Why Your Sex Drive Changed, and How to Figure Out What’s Actually Going On

A Practical Guide to Understanding Changes in Sex Drive, Especially in Menopause

Many women come in saying, “My libido is gone.”

But libido is not one single switch.

Sexual functioning is a system made up of several parts, and different factors affect each one. When something changes, especially during perimenopause or menopause, it is rarely random. The problem is that women are often given quick explanations or quick fixes without help answering the most important question:

What exactly isn’t working, and why?

Gynecologists often focus on hormones and pelvic health. Mental health providers tend to focus on mood, stress, medications, attention, and relationship dynamics. Most women need both perspectives, because sex drive lives at the intersection of the body, the brain, and the relationship.

This guide is designed to help you:

• identify which part of your sexual response is changing

• understand the most common causes, especially in menopause

• know which blood tests can be helpful

• ask better questions at medical visits

• think clearly about options like Wellbutrin, testosterone, supplements, THC products, and libido medications

Part 1: The Components of “Sex Drive”

When people say “sex drive,” they may be referring to one or more of the following:

1. Desire (libido)

Desire is the psychological wanting of sex.

There are two types:

• Spontaneous desire, where sexual thoughts or urges arise on their own

• Responsive desire, where desire appears after closeness, touch, or arousal has already started

Many women in menopause lose spontaneous desire but still experience responsive desire. This is common, normal, and not a failure.

2. Arousal

Arousal is the body’s physical response. It includes:

• lubrication

• blood flow

• warmth and swelling

• sensation and sensitivity

Arousal can be difficult even when desire is present. It can also be intact even when desire is low.

3. Orgasm

Orgasm is a separate process. Some women maintain orgasm even when desire or arousal changes. Others notice orgasm takes longer or feels less intense.

4. Comfort and pain

This is one of the most overlooked reasons sex drive drops.

When sex becomes uncomfortable, even subtly, the brain learns to avoid it. Over time, discomfort can reduce desire, slow arousal, and make initiation feel harder, even in loving relationships.

In menopause, this often relates to genitourinary syndrome of menopause (GSM), which includes vaginal, vulvar, and urinary changes related to reduced estrogen effect on tissues.

Many women do not say “sex hurts.” Instead, they notice:

• needing much longer to warm up

• sex feeling less comfortable than it used to

• soreness afterward

• muted sensation

• avoiding penetration because it feels unpleasant

When the body anticipates discomfort:

• the nervous system stays guarded

• arousal becomes harder

• desire drops because sex stops feeling easy and rewarding

This is not “all in your head.” It is a real brain and body response, and the good news is that GSM is common and treatable.

5. Initiation and mental load

Many women enjoy sex once it starts but struggle with initiation because of:

• exhaustion

• cognitive overload

• feeling “touched out”

• stress or anxiety

• performance pressure

• resentment or disconnection

This is not always low libido. Often, it is high inhibition. The brakes are on.

Part 2: Why Menopause Changes Sexual Functioning

Menopause can affect multiple parts of sexual response at once.

Tissue and blood flow changes

Reduced estrogen effect on vaginal and vulvar tissues can lead to:

• dryness

• irritation or burning

• reduced sensation

• pain with sex

• micro-tears or spotting

• urinary urgency, frequency, or recurrent UTIs

These changes fall under GSM.

Brain and nervous system changes

Menopause can also affect:

• sleep

• stress tolerance

• energy and motivation

• mood stability

• attention and ability to shift gears

• irritability or emotional flatness

This is why a woman can have “normal hormones” and still feel like her sexual ignition is weak.

Part 3: What Is GSM?

GSM stands for Genitourinary Syndrome of Menopause.

It describes vaginal, vulvar, and urinary changes related to decreased estrogen effect on tissues.

Common symptoms include:

• dryness

• burning or irritation

• pain with penetration

• needing more time to warm up

• reduced sensation

• discomfort after sex

• recurrent UTIs or urinary urgency

Important note: Even women on systemic estrogen can still have GSM and may benefit from local vaginal estrogen or other targeted treatments.

Part 4: One Question That Changes Everything

Is the problem desire, arousal, pain, or inhibition?

This is the question many women are never helped to answer.

If alcohol increases desire or arousal

This usually means:

• desire circuitry still works

• inhibition is high

Alcohol lowers the brakes. This often points toward stress, anxiety, mental load, or difficulty shifting out of “doing mode.”

If stimulants increase physical urge or spontaneous arousal

This suggests dopamine and attention play a strong role. When focus improves, the sexual signal becomes clearer and less drowned out.

If THC products help

Low-dose THC can lower inhibition, increase sensory awareness, and reduce self-consciousness. Dosing matters; too much can cause anxiety or sedation.

Part 5: A Structured Way to Investigate What’s Happening

Before choosing testosterone, Wellbutrin, supplements, or libido medications, clarify the pattern.

Ask yourself:

Desire

• Do I ever crave sex?

• Do I initiate?

• Do I fantasize?

Arousal

• Does my body respond to touch?

• Do I lubricate?

• Does it take longer to warm up?

Orgasm

• Can I climax when aroused?

• Has orgasm changed in intensity or timing?

Comfort

• Is there dryness, burning, or irritation?

• Is penetration avoided?

• Am I sore afterward?

Brain and nervous system

• Am I exhausted or overstimulated?

• Do I stay in my head during intimacy?

• Is it hard to shift gears?

Relationship

• Do I feel emotionally safe and desired?

• Is there resentment or disconnection?

Medications

• Am I on SSRIs or SNRIs?

• Did symptoms start after a medication change?

• Do I feel emotionally blunted?

Part 6: Bloodwork, What Helps and What Doesn’t

Hormone labs can be useful, but they do not explain everything.

Helpful labs may include:

• estradiol

• total and free testosterone

• SHBG

• DHEA-S

• TSH

• ferritin and CBC

• B12 and vitamin D when fatigue is prominent

Many women have normal labs and still have sexual dysfunction, because libido is not purely hormonal.

Part 7: Treatments, Matched to the Mechanism

A) GSM, dryness, pain, reduced sensation

Start here when present.

• vaginal estrogen

• moisturizers and lubricants

• pelvic floor support when needed

Treating discomfort often restores desire naturally.

B) Low desire with low energy or motivation

This is where Wellbutrin (bupropion) may help by supporting dopamine and norepinephrine.

C) True loss of desire in postmenopause

Testosterone may help some women when desire is persistently low and distressing, and other factors have been addressed. Dosing should be physiologic and monitored. ISSWSH provides clear guidelines.

D) Daily non-hormonal medication

Addyi (flibanserin) may help certain women with persistent low desire. It requires daily use and has alcohol restrictions.

E) Supplements

Products like Ristela may support arousal and blood flow. Results vary.

F) High inhibition, stress, or difficulty shifting gears

This is extremely common.

Helpful approaches include:

• sex therapy or couples therapy

• reducing performance pressure

• planned intimacy earlier in the day

• sensory rituals

• mindfulness and body-based practices

  
  

Part 8: Over-the-Counter Options That May Support Arousal and Sensation

Over-the-counter products do not “create” libido, but some can support specific parts of sexual response, especially arousal, blood flow, sensation, or inhibition. These options tend to work best when matched to the underlying issue.

Products that support nervous system calming and reduce inhibition

For some women, the main barrier to desire is not lack of interest but an overactive nervous system. When stress, anxiety, or mental overload are high, the brakes stay on.

Ashwagandha

Ashwagandha is an adaptogenic herb that can help reduce stress reactivity and cortisol levels. It may be helpful when anxiety or chronic stress is dampening sexual interest. It does not directly increase arousal or blood flow, but by calming the nervous system, it can make desire more accessible. Some women find it sedating, so it is best used cautiously, especially if fatigue is already an issue.

Magnesium

Magnesium, especially glycinate or threonate, can support relaxation and sleep quality. Better sleep and lower baseline tension often improve sexual responsiveness indirectly.

THC-based products and microdosing

Low-dose THC can lower inhibition, increase sensory awareness, and improve presence in the body. For some women, this makes arousal and pleasure easier.

Microdosed THC products

Products like 1906 Love Drops use very small amounts of THC combined with botanicals. The effect is typically subtle and depends heavily on dose and individual sensitivity. Too much can increase anxiety or cause sedation, so starting low is essential.

Important note: THC may help with inhibition and sensation, but it does not treat hormonal tissue changes like GSM.

Topical arousal and blood flow creams (“scream creams”)

Topical arousal creams work locally and can be helpful when desire is present but the body’s physical response feels weak or delayed.

These products often contain ingredients that increase blood flow or sensitivity, such as L-arginine, menthol, peppermint, cinnamon, or CBD. When effective, they can increase warmth, swelling, and sensation.

They are best suited for women who:

• feel mentally interested but physically under-responsive

• notice muted sensation

• have slower arousal

They should be avoided if there is untreated vaginal dryness, irritation, or pain, and patch testing is recommended.

Lubricants and vaginal moisturizers with added benefits

For dryness and comfort

Regular use of vaginal moisturizers, especially hyaluronic acid-based products, can improve comfort and reduce friction. This alone can improve desire by making sex feel easier and more pleasant.

For sensation and arousal

Some lubricants include warming agents or CBD. These may enhance sensation temporarily but do not replace estrogen treatment when GSM is present.

Oral supplements marketed for arousal

Ristela

Ristela is a non-hormonal supplement designed to support arousal and blood flow. It is taken daily and may take several weeks to have an effect. Results vary, but it is generally well tolerated.

Other supplements marketed for libido have limited evidence and inconsistent effects. They may help mild arousal concerns but are unlikely to address more complex sexual changes.

How to Think About These Options

A helpful way to choose is to match the product to the problem:

• High stress or anxiety → nervous system calming supports

• Low sensation or slow arousal → topical arousal products

• Difficulty staying present → cautious THC microdosing when appropriate

• Dryness or discomfort → moisturizers and evaluation for GSM

Over-the-counter products can be useful tools, but they work best as part of a thoughtful approach that considers hormones, nervous system state, comfort, and relationship context.

Part 9: When Hormones Are Normal but Things Still Aren’t Working

Normal hormones do not guarantee:

• a regulated nervous system

• emotional presence

• physical comfort

• relationship connection

• medication neutrality

• low stress or fatigue

That is why “your labs are normal” is not the end of the conversation.

Closing Thoughts

Sex drive is not one switch. It is a dashboard.

The most empowering path is to:

• identify which component is struggling

• investigate both body and brain contributors

• choose treatments that match the mechanism

You deserve a thoughtful, individualized plan, not a one-size-fits-all answer.