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Low libido in women: Causes, blood tests, and treatment

Clinical review pending

Why sexual desire can decline, when blood tests help, and how treatment can address pain, medication effects, hormonal changes, or other concerns.

Loose gray shapes enter a clear prism and become three blue light bands.

When sexual desire changes, physical symptoms, emotional strain, and the circumstances of a relationship may all play a part. Blood tests can help identify certain contributors, but the results alone cannot explain why desire has declined. A conversation with a clinician can help when the change bothers you or is affecting a relationship you want to improve. Having less interest in sex is not, by itself, a disorder.

What does low libido mean in women?

Libido means sexual desire. A persistent reduction in interest may be described as low libido. When reduced desire lasts at least six months and causes personal distress, hypoactive sexual desire disorder, or HSDD, may be considered. Duration and distress are not enough for a diagnosis: other medical, psychological, medication-related, and relationship explanations need assessment. Estimates cited in clinical reviews suggest that roughly one in 10 adult women experiences HSDD, although prevalence depends on the population and definition used. Clayton et al., 2018, Pettigrew and Novick, 2021

Desire changes across a lifetime. Low desire becomes more common after menopause, but sexual difficulties and distress about them are not the same thing. Many women report a sexual concern without finding it personally troubling. What matters is how the woman herself experiences the change, rather than whether her interest matches someone else’s expectations. West et al., 2008, Shifren et al., 2008, Simon et al., 2018

Signs that low desire may be more than a passing phase

A closer assessment can be useful when reduced desire lasts for months, occurs in different situations, and causes concern. You do not have to wait six months to ask for help with pain, a medication side effect, or another symptom. A clinician may ask:

  • Are sexual thoughts, fantasies, or feelings rare or absent? Pettigrew and Novick, 2021
  • Does interest remain low when a partner initiates intimacy? Pettigrew and Novick, 2021
  • Does the change bother you, or has it created relationship tension you would like to address?
  • Is sex uncomfortable because of pain or dryness? Vaginal dryness can affect sexual function. NAMS, 2020

The answers help explain what has changed and what else is happening alongside it. More than one contributor is common. A difference in desire between partners does not automatically mean that the person with less desire needs medical treatment.

Common causes of low libido in women

There is often no single explanation. Pain, fatigue, medication effects, and relationship difficulties can overlap. An assessment should consider physical and mental health as well as the relationship and the person’s own priorities.

Contributor Examples Possible clues
Hormonal changes Perimenopause, menopause, pregnancy, and breastfeeding Desire changes during pregnancy, alongside irregular periods, or after starting a different contraceptive. Some hormonal contraceptives reduce desire in some women, but the effect is not universal. Cleveland Clinic, Burrows et al., 2012
Physical health Underactive or overactive thyroid, diabetes, elevated prolactin, and chronic pain Low desire occurs with fatigue, weight changes, pain, or dryness during sex. Gabrielson et al., 2019, Prolactin background, Cleveland Clinic
Medication Certain antidepressants, blood pressure medicines, and antipsychotics Desire changes after starting a medication or changing the dose or drug. Serretti and Chiesa, 2009, Blood pressure background, Cleveland Clinic
Mental health and stress Depression, anxiety, past sexual trauma, chronic stress, and exhaustion associated with burnout Low mood, worry, or exhaustion began before desire declined. Depression and low desire often occur together. Depression background, Cleveland Clinic, Chronic stress background, Burnout background, Johannes et al., 2009
Relationship factors Conflict, communication difficulties, or emotional distance Desire declined as tension or distance increased. Cleveland Clinic
Lifestyle Alcohol, smoking, recreational drugs, and an activity pattern that affects health or recovery Habits may also be affecting sleep, energy, or mood. Both very low activity and excessive exercise can warrant discussion in context. Cleveland Clinic

For example, a meta-analysis found sexual difficulties and depression were more common in women with diabetes. That association does not mean diabetes explains every symptom, or that treating it will necessarily resolve low desire. Some possible contributors can be investigated with blood tests; others become clearer through conversation. Pontiroli et al., 2013

Blood tests that may help with the assessment

The starting point is usually a discussion of symptoms, medication, mood, and relationships. That guides whether tests are useful and which ones to choose. A broad hormone panel is not a standard requirement for every woman with low desire.

Test When it may be relevant
Thyroid-stimulating hormone (TSH) Helps evaluate thyroid function when symptoms or history suggest a thyroid disorder. Both underactive and overactive thyroid disease have been associated with sexual difficulties; some studies found improvement after thyroid function normalized. Gabrielson et al., 2019
Total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) SHBG binds sex hormones and affects the free fraction. Combined oral contraceptives raise SHBG and reduce free testosterone, but those changes do not by themselves establish the cause of low desire. Testosterone levels do not diagnose HSDD. Total testosterone and SHBG may help assess and monitor a carefully selected testosterone treatment, rather than serve as a universal diagnostic panel. Zimmerman et al., 2014, Parish et al., 2021
Estradiol Estradiol fluctuates during perimenopause and is generally lower after menopause. Lower estrogen can contribute to genital dryness and pain, which may affect sexual interest. A single value does not explain desire or reliably identify the menopause transition. Estradiol testing is not routinely recommended to identify perimenopause or menopause in otherwise typical presentations at age 45 or older. Menopause background, Simon et al., 2018, NICE guidance
Prolactin Elevated prolactin can contribute to low desire. Testing is selected according to the clinical picture, rather than ordered for everyone. Cleveland Clinic
Glucose or hemoglobin A1c (HbA1c) These assess blood sugar when diabetes screening or monitoring is appropriate. Diabetes is associated with sexual difficulties in women, but a glucose result cannot explain all aspects of desire. Pontiroli et al., 2013

Laboratory results can narrow the investigation when interpreted alongside symptoms and medical history. Normal results do not mean the concern is imaginary or that nothing can help.

Why normal blood tests do not rule out a cause

A normal result answers a limited question about the condition being investigated. Blood tests do not capture all the factors that shape sexual desire, and circulating hormone levels do not map neatly onto sexual experience. Davis et al., 2005

In a study whose final analysis included 1,021 women ages 18 to 75, low sexual-function scores were not clinically meaningfully associated with low total or free testosterone. The finding concerns androgen levels and sexual function; it does not establish that normal blood tests exclude other physical causes. A total testosterone result is therefore not a diagnostic test for HSDD. Davis et al., 2005, Parish et al., 2021

Medication effects, stress, relationship strain, and depression cannot be read from a hormone value. In one US survey, roughly 40% of women with distressing problems involving desire, arousal, or orgasm also had concurrent depression, defined using symptoms and/or antidepressant use. The figure covered several types of sexual concern and did not show which condition caused the other. These possibilities remain relevant whether laboratory results are normal or abnormal. Johannes et al., 2009

Treatment options for low libido in women

Treatment should address the factors that matter to the individual. Several approaches may complement one another:

  • Review medication effects. If desire declined after a medication change, a clinician can consider alternatives or other ways to manage the effect. Do not stop a prescribed medicine abruptly on your own. Cleveland Clinic
  • Treat an underlying health condition. Treating thyroid disease may improve sexual function when the condition contributes to the problem. Diabetes also deserves appropriate care, though better blood sugar control does not guarantee that low desire will resolve. Gabrielson et al., 2019, Pontiroli et al., 2013
  • Address dryness and pain. Lubricants and vaginal moisturizers can help with mild menopausal genitourinary symptoms. Persistent or more severe symptoms deserve assessment and discussion of other options. Making sex comfortable may matter more than focusing on desire in isolation. NAMS, 2020
  • Consider testosterone in selected cases. Systemic transdermal testosterone may be considered for postmenopausal women with HSDD after a biopsychosocial assessment. In the United States, this use is off-label. It requires discussion of benefits and risks, appropriate dosing, and monitoring; long-term safety remains uncertain. It is not simply replacement of a laboratory value labeled “low.” Clayton et al., 2018, Parish et al., 2021
  • Discuss HSDD-specific prescription medicines when appropriate. Older reviews described two US options for premenopausal women. The indication for flibanserin (Addyi) changed in December 2025: it now includes women younger than 65 with acquired, generalized HSDD, regardless of menopause status. Bremelanotide (Vyleesi) remains indicated for premenopausal women with acquired, generalized HSDD. Neither is intended to treat low desire primarily explained by another medical or psychiatric condition, relationship problems, or drug effects. Approval and availability differ by country. Cleveland Clinic, Pettigrew and Novick, 2021, current Addyi label, current Vyleesi label
  • Explore sex therapy or counseling. Psychological interventions can help with sexual difficulties, including low desire. The approach should fit the person’s concerns and preferences. Frühauf et al., 2013

The prescription options have different safety considerations. Flibanserin can cause low blood pressure and fainting, especially with alcohol taken close in time, certain interacting medicines, or liver impairment. Bremelanotide is contraindicated with uncontrolled hypertension or known cardiovascular disease. A prescriber should review eligibility and the full instructions before either is used. Addyi prescribing information, Vyleesi prescribing information

Reducing stress or cutting back on alcohol may support care when those factors are relevant. These changes are options to discuss, not a test of willpower or a requirement to achieve a particular level of desire. Cleveland Clinic

When to talk with a clinician about low libido

You can raise the subject whenever a change in desire bothers you or creates a difficulty you want help with. Pain during sex, persistent low mood, or a change following a new medication are reasons to seek advice sooner rather than wait for a diagnostic time threshold.

Dryness and pain after menopause can go unrecognized unless they are mentioned directly. Low mood also deserves assessment in its own right. If you already have recent blood or hormone results, bring them to the appointment, but you do not need a new panel before starting the conversation. Johannes et al., 2009, NAMS, 2020

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