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Know that old song "Where Did Our Love Go"? Many women in their 40s, 50s, and 60s are asking, "Where did our sex go?"

Loss of desire is common in the years before and after menopause. Desire problems peak around ages 35 to 64.

Why? It’s a time of life with a lot going on! Changing hormones can cause spontaneous desire --or craving sex out of the blue -- to plummet.

“To blame it all on hormones is unfair, though,” says Stephanie Faubion, MD, director of the Mayo Clinic’s Women’s Health Clinic.

What’s called receptive desire -- being turned on when your partner makes the first move -- keeps going. At least, it can if related issues in your body, mind, or relationship -- usually some mix -- don’t get in the way, Faubion says.

The fix for sex drive issues: Tease out the complex causes and address them. 

Sex-drive zapper: Pain, dryness and other hormonal issues

Before menopause, your libido peaked just before and after you ovulated. But when your periods stop, those revved-up days in your cycle vanish. Less estrogen also means less blood flow to the vagina and more dryness. So when you do have sex, it hurts -- and who craves more of it when it feels like that?

What helps:Start by removing pain. Try over-the-counter water- or silicone-based lubricants to reduce friction. Also, ask the doctor about vaginal moisturizers or low-dose vaginal estrogen in a cream, suppository, or ring. Hormone therapy (HT) doesn't seem to kindle desire for most women. But it can ease hot flashes, night sweats, and other symptoms that leave you feeling not-so-sexy. Regular sex can help promote blood flow and reduce dryness, too.

The drug ospemifene is used to treat severe vaginal pain due to menopause, but it can cause hot flashes. The medication flibanserin is approved for premenopausal women who have hypoactive sexual desire disorder (loss of libido) with no other things affecting desire. “That’s a very small group of women,” says Faubion, who also wrote The Menopause Solution.

Sex-drive zapper: Stress

At midlife, many women are deep into a marriage, a job, raising teens, and caregiving. Any of these can amp up stress, and the tension puts sex drive in park. Avoiding sex because you're not feeling it can, in turn, make you get along less well. “Your relationship is key -- if you don’t like your partner, you won’t feel sexy,” Faubion says.

What helps: Make plans for dates and lovemaking, even if you never had to do this before. Downplay the focus on sex and focus on just making time to be together, along with foreplay, massage, and oral. Consider getting short-term couples counseling when your sex life or relationship in general hits a rough patch.

Sex-drive zapper: Normal aging

Desire slows with age for both women and men. Women are two to three times more likely to have this problem. In part, blame dropping testosterone. It's the hormone active in every stage of sex response, starting with desire.

What helps:There's no FDA-approved testosterone therapy, but some doctors prescribe creams off-label for some women. Kegels, exercise, and not smoking also help your sexual health.

There's good news about aging and sex, too: Many women say they feel an uptick in desire after menopause. 

Sex-drive zapper: Mood disorders -- and meds

Double whammy: Depression and anxiety can add to sexual problems, and menopause itself can cause mood changes. Women get mood disorders more, and they peak around 40 to 59.

It doesn't help that key treatments for depression, SSRI and SNRI antidepressant drugs, can also mute desire and slow sexual response. Many women who aren't depressed are prescribed antidepressants short-term to deal with hot flashes and other menopause symptoms. Though the pills fix these problems, desire can tank.

What helps: See a doctor about treating depression with both pills and talk therapy. Some non-SSRI antidepressants, such as bupropion, cause fewer sexual side effects.

Sex-drive zappers: Other factors in your head and body

If graying hairs, extra pounds, and dry skin make you see yourself as "old," you're less likely to see yourself as "hot."

Women may also blame menopause for lost desire when other health problems are the real stoppers. Common culprits: Bladder problems, an underactive thyroid, chronic pain, and medication side effects.

What helps:Get a checkup to make sure there's nothing else going on with symptoms that bother you. When you make time to take care of your body and relationships now, it pays off in many ways -- including more fun in bed. Your brain is one of your best sex organs.

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