinary incontinence (typically caused by pregnancy and/or vaginal labor)
  • weight gain and low body image
  • sleep disturbances

All unusual feelings in our premenopausal female bodies are directly related to a gradual loss of estrogen

Fluctuations in the other reproductive hormones like progesterone and testosterone also play a role. 

Insulin, cortisol, adrenaline, and thyroid hormones also begin to see-saw as we hit the transition period, making it like the wild west of a woman's life.

The Menopausal Transition

As we move into middle age, the transition becomes our personal unique experience. 

Some of us follow our maternal lineage and genetically express breast cancer (or other reproductive cancers).

Others experience sadness, depression, and emotional changes

We begin to question our overall health and have difficulty understanding where we "fit in."

Society has duped us to believe that beauty, health and fitness is somehow only for the young. 

There seems to be an imaginary line that women cross over at 50.

We are self-assured, assertive, and competent.

Yet, most of us fall prey to the beauty industry's lies about "anti-aging" and "youth serums" and chase the next fad to keep us looking like our younger selves. 

Lack of Sex Drive & Desire

I polled most of my menopausal patients and asked them if they lacked the desire for sex.

Most of them said that they "desire intimacy," but their need for the act of sex is lower than when they were younger. 

In addition, they were honest about how they experienced painful sex due to dryness and high sensitivity of their vagina. 

This played a significant role in them not enjoying penetration.

Our ability to naturally lubricate is a sexual reflex biologically built into our systems. A blood supply increase will always bring arousal! Acting on arousal is not always easy, though.

When we lose our self-lubricating abilities, we can experience sexual dysfunction

When the well is running dry, grab some lube!

It might be an excellent time to explore lube options if you're feeling dry. Vaginal dryness affects 50% of menopausal women, although statistics are probably more since it is an under-reported complaint. 

There are three types of lube to buy: 

  1. water based
  2. silicon based
  3. oil based 

Experts report that water-based lube is best since it leaves the body quickly and doesn't change the pH of the vagina. 

Our vaginal pH usually is slightly acidic

menopause transition

Lubricants like oil can change our pH, leaving us vulnerable to infections

Whereas silicon based lube can help to maintain the healthy bacteria of the vagina. 

Organic, plant-based lubricants can be best for some since they:

  1. won't raise estrogen levels
  2. biodegradable
  3. don't contain parabens

Lube is a personal preference and there are plenty on the market. Have fun choosing!

Beware of the following ingredients in vaginal lubricants

  • Any product with glycerin. It's a food for yeast! Anything with more than 20% glycerin can be irritating. Ladies, you're not baking bread down there! 
  • Flavors and fragrances can change the pH of the vagina. When the pH changes, the vagina can smell and taste "off." A healthy and clean vagina does not taste like bubble gum or Coca-Cola! This further stigmatizes the vagina and oral sex as dirty, which is farthest from the truth.
  • Free from parabens. Parabens can act like estrogen in the body, making this a no-no for women diagnosed with estrogenic or reproductive cancers.

Sexual Intimacy and Relationship Issues

I heard a phrase recently from a podcast called "Sex With Emily" by sex expert Dr. Emily Morse: "Communication is Lubrication." 

Biology and society have shaped our overall belief that a man's sex drive is driven by testosterone and his desire for sex is always higher than a woman's.

However, it is simplistic to think that men do not also go through complex hormonal and chemical changes.

As pointed out by Sarah Hunter Murray, Ph.D., author of Not Always in the Mood: The New Science of Men, Sex, and Relationshipsmen's drive fluctuates up and down in their willingness to have sex. Just like women.

hands holding desire and libido

Society, religion, and cultural norms have played a big part in how men and women pursue their sexual interest and express their sexual drive. 

Men have been permitted to talk about sex for centuries, whereas it has been taboo for women. As a result, wanting sex and expressing your sexuality as a woman hasn't and isn't being supported, therefore leading to more widespread sexual problems for women vs. men throughout time.

  • Talking more to your partner leads to more connections. Express yourself. Ask for what you want. Intimacy can be the result of good communication. Vulnerability to yourself and your partner can lubricate some of those relationship parts that are stuck! No pun intended. 

Hormone Replacement Therapy 

HRT or hormone replacement therapy is offered to women to help offset some hard-to-deal menopause symptoms. These symptoms can begin in women in their late 40s, and some women can experience them for up to 20 years after menopause! Please, no! 

Since symptom severity can go from mild to severe, here are some of the ones that can put a big damper on a woman's life: 

  • hot flashes
  • bone loss
  • night sweats
  • low libido
  • vaginal atrophy
  • mood swings

The hormones in HRT are typically a form of estrogen or a combination of estrogen and progesterone.

The estrogen portion of HRT can come from two sources:

  1. synthetic or made in a laboratory
  2. from the urine of pregnant female horses (mares)

Progesterone is not always used with estrogen in HRT.

The progesterone portion of HRT can also come from two sources: 

  1. synthetic
  2. micronized or "body identical" aka bio-identical

Quality of life

Quality of life is unique to each of us and is how we define our contentedness and happiness. 

Choosing to use HRT is a very personal choice. Some women cannot live with the severity of their symptoms, whereas some have mild or none.

It is essential to communicate your concerns with your medical practitioner.

The more informed you are, the better decisions you can make for your well-being.


There are big debates on the risk of breast cancer when taking HRT. 

It is in your best interest to discuss options with your healthcare provider. Especially if you have a genetic predisposition to cancer or are currently a cancer patient/survivor.

The most recent research shows that women 60 years or younger within 10 years of menopause have a better outcome for reducing hot flashes and preventing bone loss with HRT.

Women over the age of 60 that begin HRT have higher risks of strokes, heart disease, and dementia.

The International Menopause Society publishes a position statement defining the risks vs. benefits of using hormone therapy.

In summary, their 2022 paper concluded with this:

  1. HRT is shown to prevent bone loss and diminish hot flushes
  2. The risk of adverse effects of HRT depends on the type, dose, duration, and use.



There are plenty of women that choose to go through menopause without any conventional medical treatment. 

Instead, women look to holistic forms of treatments like Acupuncture to lessen hot flashes. 

For example, a study done in 2019 by the British Medical Journal revealed that five weeks of Acupuncture to specific points related to hot flashes reduced symptoms significantly.

Another study done in 2016 showed promise for women with HSDD (Hypoactive Sexual Desire Disorder).

Women underwent Acupuncture 2 times per week for 5 weeks. As a result, they experienced a significant improvement in their desire for sex, and their anxiety lessened as well. 

acupuncture and alternative treatments for menopause

Sex Therapy

The adverse side effects of marital upset, depression and anxiety can all lead to a lack of sex drive. 

Like a vicious cycle, emotional issues can directly cause low sexual desire for women. Likewise, psychological factors can diminish sexual pleasure, causing an inability to orgasm or to enjoy any part of physical intimacy. 

Sex therapy can help a woman or a couple create an atmosphere where both parties feel safe, communicative, and loving.

In addition, a sex therapist can offer self-help techniques, lifestyle changes, or erotic materials to improve our receptivity to sex, leading to an increased libido.

Reading erotica, listening to podcasts, and/or performing mindfulness-based stress reduction techniques can all help get some mojo back! 

Physical Therapy

Painful intercourse can be a deterrent to a woman's sex drive. 

Beyond using vaginal moisturizers to improve lubrication, blood flow increase can help to improve how the vaginal walls relax and tighten in response to stimulation.

Good physical health of the pelvic floor can be a positive contributor to sexual function, sexual response, and sexual health of every woman. 

The pelvic floor becomes less toned in post-menopausal women due to hormonal changes and strain from childbirth or if a woman has suffered from episodes of constipation.

If you deal with constipation, read Hormones, Constipation and Menopause.

Physical therapy techniques include biofeedback exercises to help women gain better control over their pelvic floor.
This includes learning how to properly perform Kegel exercises which can help to support the uterus, bladder, and rectum.
Sex toys, weighted balls, and pelvic floor trainers can significantly improve sexual intercourse for all women.


As a fellow menopausal woman, I fully understand the effects of declining hormones and what it physically and emotionally feels like during this change of life.

The challenging conversations with my female patients make me realize that we seem to be doing this transition silently and alone. We do not have to live the second and hopefully the best second half of our lives without desire or libido.

Sex, sexuality, and expression of our sex drive can be better than ever at this midlife stage.

Desire and libido were ours all along...let's be reminded that age can bring new depth to our experience as beautiful, sexual beings.

Products I Use

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Sex Drive and Menopause: Midlife Effects on Desire & Libido

Sex Drive and Menopause Midlife Effects on Desire & Libido


August 28, 2022


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Dr. Bianca Beldini

I’m your Doctor of Physical Therapy, Acupuncturist, Master Dry Needler, and Triathlon and Running Coach. I’ve been in the health, wellness and fitness industry for over 25 years, and I’m here to help you reach your optimal health.