Some women report an increase while others report a decrease in sexual desire at menopause. Increase in sexual desire may be because of relative freedom from pregnancy and hence one may respond and perform with greater abandon and enthusiasm. Some women harbor the misconception that menopause marks the end of their sexual career and this fear (about their waning sexuality) increases their sex drive so that they may reaffirm their femininity. A decline in sexual desire could be because of physical reasons.

During menopause (or even a few years earlier), a reduction in the secretion of the ovarian hormones may cause atrophy of the vaginal epithelium which leads to reduction in lubrication and hence pain at the time of sexual intercourse (which can be remedied by estrogen replacement therapy). This causes a decline in sexual desire and a woman avoids sexual overtures. Depression and anxiety are common features and they also tend to reduce the sexual desire.