As women approach and enter their 40s, they can expect to experience a lot of changes. Women with children will likely watch their children leave the home. Other women may experience turning points in their careers. But all women will begin to experience the early signs of menopause.

Although menopause is a fact of life for people who have a uterus, many women aren’t entirely sure what to expect when these changes begin. One thing that tends to take people by surprise is how much perimenopause—the transitional period before menopause—can take a toll on their sex drive. Statistically, women are two to three times more likely to have their sex drive affected by aging, and this becomes much more apparent when they enter their 40s and 50s.

If you’re nearing the age of menopause, here’s what you should know about perimenopause and its effects on sex.

Perimenopause: A time of transition

The period called perimenopause is the time of transition preceding a woman’s final menstrual period—which officially denotes menopause. Perimenopause typically begins in a woman’s 40s and often lasts between three and six years.

During this stage, the ovaries start to decrease estrogen production. Menstruation slows and often becomes irregular. Hormones can fluctuate considerably during this time, which typically causes many of the symptoms people commonly associate with menopause—hot flashes, insomnia, mood swings and more.

Unfortunately, many of these symptoms are more than merely annoying or uncomfortable. Perimenopause symptoms can take a major toll on your sex drive, affecting your interest and the pleasure you derive from sex. And, because perimenopause is a period often denoted by fluctuations, many women find that their sexual desire ebbs and flows along with their fluctuating hormone levels.

Here are some of the ways perimenopause can affect your sex life in your 40s.

• Vaginal changes: Some of the most common perimenopause-related sex concerns women experience involve physical changes to their vaginal tissues and vulva. When estrogen levels begin to decline, the vagina can experience changes, including becoming thinner, drier and less flexible. The vagina may also not generate as much lubrication during arousal or penetrative sex. These physical changes can cause sex to be uncomfortable or even painful.
• Bleeding during sex: Some women may notice a small amount of bleeding during or after penetrative sex. The dryness and reduced elasticity of the vagina increases friction, which not only leads to discomfort but may also cause minor damage along the vaginal walls. Bleeding during sex isn’t serious, but it’s still a good idea to bring up the concern with your doctor. Vaginal bleeding is a symptom of some infections and reproductive diseases. Your doctor can help you rule out these potential underlying causes.
• Reduced pleasure: Other physical changes the genitals can experience during perimenopause are reductions in sensitivity and blood supply. When these things occur, sex may not be as pleasurable, causing stimulation of the clitoris and vaginal tissues to be less arousing and making it more difficult for women to achieve orgasm.
• Bodily changes: Perimenopause can also kickstart a number of other bodily changes, including collagen reduction, which causes skin to become wrinkled, drier and flakier much faster. Fluctuating hormones can also cause acne breakouts. These types of changes may make women feel self-conscious about their appearance and want to refrain from sexual activity.
• Moodiness: Fluctuating hormone levels have a tendency to make women feel depressed, anxious, exhausted and irritable during perimenopause. Because much of sexual desire is linked to mental health, women may not feel “in the mood” as often.
• Irregular periods: Although having sex while menstruating is normal and safe, some women prefer to refrain from having sex while they are on their period. However, during perimenopause, periods can become quite irregular—occurring more or less frequently—and their flows may become much heavier due to lowered progesterone levels. These cycle changes may influence how often women are willing or able to have sex for the duration of perimenopause.
• Other disturbances to routine: Many of the other symptoms of perimenopause, including insomnia, hot flashes and night sweats, are not directly related to sexual desire. However, they can indirectly affect libido by making women feel fatigued, uncomfortable or stressed.

Improving your sex life during perimenopause

Experiencing a sudden change in your sexual desire can be a source of distress on top of the stress that often accompanies the transition into menopause. For many women, sexual desire is a major part of their sense of self and of the relationships they have with their partners.

Fortunately, perimenopause doesn’t have to put an end to your libido. There are many ways to combat reduced sexual desire caused by the symptoms of perimenopause.

• Libido supplements: Natural supplements designed to enhance libido may help counteract some of the physical changes associated with perimenopause, such as decreased lubrication and sensitivity of the erogenous zones, using aphrodisiac herbs and healthy nutrients.
• Hormone therapy: While estrogen and progesterone levels fluctuate, some women find relief by taking hormones through birth control pills or patches. This option isn’t the right choice for every woman, so you should discuss the possibility with your doctor.
• Healthy living: Engaging in healthy lifestyle choices, such as eating well, exercising regularly, getting good sleep and relieving stress, can contribute to an active libido in their own ways. When you feel good, you’re more likely to be in the mood!

If you’re entering perimenopause and are starting to experience libido problems as a result, don’t fret—these changes aren’t likely to last forever, and you have options for fixing them. Speak with your doctor and open a line of communication with your partner to ensure a happy and fulfilling sex life through perimenopause and beyond.

Editor’s note: This blog was originally published in December 2019. It has been updated to include more relevant and comprehensive information.