Low libido in women: common causes, what helps and when to see a GP

Sex drive, or libido, is the desire for sexual activity. It naturally varies between people and across a lifetime, and it can change with stress, tiredness, relationships and health. A low sex drive is only a problem when it troubles you or your relationship. The NHS describes there as being many possible reasons for a low sex drive and says that treating the cause should help increase it.

There is no single normal level. If you are content with your level of desire, there is nothing to treat. If it has changed noticeably, is causing distress or is affecting a relationship, it is reasonable to look for a cause and to ask for help.

The NHS lists the main causes of a low sex drive and notes that some long-term conditions can also affect it. Several apply particularly to women, and they often overlap, so more than one may be involved.

The NHS lists reduced sex drive among the symptoms of perimenopause and menopause, and says that vaginal dryness, burning, irritation or itching can also make sex feel painful. It says symptoms usually last for 7 to 9 years, sometimes longer, and can change over time, and that early advice can help reduce the effects of menopause on health, relationships and work.

NICE Clinical Knowledge Summaries notes altered sexual function among the features that should make a clinician suspect perimenopause or menopause, and describes treatment options: HRT, with low-dose vaginal oestrogen offered first-line for urogenital symptoms, and vaginal moisturisers and lubricants where HRT is not tolerated or is contraindicated. It also lists menopause-specific CBT for mood disorders and sleep problems.

Because low desire in this stage of life can be a combination of hormones, sleep disturbance, mood and relationships, it is worth describing all of these to the GP rather than the libido change alone.

The NHS says that hormone levels change when you are pregnant, and that looking after a baby can be stressful and tiring. Low desire in pregnancy and the first months after birth is common and often settles. The NHS says to see a GP if your sex drive does not return to normal after pregnancy.

The NHS lists certain medicines such as those for high blood pressure or antidepressants, hormonal contraception such as the pill, patch or implant, and drinking too much alcohol among possible causes. It also lists long-term conditions such as heart disease, diabetes, an underactive thyroid or cancer.

If you think a medicine or your contraception is affecting your sex drive, the NHS advises seeing a GP rather than stopping it. Possible approaches include changing to a different medicine or type of contraception. Do not stop a prescribed medicine without advice because the reason you take it still matters.

The NHS says to see a GP if you are worried about your low sex drive, if you are taking a medicine or using hormonal contraception and you think it may be affecting your sex drive, or if your sex drive does not return to normal after pregnancy. A GP can advise about the help you can get and any treatments that might increase your sex drive.

A consultation typically explores when the change began, what else changed at the time, your periods or menopausal symptoms, mood and sleep, medicines, relationship and any pain during sex. It can feel awkward to talk about, but GPs are used to it, and you can ask for a particular clinician or a female doctor if that helps.

The sources used for this guide emphasise treating the cause. Within that, sensible steps include addressing stress, sleep and alcohol, keeping physically active, talking openly with a partner, and using lubricants if dryness is making sex uncomfortable, as the NHS lists vaginal lubricants for vaginal dryness. Counselling and CBT are options, according to the NHS, when relationships or mood are involved.

• Talk to your partner about what has changed and what feels comfortable.

• Reduce alcohol and look after sleep.

• Use vaginal lubricants or moisturisers if dryness or discomfort is a problem.

• Ask about counselling or CBT if stress, low mood or relationship worries are involved.

• Review medicines and contraception with a GP or pharmacist.

Low libido is usually assessed in general practice on the NHS, with referral to a menopause clinic, gynaecology, sexual health or psychosexual counselling if needed. Private menopause or psychosexual clinics are available and can shorten waits; whichever route you use, ask for the evidence behind any treatment recommended and keep your GP informed so that medicines and contraception are reviewed together.