Perimenopause is a time of hormonal fluctuations that can impact multiple aspects of a woman’s health, including sexual desire (libido). Many women notice a decline in their libido, which can be frustrating and confusing. While hormonal changes are a key player, certain medications and substances including birth control pills, cannabis, opioids, benzodiazepines, and antidepressants can also contribute to low libido.
The Hormonal Connection: Why Perimenopause Affects Libido
During perimenopause, levels of estrogen, progesterone, and testosterone fluctuate and eventually decline.
- Estrogen is essential for vaginal lubrication and blood flow to the genitals. As it decreases, women may experience vaginal dryness, discomfort during sex, and lower sensitivity.
- Testosterone, often considered a “male hormone,” is crucial for sexual desire in women as well. Research in the Journal of Clinical Endocrinology & Metabolism suggests that declining testosterone during perimenopause/menopause correlates with reduced libido.
- Progesterone impacts mood and relaxation, and its decline can contribute to irritability, poor sleep, and stress, which indirectly affect sexual interest.
How Medications and Substances May Reduce Libido
Understanding the reasons behind low libido during perimenopause can help women navigate this challenging time more effectively.
While hormones play a major role, certain medications and substances can exacerbate sexual dysfunction. I think a common medication, most women have heard of causing low libido are birth control pills. They lower testosterone and suppress natural hormone fluctuations. A possible alternative is an IUD (more on this in a future post). Lets discuss other culprits.
1. Antidepressants (SSRIs & SNRIs)
Selective serotonin reuptake inhibitors (SSRIs) like Lexapro, Prozac, and Zoloft are commonly prescribed for depression and anxiety but are strongly linked to sexual dysfunction.
- How they affect libido: SSRIs increase serotonin levels, which can suppress dopamine, a neurotransmitter involved in sexual desire and arousal.
- What research says: Studies in the Journal of Clinical Psychiatry confirm that SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs, such as Effexor and Cymbalta) can significantly reduce libido, delay orgasm, and cause arousal issues.
2. Cannabis (Marijuana & CBD Products)
Cannabis is often marketed as a relaxant, but research suggests it may lower libido for some women especially with chronic or high-dose use.
- How it affects libido:
- THC (tetrahydrocannabinol) affects the endocannabinoid system, which plays a role in hormone regulation.
- Chronic use may suppress estrogen and testosterone production, reducing sex drive.
- It can also cause fatigue and sedation, which lowers sexual motivation.
- What research says: A study in The Journal of Sexual Medicine found that cannabis use affects sexual function inconsistently in some women report increased desire at lower doses but reduced libido at higher doses.
3. Opioids (Percocet, Vicodin, OxyContin)
Opioid painkillers, such as Percocet, Vicodin, and OxyContin, are notorious for reducing testosterone levels which, in turn, can decrease sexual desire.
- How they affect libido:
- Opioids suppress the hypothalamic-pituitary-gonadal (HPG) axis, leading to lower testosterone production.
- Long-term use can cause fatigue, depression, and reduced sexual responsiveness.
- What research says: A study in The Clinical Journal of Pain reported that chronic opioid use is strongly linked to hypogonadism, which is associated with low testosterone and sexual dysfunction.
4. Benzodiazepines (Xanax, Valium, Klonopin, Ativan)
Benzodiazepines (Xanax, Valium, Klonopin, and Ativan) are prescribed for anxiety and sleep disorders, but they can dampen sexual function.
- How they affect libido:
- They suppress the central nervous system (CNS), leading to fatigue, reduced arousal, and emotional blunting.
- They can increase prolactin, a hormone that suppresses dopamine, which is needed for sexual desire.
- What research says: The Journal of Affective Disorders found that benzodiazepines reduce sexual motivation and arousal especially in women taking them long-term.
5. Antihistamines (Benadryl, Zyrtec, Claritin)
Antihistamines may help with allergies, but they can also “dry out” areas beyond the sinuses—including vaginal tissues.
- How they affect libido:
- They have anticholinergic effects, which can lead to reduced lubrication and sensitivity.
- Some may cause sedation, making sexual activity less appealing.
6. Antihypertensive Medications (Blood Pressure Medications)
Certain blood pressure medications, such as beta-blockers (Metoprolol) and diuretics (HCTZ, Furosemide), can contribute to low libido and erectile dysfunction.
- How they affect libido:
- They reduce blood flow to the genitals, affecting arousal.
- They can cause fatigue and decreased dopamine levels.
7. Hormonal Contraceptives (Birth Control Pills, IUDs)
Birth control pills and hormonal IUDs can alter libido due to their effects on testosterone.
- How they affect libido:
- They increase sex hormone-binding globulin (SHBG), which binds to free testosterone, making it less available.
- Lower testosterone can lead to a reduced interest in sex.
- What research says: The Journal of Sexual Medicine found that some women on hormonal contraceptives experience a significant decrease in libido, even after stopping birth control.
Addressing Low Libido: What Women Can Do
If you’re experiencing low libido in perimenopause, consider the following:
- Talk to a Healthcare Provider: If you suspect medications or hormonal changes are affecting your sex drive, discuss alternatives or adjustments with your provider.
- Check Your Hormones: Blood tests for example estrogen, testosterone, progesterone, and SHBG can help pinpoint imbalances.
- Optimize Lifestyle Factors: Exercise, stress reduction, and proper sleep can help support hormone balance and sexual function.
- Consider Alternative Therapies: Some women benefit from bioidentical hormone replacement therapy (BHRT) or testosterone therapy under medical supervision.
- Explore Medications for Low Libido: FDA-approved treatments like flibanserin (Addyi) can help premenopausal women with hypoactive sexual desire disorder (HSDD).
Final Thoughts
Low libido in perimenopause is often not just a psychological issue it’s biological and influenced by both hormones and medications. If you’re feeling like you’ve “lost the spark,” it’s important to look beyond self-blame and explore potential culprits.
By understanding the role of hormones, medications, and lifestyle factors, women can take proactive steps to restore their sexual well-being.
I truly hope this helps you and others. If you do not have a provider, please reach out to chat about your concerns.
Studies reviewed:
https://pmc.ncbi.nlm.nih.gov/articles/PMC2834444
https://www.jsm.jsexmed.org/article/S1743-6095(17)31395-3/fulltext
https://www.sciencedirect.com/science/article/abs/pii/S016503272030657X
https://www.health.harvard.edu/womens-health/when-an-ssri-medication-impacts-your-sex-life
https://doi.org/10.1056/NEJM198908033210501
https://doi.org/10.1192/bjo.2018.35