Sexplain It: Perimenopause Has Killed My Wife’s Libido. I’m Now a Horny Mess.

I’m Zachary Zane, a sex columnist and author of Boyslut: A Memoir and Manifesto. Over the years, I’ve had my fair share of sexual experiences, dating and sleeping with hundreds of people of all genders and orientations. In doing so, I’ve learned a thing or two about navigating issues in the bedroom (and many other places, TBH). I’m here to answer your most pressing sex questions with thorough, actionable advice that isn’t just “communicate with your partner” because you know that already. Ask me anything—literally, anything—and I will gladly Sexplain It.

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Dear Sexplain It,

My wife is going through body changes from perimenopause, and it’s having a big impact on our sex life. Her libido is out the window. Are there any legitimate female prescriptions to help with this for women over 50?

— Frustrated Husband

Dear Frustrated Husband,

To best answer your question, I reached out to Dr. Kate Balestrieri, Psy.D., CST, founder of Modern Intimacy and author of What Happened to Me Sex Life? A Sex Therapist’s Guide to Reclaiming Lost Desire, Connection, and Pleasure. Balestrieri has over 15 years of clinical experience working with individuals and couples, helping them navigate their sex lives. Discrepant sexual desires, more specifically, when one partner wants sex more frequently than the other, is something she’s helped couples with countless times. After speaking with her, I decided it was best that she, alone, answer your question.

Here’s what Balestrieri said:

It’s completely natural to feel a bit stumped and frustrated in times like these. Your wife is probably feeling confused and frustrated as well, likely with more intensity. The transition she is going through is no small thing! During perimenopause, hormone levels fluctuate, which can impact everything from sleep to mood and can affect libido. But before diving into the potential for prescriptions, it’s worth focusing on how you, as her partner, can make her feel supported, desired, and connected during this time. Sometimes, these small gestures can actually do more for intimacy and sexual connection than we realize.

Start by checking in with her emotionally. Her body is going through a lot, and even just letting her know you’re there for her can be incredibly powerful. Make it clear that you’re interested not only in finding solutions but also in simply understanding what she’s feeling. Ask her what’s been hard, listen without trying to fix, and let her vent if she needs to. Doing your own research into the experience of menopause can help you ask informed questions (without interrogating her!) that show her you care. In times like these, emotional closeness often builds the groundwork for physical closeness, even if it’s not right away.

Next, consider how you can help her unwind. Stress can be a major libido killer, especially when hormones are doing their own thing. Maybe it’s a new routine of small things—more shared downtime, quality one-on-one time, or simply taking some things off her plate. But it’s probably best not to ask her to make a list. That only adds to her list of things to do. Instead, take initiative to alleviate her mental load. Look for ways to help her feel relaxed and valued in ways that don’t center on the bedroom but instead focus on the bigger picture. A relaxed mind and a nurtured spirit can sometimes rekindle that spark over time.

And remember, intimacy doesn’t have to mean sex. Show her affection without expectations, like offering a shoulder rub, cooking a nice meal, or planning a simple day out. Just being close can make her feel safe and seen. Over time, that emotional connection may lead to a natural desire to reconnect physically—at her pace, in her own time. While you might be feeling antsy, do not pressure her for sex, or pout, or punish her with your sour mood if she is not feeling sexual when you are. Obligatory sex, sexual entitlement, or coercion can leave partners feeling estranged and unsafe, which has a chilling effect on their desire both in the moment and the long term.

So, while there are prescription options that she could explore with her doctor, focusing on building emotional closeness and showing her how much you care might bring you two closer in ways that no pill ever could.

Frustrated Husband, if, after a few months of supporting and reconnecting with your wife, you find yourself in the same sexless position, I would then consult a gynecologist or endocrinologist who specializes in women’s health about potential medications. But, to Balestrieri’s point, medications shouldn’t be your first option; being a supportive husband should be.