Sex drive is a funny thing: It’s entirely subjective, right? There is no right number of times to have sex per week or month, and there’s a large variability of what people consider “sex” or intimacy. Every point on that spectrum is completely valid.
Where the problem pops up is when what you want doesn’t align with what’s happening in your life, says Lilli Link, MD , an internist and functional medicine doctor with Parsley Health in New York City.
For instance: You and your partner used to have sex once a week and were both happy with that frequency. But now, you’re pushing it off to once a month, and maybe feeling as if you’re dutifully doing it for your partner’s benefit only. If that’s distressing to you, that’s a problem. But if, on the other hand, you’ve experienced a slow burn out of desire over time, perhaps because you’ve been coupled up in a long-term relationship, but you and your partner are happy with the current level of intimacy, well, then carry on.
Low sex drive in women is the most common sexual health problem , possibly affecting one-third of women . A more severe form, called hypoactive sexual desire disorder (lack of sexual interest that causes distress in your life) affects nine percent of women 18 to 44 and 12 percent of women ages 45 to 64, according to a study in Sexual Medicine Reviews .
It may be a common experience, but it shouldn’t be ignored. “Your sex drive can be one marker of your health,” says Dr. Link. So what causes low sex drive in women? From hormonal changes to lifestyle habits, here are seven reasons why you’re no longer eager to hop between the sheets:
Perimenopause, or the years before menopause when you’re in your 30s and 40s, is a time when levels of the hormone estrogen fluctuate, notes the American College of Obstetricians and Gynecologists (ACOG). Once you reach menopause, your ovaries essentially shut down and no longer pump out estrogen. On average, this happens at age 51. When it comes to the libido, “menopause can be like a cliff,” says Dr. Link. In fact women ages 40 to 60 are most likely to experience a distressing lack of desire for sex.
The symptoms of menopause don’t exactly put you in a prime mental or physical space to want to take off your clothes. There are the hot flashes, sleep changes, and mood problems that won’t get you in a sexy frame of mind. Vaginal dryness is a big concern, too. As ACOG explains, with a lack of estrogen, the lining of the vagina thins and becomes dry. Without lubrication and stretch, sex can easily become uncomfortable or hurt. And if it doesn’t feel good, you’re not going to want to do it.
Dr. Link suggests making sex more comfortable, which can be done with vaginal estrogens, and—if you’re willing—making a commitment to ramping up sexual intimacy. “Having sex puts you more in the mood for having sex,” she says. Certain supplements to increase sex drive , like maca, may also make a small difference. A Parsley Health doctor can recommend the types and doses of supplements that may help improve low sex drive for some women.
When you have hypothyroidism (an underactive thyroid ) your body’s functions begin to slow, and your libido may dissipate, too, says Dr. Link. That said, if thyroid dysfunction is behind your stuttering libido, it’s not going to exist on its own. More than likely, you’ll also experience other signs, she says. Symptoms of thyroid issues include hair loss, weight gain, constipation, depressed mood, and dry skin.
Interestingly, hyperthyroidism (an overactive thyroid) can also make you shy away from sex. Thyroid dysfunction impacts sex hormones that drive down desire and also make sex less enjoyable (decreasing arousal and lubrication, orgasm, and even contributing to pain during penetrative sex), according to a review of 40 years of research published in the journal Sexual Medicine Reviews in 2019 . As many as 63 percent of patients with hypothyroidism and 77 percent of patients with hyperthyroidism report problems with sex.
Should your doctor at Parsley Health suspect a thyroid condition, they’ll consider your lifestyle and family history. For example, autoimmunity can run in families and cause hypo- and hyperthyroidism. And autoimmune disorders can manifest in different ways. (For example: If your mom has rheumatoid arthritis, an autoimmune condition, then you could develop an autoimmune thyroid disease.)
Following that, you may take a quick and easy blood test to check for optimal levels of thyroid functioning . That’s different from conventional doctor practices, which may simply check to see that your thyroid hormones are in “normal” ranges. In other words, your levels could be technically normal but not “optimal,” which could explain your symptoms, says Dr. Link.
Depending on how bothersome your symptoms are, you may be prescribed thyroid medication. Other times, you may talk about lifestyle factors that can improve thyroid function without drugs. Parsley Health’s health coaches work with members to implement lifestyle changes. That might include:
It can be difficult to want sex if your body isn’t getting the nutrients and energy it needs. While there isn’t research that looks at how specific diets affect libido, your period can disappear if you’re not eating enough or exercising too much, says Dr. Link. This is a condition called amenorrhea. It may be associated with having lower levels of androgens (traditional “male” hormones), which can lower sex drive in women. Getting out of potentially unhealthy and restrictive eating habits can take a lot of work, and speaking with a dietitian who has experience in treating disordered eating habits may help you.
Problems within the relationship (e.g. you’re on the edge of a breakup) understandably may make you want to avoid sexual intimacy. On the other hand, if you’re not in a relationship right now, it’s totally understandable if you’re not running hot and heavy. “Sometimes [not dating] is enough to make your libido decrease,” says Dr. Link. Same goes for being in a long-term relationship. (People make jokes about married sex—or lack of it—but, hey, that’s normal for some couples.) Whether or not that’s a problem goes back to how you (and your partner, if you have one) feel about what’s happening between the sheets.
Depression affects your ability to enjoy things in life, and that goes for having sex, too. Mood problems are so multi-factorial, and it can take a lot of digging to get to what’s behind it. Some places to start: Dietary changes may help bring you out of a funk, says Dr. Link. This includes whole foods, ample healthy fats , and avoiding sugar. (Here are six foods that can boost your mood .) Identifying any nutrient shortfalls in your diet that could affect your mood, like folate or B12, and then correcting them can help provide the foundation that supports mental health.
Developing stress relief management skills will help you quiet your nervous system so it’s not in overdrive all the time. “Sometimes these things help, but often some other type of support is needed, like talk therapy or medication,” she says. Parsley Health’s providers can work in conjunction with your mental health provider to ensure you’re managing your physical and mental health from all angles.
Did you just start a new job? Is someone in your family chronically ill? Do you have a baby, have little kids, or are coaching school-aged kids through virtual classes while maintaining your job? Then stress and/or a lack of sleep may be contributing to low sex drive for some women. “You might otherwise feel fine, but sex is the last thing on your mind,” says Dr. Link. Working with your schedule to fit in blocks of time for de-stressing or self-care, as well as prioritizing sleep is important right now. Of course, that might be especially difficult at this time, but even small actions—a few stretches here, an extra walk there—can help you feel more balanced and make room for the things that got pushed to the wayside.
How annoying that the very thing that prevents a pregnancy also makes you ho-hum about sex. Hormonal birth control pills may decrease testosterone in your body, explains Dr. Link. If you’re interested in switching your birth control because it’s messed with your sex life, “there are absolutely options besides the pill,” she says. That includes apps that track your cycle (so you can avoid sex on fertile days), using condoms, or considering an IUD, particularly a copper IUD, which is free of hormones.
If you decide to get off of birth control, it may take some time for your hormones to rebalance. Parsley Health’s providers can also help to balance hormones and regulate your cycle naturally after stopping birth control .