Low Libido in Midlife: Is It Real, and Can You Do Something About It?

If you're in your 40s or 50s and have noticed a decline in your desire for intimacy, you’re not alone. Many women experience a shift in libido during midlife, and it can be frustrating—especially if it’s impacting your relationship. But is low libido a real thing, or is it just “in your head”? And more importantly, is there something you can do about it?

Dr. Kelly Casperson, a urologist and author of You Are Not Broken, tackles these questions head-on. Let’s break it down.

Yes, Low Libido Is Real—And Yes, It’s in Your Head (But Not in the Way You Think)

One of the biggest misconceptions about low libido is that it’s just a mindset issue. While it’s true that libido originates in the brain (not, as Dr. Casperson humorously puts it, in your elbow), that doesn’t mean it’s imaginary. Libido is a complex mix of brain chemistry, hormones, mood, and emotional connection.

In fact, research shows that 40 to 60% of women struggle with some form of sexual dysfunction in midlife, and the distress related to low libido is highest in perimenopausal women, typically between the ages of 40 and 50.

Why Does Libido Drop in Midlife?

Several key factors play a role in this change:

• Hormonal shifts – Estrogen and testosterone levels decline during perimenopause and menopause. These hormones impact dopamine, the neurotransmitter responsible for desire and motivation.
• Dopamine levels – If dopamine is low, desire naturally decreases. In some cases, medication or lifestyle changes can help boost dopamine levels.
• Stress and lifestyle – Sleep deprivation, chronic stress, and mental overload (hello, midlife responsibilities!) can also take a toll on libido.
• Different types of libido – There’s spontaneous libido (a sudden urge for intimacy) and responsive libido (desire that builds with stimulation). Many women shift to more responsive libido in midlife, which means arousal may take a little more time or intention.

What Can You Do About It?

If your lack of libido isn’t bothering you, then there’s no reason to stress about it! However, if you’re feeling frustrated and want to regain that spark, here are a few steps to consider:

1. Educate Yourself – Understanding how libido works is the first step. Dr. Casperson recommends her book You Are Not Broken as a resource.
2. Check Your Hormones – Low estrogen or testosterone could be affecting your desire. A doctor can help assess if hormone therapy is right for you.
3. Boost Dopamine Naturally – Exercise, quality sleep, and activities that bring you joy can help improve dopamine levels.
4. Consider Treatment Options – There are FDA-approved medications for low libido that work by enhancing dopamine pathways in the brain.
5. Prioritize Intimacy – If intimacy is important in your relationship, treating it like a priority rather than an afterthought can make a difference.

The Bottom Line

Low libido in midlife is real, and it’s not just in your head—it’s a combination of brain chemistry, hormones, and life circumstances. The good news? There are plenty of options to help reignite desire if that’s something you want to work on.

If this is something you’re struggling with, know that you’re not alone, and more importantly, you’re not broken. With the right knowledge and support, you can take steps toward feeling more like yourself again.

More Resources & Links

Listen to EP 402. Feeling Broken? UTI’s, Low Libido & Prolapse with Dr. Kelly Casperson

Grab Dr. Kelly Casperson’s Book “You Are Not Broken”

Listen to Dr. Kelly Casperson on the “You Are Not Broken” podcast here

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