Libido and PMS

What's a typical sex drive?

There's no such thing as a ‘normal’ sex drive — how much we want to have sex depends on many things, including our lifestyle, health, stress levels, the psychology of the relationship between two people, and many other things (the only normal that matters is your normal!). No one should ever make us feel like we’re having too little or too much sex. Our bodies, our choice. The most important thing is finding out what works for you. 

When we notice a change in our libido, it can cause us to worry. Libido and sex drive are both terms that describe our desire for sex, and healthcare providers are increasingly recognising the importance of libido as an indicator of general health and quality of life. Our libido is known to fluctuate throughout our menstrual cycle (specifically, it increases just before ovulation), but what happens to our libido during PMS?

 

Low sex drive and PMS

It’s thought that around one in three experience low sex drive. This can be caused by a number of things, including:

• stress
• the specific relationship in question
• medication
• weight
• menopause
• pregnancy
• sexual trauma
• or simply because we’re at a specific point in our cycle.

For people who experience PMS, hormone fluctuations, symptoms, and even some treatments can interfere with the desire to have sex. 

When we’re in the luteal phase, the second half of our menstrual cycle, our hormones fluctuate. Namely, in the first half of the luteal phase, oestrogen levels are predominately low, whilst progesterone rises. In the second half, both hormones drop off until menstruation starts. Oestrogen is known to increase libido; it raises sexual desire, increases sensitivity in our breasts and nipples and promotes vaginal lubrication. All of these generally make it easier, and more enjoyable, to have sex. So during the luteal phase, when oestrogen levels are low, it’s no surprise that these feelings may reduce or disappear altogether. Additionally, raised testosterone is known to have a positive effect on libido. Testosterone is at its highest around ovulation, and drops during the luteal phase, which can reduce our desire for sex in the weeks leading up to our period.

Unlike the direct effect that a drop in oestrogen has on our libido, the increase in progesterone can contribute to our lack of sex drive but in a more indirect manner. Most of the symptoms of PMS/PMDD, like disrupted sleep and fatigue, headaches, bloating, withdrawal, depression, and anxiety^** don’t generally make us feel all that up for sex.

Physical symptoms like breast tenderness and swelling, bloating that makes us feel full or our abdomens appear bigger, and more acne can make being intimate painful or uncomfortable. It can also affect our opinion of ourselves, reducing self-confidence and our desire to get naked or intimate with others.

Changes in discharge consistency can also make penetrative sex less comfortable as the vaginal canal becomes dryer and naturally less lubricated. Additionally, disrupted sleep and fatigue can cause people to prioritise sleep or rest over sex. Similarly, changes in mental health, particularly an increase in feelings of depression, anxiety and withdrawal can mean we’re less interested in getting jiggy with it. 

Ultimately, without high enough levels of oestrogen, our bodies may not be switched on enough to desire sex. 

 

High sex drive and PMS

On the other hand, there are a number of reasons why we might experience an increased sex drive during PMS. For some people, this may be due to fluctuating hormones, and for others, it may be because of the association between pleasure from sex and how this relieves or reduces PMS symptoms. 

Hormones

As mentioned earlier, oestrogen is known to increase libido. However, during the luteal phase, oestrogen levels stay relatively low. So, what might cause increased sex drive in the second half of our cycle? Well, the key may lie not at the end of our cycle, but at the beginning of the next, as oestrogen begins to rise as we enter our next cycle. 

Again, testosterone is known to have a positive effect on libido. So when it’s at its highest (around ovulation and the beginning of the luteal phase), we typically feel more interested in sex.

 

Relief

For some, PMS and sexuality may be positively linked due to symptom relief. In terms of physical symptoms, bloating can stop some people from wanting to have sex. However, in others, being bloated may put pressure on the G spot and vulva, making them feel increasingly sensitive and increase our desire for, or enjoyment of, sex.

Finally, it could be that the positive effects of sex alleviate PMS symptoms, and therefore increase our desire to have sex. Multiple studies have found that sex is a good pain relief. One study found that PMS symptoms like headaches specifically can be eased or relieved by sexual activity, most likely through the release of endorphins.

 

Other reasons for a change in sex drive

A change in libido can be caused by many things, and it can cause us to worry. There are many other reasons why your sex drive may increase or decrease, and the following list is not exhaustive.

Other causes of decreased sex drive: 

Various medications

Various medications can affect our desire to have sex. For example, one piece of research reported that up to 43% of people studied experienced a reduction in libido when taking hormonal contraception, compared to just 12% of people who took non-hormonal contraception. Further, many people taking SSRIs report decreased libido as a side effect. However, not all medication has an effect on libido, and medication additionally affects everybody differently. Always speak to your healthcare provider if you think your medication has decreased your libido. 

 

Mental health and stress

Mental health issues such as depression and anxiety** not linked to PMS can lower our libido and impede sexual function.

If our stress levels are high, or there are other factors affecting how aroused we may be feeling, our vaginas won’t produce enough moisture to make it comfortable. This can then impact how much we want or enjoy sex.

 

Pregnancy and family life

Pregnancy can change our attitude towards sex — changes in our bodies and hormone levels can leave us feeling like sex is the last thing on our minds. After pregnancy, the introduction of a newborn can mean there's little time for sleep and intimacy, decreasing your desire for sex.

Even without pregnancy or a newborn, some people experience disturbed sleep or chronic fatigue, which can stop us from wanting to have sex.

 

Past trauma

Survivors of sexual assault, or people with past trauma, may find it difficult to be intimate with another person, and as a result, desire sex less. Certain injuries can also affect your libido due to them causing discomfort or pain.

Age

Between our mid-30s and early 60s, adrenal androgen production reduces by about two-thirds. The main androgen is testosterone, and it’s thought that a reduction in levels of such can cause a change in libido.

Additionally, as we age, it’s common for our vaginas to produce less natural lubricant, potentially making sex less comfortable and therefore less desirable. 

 

Other causes of increased sex drive: 

New relationships

At the beginning of a relationship, we often feel more excited by the idea of sex and all the new things we can discover with a new person. 

 

Self-confidence

When we feel good about ourselves, we’re more likely to feel confident being intimate and open with another person. Working on self-confidence and a positive body image can improve your sexual response. 

 

Exercise

There are many reasons you may have an increased libido if you’re exercising a lot:

• Exercise stimulates the sympathetic nervous system and initiates the release of certain hormones and enzymes that may increase sexual desire.
• Exercise helps preserve autonomic flexibility, which benefits heart health and mood, helping with libido and sexual desire.
• Lots of exercise can lead to body positivity, which also increases sexual well-being.
• Exercise has been proven to reduce stress, which is one of the biggest libido killers! Therefore exercising frequently can help balance our mood, and therefore our libido. 

 

Pregnancy

While pregnancy might decrease some people’s libido, in others it can in fact increase other people’s appetite for sex, particularly in the second trimester. 

 

HRT

People taking hormone-replacement therapy (HRT) for perimenopause or menopause may find an increase in sexual desire as their medication increases the level of oestrogen (and sometimes testosterone), which in turn increase our libido. 

Age

 

Pain during PMS and sex

In the UK, around 7.5% of women* report pain during sex, otherwise known as dyspareunia. There are many reasons why we might be experiencing pain during sex, such as STDs or underlying conditions like:

 

• vaginismus
• pudendal neuralgia
• vulvodynia
• vaginal dryness
• or endometriosis.

Symptoms of PMS can also be a contributing factor when experiencing pain during sex. Vaginal dryness, breast tenderness, headaches, cramps, joint and muscle aches and more can all make having sex pretty uncomfortable.

Additionally, just before your period, the cervix sits lower and closer to the vaginal wall, which can make sex more uncomfortable as it’s easier to bump. However, these aches and pains should disappear once you get your period. So, if you’re still experiencing discomfort when having sex, or if at any time this discomfort becomes pain, it’s important you see a healthcare professional or speak to your GP. We never suggest normalising painful sex; always get it checked out in case of underlying medical conditions.

 

What can I do if I'm concerned about my PMS and libido?

It’s really important to know your body; what ‘normal’ looks and feels like for you, what you find enjoyable, and how to fulfil your desires and needs. When there’s a change that concerns you, start by being kind to yourself and avoid any feelings of self-blame or shame. There is no wrong or right amount of sex, and it’s completely normal to want to have lots of sex or no sex at all. But if your libido or a change in it worries you or you feel you want to address it, there are a number of things you can try. Similarly, if the person experiencing a change in libido is your partner, treat them with understanding and kindness as they work to figure out what they want to do about it. 

For people who experience PMDD or PMS and low sex drive and want to increase it, IAPMD (International Association for Premenstrual Disorders) suggest a number of things you can try yourself to improve your sex drive. 

Communicate your needs

Start with communicating your needs and what feels good to you to the person you’re being intimate with. If everyone understands what’s going on with your body, they can meet your needs/desires better.

Ease tension

You can also try including pain relief before or during sex. A massage or a long, hot bath could help relieve physical and psychological tension. Aromatherapy has been shown to help some people ease the symptoms of PMS. Diffusers, room sprays, or bath oils with essential oils may help ease tension before sex.

Focus on what feels good

Next, think about what turns you on or off. Try connecting with your body by focusing on sensations that feel good. If you’re experiencing PMS-related vaginal dryness, try lubrication. Avoid scented lubes that can disrupt your vaginal pH, and take care when using silicon-based lubricants with toys - they’re not always compatible. Try different sex positions, those that might help reduce the impact on your cervix or stimulate your G spot better when in the luteal phase. Make a note of what these are and when they feel best, so you can get into a rhythm of knowing what works best for you during different phases of your cycle. 

Medical treatment

Some people might want to explore traditional medical options. If you seek support from a healthcare professional, they’ll likely ask for your medical history, if you’re taking any medication (and what that might be), and whether you have any existing medical conditions. They might also ask to perform a pelvic floor exam and take a blood sample.

Treatment can vary depending on what the healthcare provider believes is the issue with your libido might be. If the issue is about medication, they might suggest trying a different one. If you’re feeling pain after a traumatic birth experience, they may suggest pelvic floor therapy could benefit you. A healthcare provider may also suggest talking therapy to help you unpack feelings you’re having around your libido change and help enhance intimacy. 

 

Final thoughts

It’s important to remember that there's no such thing as a ‘normal’ sex drive or ‘normal’ PMS; everybody is different and the best thing you can do is get to know your own ‘normal’ and what makes you happy. If you want to read more about understanding and working with your sex drive, we recommend a brilliant book called Come As You Are, by Emily Nagoski. 

Learning more about our bodies and what makes them tick is the first step in understanding how to enhance that, or when something may have changed or needs further investigation. If you want to speak to a healthcare provider, remember they're trained to talk about sex, so there’s nothing to be worried or embarrassed about. Friends, family, and the Evelyn community are also brilliant sources of information, support and advice.

 

Related articles:

• Evelyn's guide to PMS, PMDD and relationships
• Evelyn's guide to talking to your GP about PMS and PMDD

 

Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.