Understanding Desire Changes in Midlife
Low sexual desire can often be a common complaint, especially during perimenopause and menopause.
Hormonal shifts, stress, sleep disruption, and life demands can all play a role.
However, when desire loss becomes persistent, distressing, and impacts quality of life, it may be more than situational low libido.
For some women, it may reflect Hypoactive Sexual Desire Disorder (HSDD)—a recognized medical condition involving changes in how the brain regulates desire.
What Is HSDD (Hypoactive Sexual Desire Disorder)?
HSDD is defined by:
- Persistently or recurrently low sexual desire
- That causes personal distress or relationship strain
- And is not better explained by another medical condition, medication, or relationship issue alone
Importantly, HSDD is not about frequency of sex. Instead, it is about a loss of desire that feels troubling to the woman herself.
Low Libido vs. HSDD: Why the Difference Matters
Not all low libido is HSDD. Desire may dip temporarily during stressful seasons. However, HSDD is typically:
- Acquired (develops after a period of normal desire)
- Generalized (present across situations)
- Distressing
Because of this, identifying the why behind desire changes is essential. Treatment depends on the underlying drivers.
Common Contributors to Low Desire
Desire is influenced by many overlapping factors, including:
- Hormonal changes (estrogen, progesterone, testosterone, thyroid)
- Chronic stress and elevated cortisol
- Sleep disruption and fatigue
- Vaginal dryness or pain with intimacy
- Medications such as SSRIs or hormonal contraceptives
- Emotional and life transitions, including caregiving or burnout
Often, multiple contributors are present at once.
Supportive Non-Medication Options
Even when HSDD is suspected, foundational support matters.
- Stress reduction: Nervous system regulation through mindfulness, therapy, gentle movement, or restorative practices
- Nutrition: Adequate protein, stable blood sugar, omega-3 fats, and reduced alcohol
- Exercise: Strength training and consistent movement to support hormones and mood
- Supplements (personalized): Magnesium, vitamin D, omega-3s, adaptogens, or botanicals when appropriate
- Topical arousal support (“scream cream”): Compounded creams may support local blood flow and sensitivity for some women
When Testing Can Change Everything
If desire loss is paired with fatigue, mood changes, weight shifts, sleep issues, or menopausal symptoms, testing can provide clarity.
Cutting-edge, comprehensive hormone testing such as the DUTCH Complete Hormone Test, adrenal hormones, thyroid markers, nutrient levels, and metabolic labs help guide truly personalized care.
The Bottom Line
Low desire can be a common complaint during perimenopause and menopause—but distressing loss of desire deserves attention.
Whether the cause is hormonal, neurological, emotional, or multifactorial, answers are available.
You deserve care that looks at the whole picture, not just one symptom.
In Health,
Dr. Helene
If this feels familiar, I invite you to explore whether naturopathic medicine—and ongoing, individualized care—might be the right next step for you.
Together, we can take the time to listen, understand, and support meaningful change.
Lasting change often happens with steady, relationship-based care.
The 6-Month Naturopathic Medical Membership provides consistent support and deeper insight over time—designed for those who want care that evolves with real life.
→ Explore the membership.
Check out the DUTCH Complete Hormone test HERE.