Why Women Lose Interest in Sex in Perimenopause and Midlife | Emily Morse

0:00About half of women in perimenopause report a drop in libido. What's the real reason women stop wanting sex midlife? That is a multi-layered answer because there are so many different things going on. Hormone is part of the factor. It's also relational. Do we feel safe in our relationship? Do we feel connected in our relationship? Do we have resentments that have built up? I call them the pleasure thieves. It's stress, trauma, and shame. And stress is one of the biggest factors of killing our libido. Scheduling intimacy makes sex less exciting. Oh God, this is also not true. Scheduling sex can actually be the antidote to much of what challenges people around sex.

0:3670 % of divorces are initiated by women midlife. What do you think's not being addressed in relationships that's contributing to this? I think women's needs are not getting met across the board. I'm gonna be my own best advocate and I'm going to ask for it. Emily Morse. In a culture that still teaches us to downplay desire, Dr. Emily Morse is rewriting the rules. As a doctor of human sexuality and host of the number one podcast, Sex with Emily, she spent two decades helping millions communicate more honestly, build deeper relationships, and feel more confident in how they connect. You brought up a couple of times most women haven't even experienced great sex.

1:12I'm going to say it, yeah. How can women achieve great sex? Okay, it's a great point. I would say most women can have great sex by... So good, so good, so good. New summer arrivals are at Nordstrom Rack Stores now. Get ready to save big with up to 60 % off brands like Rag & Bone, Levi's, Adidas, and Free People. Join the Nordiclub to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and pick up at your favorite rack store for free. Great brands, great prices. That's why you rack. Plan B is a backup birth control option that's there for you when things don't go according to plan.

1:52It specifically works after unprotected sex and before pregnancy occurs by temporarily delaying ovulation. Plan B is available nationwide at all major retailers and through delivery apps like DoorDash. No ID, prescription or age requirement. It's the number one OBGYN recommended brand of emergency contraception and it won't impact your future fertility. be. That's freedom to be. Use as directed. Welcome to the Dr. Brighton show, where we burn the BS in women's health to the ground. I'm your host, Dr. Jolene Brighton. And if you've ever been dismissed, told your symptoms are normal or just in your head, or been told just to deal with it, this show is for you.

2:33And if while listening to this, you decide you like this kind of content, I invite you to head over to drbrighton.com, where you'll find free guides, twice weekly podcast releases and a ton of resources to support you on your journey. Let's dive in. About half of women in perimenopause report a drop in their libido. What's the real reason women stop wanting sex midlife? Well, that is a multi-layered answer because there are so many different things going on. It's not as simple as like, oh, my hormones dropped, you know, get me on HRT, everything's going to be better. When there's a drop in perimenopause, first thing women turn to is, oh, it must be hormones.

3:10I got to get my hormones fixed and then my libido is going to get back to where it was. But I often go deeper and I say, okay, really? So how was it before perimenopause? How was it after you had kids, after childbirth? Was it really that great in your 20s? So I'm just going to land the plane here and say that I think that for a lot of women, sex has always been really challenging and libido and desire and arousal have gone up and down. And then in perimenopause is when they're like really maybe have the time and space to take a look at it. And while hormone is part of it, part of the factor, it's also relational.

3:40Do we feel safe in our relationship? Do we feel connected in our relationship? Do we have resentments that build up? So really there's a lot of different things going on during period of menopause. I think it's hormones and relational. Well, I appreciate you saying that because I think so often, especially now we see hormone therapy is getting all the air time, right? people often default to, if I have a libido problem, it's a hormone problem. All I have to do is use hormones and that fixes the problem. Clinically, I don't see that to be true because often relationship issues can develop from that or they were contributing and tipping the scales on the hormone issues.

4:17Yes, yes, absolutely. So I think that, I think at this time of life, we can look at, like in HRT, we know, listen, this is how we know. If you're having arousal challenges, maybe lubrication issues, sleep, night sweats, all those things, you're like, that is hormonal. But if you don't feel safe, you have resentments for your partner, there's been some communication issues and things have built up over time. We always have to look at everything. That's why in my last book, Smart Sex, I talked about sexual intelligence and I developed these five pillars of sex IQ. And that's why you really have to look at, it's a lot of things.

4:49You know, do I feel embodied during sex? Am I present or am I thinking about the laundry? then you think about health and that's where hormones come into play and you know blood flow are we moving our bodies are we eating foods that make us feel good you know there's also yeah i mean i can go through all of them but i don't have to go through all of them right now but the point is there's like do i feel self-knowledge how well do i know myself do i know what time today i get turned on do i accept my body for where it is right now or do i you know have a lot of shame around my body and then there's how well do i actually communicate about my sex life so it's never just one thing.

5:24And what I love is at this time of life, I think it's when women maybe have the time, space, and energy to really look at it, or they're thinking, you know, I have to do something. So if they start with hormones and they realize there's a lot of other things going on, that's important. It's time to take a look at everything. All these areas of our life contribute to us having healthy sex. Women will say, not now. Men then say, you're punishing me. what can couples do to navigate this scenario and this low libido, which maybe not even be actually a low libido, but this disconnect when it comes to sex?

5:58Okay. Well, first we have to stop saying that just because I don't want sex, I'm rejecting you. So we say no, and then our partner feels bad. And then we get into a loop. I think we have to learn to say to our partner, I'm not in the mood for sex right now, but here's why. Here's what's going on. I actually feel like I need some connection right now. Can we hold hands? Can we have an intimate conversation? can we go for a walk you know i'm actually going or even just saying like honestly like i don't know what's going on with my libido right now and my arousal i'm not really feeling it but it's not about you it's just more about really stuff that i'm so stuff that i'm going through how can we find ways to connect i think that when it comes into just we say like a blanket no our partner feels bad and just gets into this cycle where we have to just be really clear about what's going on and bring our partner into it so that sounds easier said than done for a lot of people though So how do you actually have that conversation?

6:47So the first thing is you say, okay, I mean, this is me. You know, I always say communication is a lubrication and it's really the more we get comfortable talking about sex, it's going to help our sex life. We're going to have such better sex, better communication, better everything. And so it is not easy to talk about sex. I will say that, but just starting with, hey, I really want us to be great lovers to each other. I love our relationship. um i want us to feel intimate and connected and so right now you know i'm working i'm in perimenopause and i'm trying to figure out troubleshooting right now you know i've gone to my doctor and i figure out hormones but i also am just not feeling i'm not feeling it right now and so i need you to work with it let's work together on what might you know make us both feel in the mood and be great lovers to each other and so i think this is when we have to really get curious, first of all, we're asking for compassion, understanding, and curiosity.

7:42So if I think, for example, for me, if I'm not feeling, you know, desire, I get curious. I run through my five pillars of sex IQ and I'm like, okay, I'm feeling pretty embodied. I went to yoga. I did some breath work. My hormones seem to be on point. I work out a lot. Huh. You know, I'm actually not, I haven't really, I'm having some resentments with my partner. I've actually haven't talked to him lately because I just found out, you know, I mean, that maybe they were, I haven't really feel like they've been there for me. They've been traveling a lot. I've been feeling really distant. So we have to troubleshoot.

8:09We are responsible for our own pleasure. So we have to troubleshoot our own sex life. So really, I have to think, what do I actually need right now to feel safe, connected, and turned on? And we get to do that together. So while it's easier said than done, it's never been a quick switch to turn on our sex life. I think that there's so many problems with thinking I should just be aroused, turned on, and ready to go, where it doesn't work like that for 99.9 % of people, especially women. So I want to play two truths and a lie. Okay. Okay. I'm going to make these three statements and then we'll give people a chance to comment and then we'll come back to them and you'll tell us which is a lie.

8:43So firstly, your brain is your biggest sex organ. Second, estrogen decline automatically kills libido. Third, scheduling intimacy makes sex less exciting. So everybody who's listening, I want you to go to YouTube, comment to us, which one is the lie? We'll be drawing a winner for the people who get it right. And while you guys are doing that, I want to ask you, can you explain the brain hormone desire connection for women, especially in perimenopause? Because we're often told, again, it's just a hormone thing, but there is a brain hormone desire connection going on. Yeah. Our brain is the the engine.

9:23Our brain is the, the, where everything starts, our desire starts and think about the hormones being the fuel. Hormones are the fuel to our desire, but everything's going to start in our brain, our desiring, our want to want to have sex. And the hormones are just like a supporting role in that. I mean, a huge role in it, but they're not everything. So with, with that said, it's like, again, our brains are about, you know, the desire. Has there been anything going on in my life that's keeping it relationally do i feel safe in my relationship um do i we have to like troubleshoot it but then hormones again you can immediately tell it's a hormone issue again with libido with um with lubrication with you know arousal am i feeling red am i feeling aroused am i feeling turned on and with um yeah like if we've got night sweats these are all the ways that we can you know this with hormones but i think that with the desires understanding what is my like what we're getting curious, what do I actually need to be turned out in this situation?

10:21And you can even work backwards. What's worked for me in the past? What do I know about myself? Like I know if I haven't been moving my body, if I haven't been eating foods that make me feel good, if I haven't been communicating with my partner, again, we always have to like troubleshoot those things. So yeah. Well, if the brain is primary sex organ, I think it's important for people to understand that sleep, stress, emotions can all impact desire. Can you say more about that? Yes. So all these things are continually to impact our desire. Sleep, stress, emotional load. If we're not getting sleep, if our sleep is disrupted, it's going to be really hard to feel like turned on and ready when we're exhausted all the time.

11:02If we have stress, we have a spike in our anxiety, which a lot of us do. We have a spike in cortisol that can't live in the same place as our pleasure and our desire. And they literally cancel each other out. So you have a spike in cortisol and then you have a drop in the desire in our dopamine, oxytocin. Like it's just really hard to feel really aroused and turned on when everything else feels, when we're stressed, it overrides it completely. So I think we can't, I call them the pleasure thieves. It's stress, trauma, and shame. And stress is one of the biggest factors of killing our libido. So we have to deal with all of that first.

11:36So all of that's going to also impact arousal and make it really hard. And a lot of us are running around very stressed right now. And we're wondering why we don't want to have sex. Let's deal with the stress, the anxiety. I love the calm pleasure theme. It's so perfect because they are sneaky too. They're so sneaky. Yeah. I mean, think about it though. We are like wondering why we're stressed all the time. We're anxious. Like I said, it can't live in the same place. Spiking cortisol. You can't even receive pleasure. Like I hear from women all the time, like, I don't even know that my partner's touching me.

12:07I didn't feel it. I didn't even see him walk in the room because I'm so stressed, because I'm so anxious. And then if we have trauma too, like they are the pleasure. These are all the things like trauma, big T trauma, little T trauma. It lives in our body. It lives in our nervous system. If our nervous system is dysregulated, also really hard to experience pleasure and arousal. And then shame. I mean, shame is a, you know, shame is a sneaky one too. Shame says, you know, I am a bad person. I did something wrong. Not just shame is like, I am bad. And then we have a guilt that says, you know, maybe I did something bad.

12:39But shame is if someone shamed us about our body or we grew up in a culture that we thought that sex wasn't really accepted, that we just feel bad that we're not like as sexual as we used to be. All of these things get in the way. And so that's why when they think like hormone, just a quick fix, we have to look at all these other factors because you could be on the most perfect cocktail of hormones. But if you have these sneaky pleasure thieves, it's going to be just a challenge to feel like you are, you know, aroused or not and ready for pleasure. I think it's so important as we've been talking about in the framework of perimenopause, women to understand that these hormonal changes can also make you more susceptible to stress, make it harder for you to sleep.

13:19And the result of all of that can be feeling shame because now you're like, I'm not in the mood. I can't please my partner. I can't please myself. and they can be all of these layers that stack against you. And again, this is why we can't just give you hormones and be like, poof, it all went away because these underlying issues, even if your sleep does get better, maybe the stress, the relationship dynamic, or the way you feel about yourself is still there. Absolutely. We have to look at the entire factor. All of those matter. All of those matter when it comes to our relationships. And I think that, again in this time of life we're really ready to examine them but a lot of them have been going around for have been present for a long time but now we're just we're just like i'm done with this i have to figure out what to do to be in a healthy relationship that's so true yeah so let's go back you're gonna tell me true or false true truths and a lie okay first one your brain is your biggest sex organ true true number two estrogen decline automatically kills libido not true okay tell us why it's not true.

14:23There's a lot of things that happen when your estrogen declines. You know, we noticed like, you know, maybe we're drier, less lubrication. It can affect our sleep. All of that is our symptoms, but it's not going to directly impact your libido. It's about all these other factors that we're talking about. There's a lot of other things going on. So just because if you got your test taken and you realize you have this dip, it doesn't mean that your sex life is doomed. Okay. That was our lie. So the third one, what we know is true. I still would like to unpack it. So scheduling intimacy makes sex less exciting.

14:53Oh God, this is also not true. Scheduling sex can actually be the antidote to much of what challenges people around sex because so many couples are like, well, I want it to be spontaneous and exciting and new and novel. That's going to make great sex. However, how often does that really happen? So when you schedule sex, then you know I've anchored it I know that this is the night that we're going to be intimate we know that every Saturday night or next Saturday night I don't like to put like in every I don't like to put a time frame on couples like you have to have sex every night at this time but if you find one time a week where or one time how often you need sex that works for you then couples are like okay we know that it's Saturday night we've got time to think about that what do I need to make sure that I'm aroused and connected with my partner on that time so we work backwards again for me it's like is the house clean are the sheets clean do the kids have a sitter um do i feel good in my body am i eating foods that make me feel good like there's so many other factors i think that we just think that we have to flip a switch and our sex is going to be amazing no so scheduling sex gives us time to sort of make sure that we're both prepared and ready for sex and again i want to say this it's so important that sex isn't just about penetration because maybe you found in this stage of life that sex is more about intimacy and connection.

16:15Maybe it's a time where you're giving each other massages or you're spending some time together, you're cuddling, you're doing like non-sexual touch. I just want to emphasize that for so long and for so many women, sex never worked for them because it was centered on penetration and they're thinking that's how I should feel the best and that's how I should have orgasms and that's how I should be aroused, but that's just not the case. A lot of couples are craving connection, a deeper connection and intimacy, but not in the way that we just defined by sex. So however, whatever you schedule, maybe it's your intimate night where you put the phone away.

16:47It's just about connection. It's about getting out the massage table, hiring masseuse, figuring out how to touch each other. It might be about that, but it's just a special night that's for the two of you to connect again in ways that you haven't been able to other times. One thing I hear from women all the time is that they're struggling with symptoms like hot flashes, sleep disruptions, and brain fog, but aren't sure where to turn to for help. Menopause is inevitable, but suffering through it isn't. That's why I want to tell you about Alloy. Alloy is a digital health platform that connects you with a menopause specialized doctor who can create a personalized treatment plan tailored to your needs, all from the comfort of your home.

17:28Join the 95 % of women who tried Alloy and saw relief in the first two weeks. Head to myalloy.com and use the code Dr. Brighton. That's myalloy.com, M-Y-A-L-L-O-Y.com and the code Dr. Brighton, D-R-B-R-I-G-H-T-E-N. Share your symptoms and you'll get a fully customized treatment plan and unlimited messaging with your doctor. Plus, you'll get$20 off your first order today. That's M-Y-A-L-L-O-Y dot com, code Dr. Brighton. Who should consider scheduling their intimate time? Couples who find that they don't have time. It doesn't happen. They want it to happen. It's not happening. They're exhausted all the time.

18:22I mean, this is what I want to say too for couples who are like it never happens because it used to always happen in the evenings well maybe that's not your time like we have to be able to pivot and troubleshoot yeah I'm exhausted like I was eating with my last partner I'd say you know what if you get in bed Saturday nights at 10 o 'clock and I'm already in bed like it's not going to happen like guaranteed like don't it's I'm if I'm in bed already and the lights are off or the project off it's not going to happen so just couples who realize that like it's just hasn't been working we desperately want to connect.

18:49We want to have sex, but we haven't been able to find the time. So I think the majority of couples can stand for whether it's scheduled or just having a conversation about when is the best time of day for us to have sex? When do we feel the most turned on? What time's a day? What time's a month? What time's a week? I mean, this is like one area of our life we just don't really think about. Everything else we like to think about, we want to be healthy, we want to work out. We know what workouts we like, what times a day, the equipment we need to be ready for that workout or to feel healthy. What's the foods we need to eat?

19:19We make sure we have those foods in our home prepared. But with sex, we just kind of close our eyes and hope for the best. I hope we kind of figure it out. So I would say most couples could stand for a little bit more planning around their sex life, a little bit more intentionality and more curiosity and compassion. Yeah. And I appreciate you say like what time of day, because there's often people think there's a formula of like, we have to go out, we have dinner, we have dessert, like it's the date night, then we go home, we have sex. And a lot of people actually find that that doesn't work for them.

19:52And they're like, actually, sitter shows up, we have sex, then we get dressed. And I'm like, that's a great formula because expend the energy. Now you're hungry, go eat the dinner then. But finding what works for you instead. I'm interested, you had said you don't like to give like a number of the times that someone should be having sex. But there are people out there who say a healthy couple should have sex three times a week. Is there any truth to that? No. The way you take a breath, you're like, I'm angry at what they just said. No, I was actually going to say something. I was going to say winner, winner, sex before dinner for couples to remember that because I did a podcast about that.

20:32So just remember that. Winner, winner, sex before you go to dinner. But honestly, no. God, think about that's another item on your to-do list now. Have we had sex three times? have what does my aura ring say like what no it just puts so much pressure on couples i think that each individual each relationship gets to decide the two people in that relationship get to decide how many times a week how many times a week feels good for them what i found in most couples the most common question i've got asked in the 20 years i've been doing this since i've had the podcast and doing the show is that people um usually there's one couple that has a high desire and one couple that's a low desire.

21:10So there's a higher desire partner and a lower desire partner. And it's the lower desire partner that actually has more of the power in the relationship because they're the one that's deciding when the sex is going to happen. So for these two people, and that's how most relationships are, I'm sorry to say that it's usually, it's not two high desires and two low desires. If it was two high desires, would you leave your house though? Well, you would never leave your house and you wouldn't be tuning into this conversation. So just know you are not broken. There's nothing wrong with you. Most couples have to navigate this.

21:36so if it's like i'm the hydroser and i'm like i want it every day but you're lower and you're like i have maybe once a week well then we have to think about it well maybe it's you know once a week for an hour twice a week we have to figure out what that looks like but to say and then figure out understand what works for us when it works for us and so to prescribe this like rigid three times a week or one time a week i think it just doesn't work for most people i think you have to decide what times of day feels good to us. When you say you want it every day and we know that's not going to happen, what could we do so we feel more connected?

22:10Again, I think a lot of times we think it's about the sex, but it's really about intimacy and connection. And if your partner desires an orgasm, let's say seven days a week, well then maybe there's something they can do for themselves. If it's really about, I just need to have an orgasm, you know, listen, self-pleasure is a beautiful thing. Solo sex, I love it. You know, you get to take care of yourself, but in the relationship figure out what a healthy sex life looks for both of you without this prescriptive, you know, you have to do it at certain times. Yeah. When you say high desire, low desire, what are the definitions around that?

22:43Yeah. Great question. So higher desire, I think, is just the person who wants more sex than the lower desire partner. Like we know who that is. The person who's the one who's saying when the sex can happen, I want to have sex more frequently than you do. So really it's just the one who wants it more frequently than the lower desired partner. It's the one who wants sex more often than the partner who doesn't. But again, I'm not going to quantify it by, well, the lower desired partner is the one who wants it once a month. That just doesn't, that doesn't, it's not going to work. So it's the one who, usually it's the one who is, the one who's feeling more shame about it is probably the lower desired partner.

23:14And the higher desired partner might be feeling shame because they're asking all the time and they're getting rejected. So these are all the ways we need to talk about it and get just really clear about it. And also, again, I think it's pretty consistent in a relationship too. Usually it's maybe early on we want sex all the time because it's new and it's novel and it's exciting. But can we just normalize the fact that after you get pregnant, you have children, you have life stressors, parents get ill, there's money issues. Sex is going to often take a back burner. I don't want that to happen because once on the back burner, it's hard to get it back.

23:46But when you asked earlier, how do couples talk about it? They talk about it like as often as they're talking about their finances and how they're going to raise the kids and how they should decorate the home and where they should go on vacation and how they're going to prioritize their relationship. It has to be part of the conversation. And again, I understand that we were not equipped with this skill set of talking about or knowing how to troubleshoot it. But if you go back to sex IQ, and again, I have a book on it. I have a membership. Check out the five pillars because it's a way I develop these scenarios so people can become their own sex experts learn to troubleshoot like, is it because I don't feel embodied during sex?

24:20Is it because I've had some untreated trauma? Is it because I'm just not moving my body enough and so I have blood flow issues and so I'm not having an orgasm or erections? Is it because I don't accept my body as it's at is right now? Is it because I have a lot of shame about how I look? Is it because I don't communicate well? We just haven't talked about it. I'm jumping to, I'm guessing that my part. There's just so many, like our sex is such a bigger thing than just the old in and out. It's not about just sex positions and orgasm and release. It's such a, it's such a, it's so multi-layered and it's so many things.

24:58It's intimacy, it's connection, it's understanding desire and arousal. It's just, there's not a quick fix to your sex life. And so on a limb and say, most people listen to this and watching this probably haven't thought about it that way. it's more like i got an erection i didn't get erection i had orgasm i didn't we did it on the top we did we did missionary we did doggy style we rolled over we watched netflix like it's just it's there's just so many other things going on with sex it is our brain it's our hormones it's relational so yeah it's a much bigger thing and so people could that i don't want to overwhelm people either i just want to say you're not broken you're not alone but start talking about it today get curious the other thing i found out i know this is a very long answer but the other thing great answer keep going the other thing i found jolene is that i was going to keep joking it's fine the other thing i was going to say is that what i found in most relationships there's usually one person who's like i'm going to solve it i'm going to fix it i'm going to give it book i'm going to listen to the podcast i'm going to bring home the sex toy the loo i'm going to get hormones and i'm going to be the champion of our sex life and then there's another part who's like doesn't want to talk about it they're going to come on for the ride or they're blaming their partner or they just think they shouldn't talk about it.