Put your earbuds in. Because we are about to say the things that women in the parent pickup line whisper to each other and never say out loud anywhere else.

On this episode of Shifting Our Shit, I (Megan Bayles Bartley) sat down with Elizabeth McCormack from The Mindfulness Center to talk about sex, desire, and hormones in perimenopause and menopause — unfiltered, raw, and without a shred of shame. If you’ve ever Googled “is this normal” at 11pm, wondered why your body suddenly feels like a stranger’s, or quietly decided that talking about your libido with your doctor felt more humiliating than just… not — this one’s for you. And honestly? It’s for the husbands and partners too.

Nobody Warned Us About This Part

Here’s the thing about perimenopause: we get a lot of messaging about hot flashes and mood swings, but almost nobody prepared us for what happens to our sexual health. And when I say “what happens,” I mean everything — physical, mental, emotional, relational. All of it shifts, sometimes all at once, usually with zero warning and even less guidance.

So let’s start with the physical stuff, because that’s often where the shame creeps in first.

As estrogen and progesterone decline, a lot of women experience vaginal dryness and atrophy. Sex that used to feel good can start to feel uncomfortable, even painful. And I want to be really clear about something: painful sex is not something you should just accept as your new normal. It’s common, yes. Normal? No. If penetration hurts, that’s a conversation to have with a provider, not a signal to just quietly stop having sex and hope nobody notices.

On top of that, there’s the stuff nobody puts on a pamphlet — recurring UTIs (or what feels like UTIs), yeast infections, changes in smell, more sweating, and yes, even the way your “lady bits” look. It’s a lot. And it’s easy to spiral into “I don’t want my partner to see this, smell this, or deal with this” — which, if we’re honest, just adds another layer of anxiety on top of an already complicated season of life.

The “Normal” Trap

Here’s a phrase that needs to be retired forever: “it’s within normal range.” Because normal and optimal are not the same thing, and doctors love throwing “normal” at you like it settles the conversation.

Take testosterone. The “normal” range for women is somewhere between 15 and 150. If your number comes back at 15, technically you’re “in range” — but you’re also going to feel wildly different than someone sitting at 100. Elizabeth had this exact experience. Multiple providers heard “I have low libido” and offered up gems like “maybe you’re stressed” or, her personal favorite, “maybe you just don’t like your partner.” Meanwhile her testosterone was scraping the bottom of the barrel and nobody thought that was worth investigating further.

This is the pattern so many of us run into: you advocate for yourself, you get dismissed, you internalize it as a “you” problem instead of a hormones problem, and you stop bringing it up. We are here to interrupt that pattern.

It’s Bigger Than Libido

I want to gently pull us out of an over-focus on libido, because there’s so much more happening in this conversation. Vaginal dryness. Atrophy. Recurring “UTI-like” symptoms that turn out to just be low estrogen (that pressure-and-urgency feeling that sends you peeing in a cup every few weeks with negative results every single time — that can be estrogen, not infection, and a small amount of local estrogen can resolve it faster than you’d expect). Heavy, unpredictable bleeding from fibroids. Shame about how your body has physically changed.

All of this adds up to a body that feels unfamiliar, and a mind that’s constantly assessing risk before it can even get to desire. That’s not a character flaw. That’s your nervous system doing exactly what it’s designed to do when things feel uncertain.

Why Your OB Might Not Be the Right Person for This

Here’s something that might reframe your whole approach: the doctor who delivered your babies may not be the right doctor for this chapter. Obstetrics and gynecology training is heavily weighted toward pregnancy and delivery — there often isn’t a dedicated curriculum for menopause care. That’s not a knock on your OB. It’s just math. They spent years training on birth, not on the hormonal transition that comes decades later.

If you’ve brought up your symptoms and gotten hesitation, vague reassurance, or the classic “have you tried reducing stress, exercising more, eating better” (as if you hadn’t already thought of that) — it might be time to seek out a provider who specializes specifically in menopause. Those providers tend to treat based on your actual lived symptoms rather than waiting for a textbook-perfect diagnostic picture, and they’re far less hesitant to actually try things with you.

And on the topic of hormone testing — some providers never test estrogen or testosterone levels at all. They go by symptoms: you report what’s happening, they offer an option, you try it, you report back. If it helps, you stay on it. If it doesn’t, you adjust. There’s no perfect roadmap here, and that’s honestly part of the frustration — we’re all a little bit throwing darts at a dartboard, women included.

How to Actually Advocate for Yourself in the Exam Room

If you’ve been brushed off before, here’s how to walk into your next appointment ready to hold your ground:

•       Lead with specifics, not vague feelings. “I have low libido” is easy to wave away. “I’ve noticed zero interest in sex for the past four months, along with dryness and fatigue” is much harder to dismiss.
•       Ask for your actual numbers. You’re allowed to request hormone testing rather than accepting a purely symptom-based guess, even if your provider typically works off symptoms alone.
•       Push back on “normal.” If a number is technically in range but you feel terrible, say so directly: “I understand this is in the normal range, but I’m not willing to just live with how I feel right now.”
•       Ask what else is out there. New formulations and delivery methods are coming out regularly. If your provider seems unfamiliar with something you’ve read about, ask them to look into it or point you to someone who specializes in this.
•       Get a second opinion from a menopause specialist. Not every OB/GYN has deep training here, and that’s not a personal failing on their part — it’s a gap in how the field was educated. A provider whose sole focus is menopause care will often move faster and take your symptoms more seriously.

You are allowed to say, “I don’t care that it’s technically normal — I’m not willing to feel like this.” Say it as many times as it takes.

Rewriting the Rules of Frequency and Timing

One of the quietest, most freeing shifts you can make in this season: letting go of whatever frequency or schedule used to define your sex life. Maybe it used to be a few times a week, maybe just once. Maybe it’s shifting to something else entirely now, and that’s not a crisis — it’s a recalibration.

Time of day matters more than we tend to admit. If nighttime has become a hard no because you’re exhausted, teenagers are still awake, and your brain has nothing left to give — that’s real information, not a failure. Mornings, weekends, or whatever window actually has some bandwidth left in it might serve you better than trying to force intimacy into a slot your body has already checked out of.

And the mental load here is real. Between tracking cycles, managing the logistics of privacy in a house full of people, worrying about smells or bodies or interruptions, and simply finding the energy after a full day — it’s no wonder desire can feel buried under a mountain of practical noise. Naming that mental load out loud, to your partner, is itself a form of intimacy. It takes the burden off being the only one keeping score.

The Testosterone Rollercoaster

Let’s talk about testosterone specifically, because it deserves its own spotlight. Testosterone replacement for men is a well-established, often insurance-covered pathway. For women? Not so much. That gap exists largely because women’s bodies weren’t meaningfully included in hormone research until relatively recently — we’re talking a few decades, not a few centuries. So when your provider seems unsure, understand that the research itself is still catching up.

There are multiple delivery methods worth knowing about: creams, pellets, and injections. Every body responds differently. Cream might do nothing for one woman and change everything for another. Pellets (a small under-the-skin insert) and weekly shots are other paths some women pursue when creams aren’t cutting it. The common thread from women who’ve found their right fit isn’t necessarily “more libido” right away — it’s often “more energy,” “clearer thinking,” “less exhaustion.” Give any new approach real time before deciding whether it’s working, and keep tracking how you actually feel, not just what a number says.

Reduced Libido Doesn’t Mean Something Is Wrong With You

If your desire for sex has dropped — or if it was never sky-high to begin with — you are not broken. You don’t need to want sex “on a schedule” for your body to be functioning correctly. But if you’ve noticed a real shift and it’s bothering you or your relationship, that’s worth exploring rather than white-knuckling through.

There’s also a layer of guilt many women carry that we need to name directly: having sex out of fear that your partner will seek it elsewhere is not a good reason to have sex. Neither of you deserves a dynamic built on obligation. The goal isn’t performance — it’s honest communication about what’s actually happening in your body and your desire, so you can build something sustainable together instead of quietly resenting each other.

The Line That Changes Everything

Here’s a small script that can make a massive difference in how your partner receives this whole conversation: if it’s true for you, tell your partner that if you were going to have sex, it would only be with them. There’s a real psychological difference between your partner hearing “I don’t want sex” and hearing “I don’t want sex with anyone — including you right now.” And “If I was going to have sex, you are the only person I would have sex with.” One lands as rejection. The other lands as reassurance, even inside a hard season.

Let’s Bust the Orgasm Myth

Movies, TV, and most mainstream porn have sold us a lie: that penetrative sex alone reliably produces orgasm for women, ideally in perfect simultaneous timing with our partner. In reality, most women don’t orgasm from penetration alone — external clitoral stimulation is what actually gets most women there. That’s not a perimenopause fact, that’s just… a fact, one that generations of us were never taught clearly.

And speaking of what we were taught — if you grew up on ’90s magazine promises about the G-spot being some easy-to-locate on/off switch, you have permission to let that go. What works varies from body to body and even from partner to partner. There is no universal formula, and chasing one is a setup for frustration rather than pleasure.

The Porn Problem Nobody Wants to Talk About

If your partner has consumed a lot of pornography, it’s worth understanding that today’s on-demand, endlessly available content is a completely different exposure than what earlier generations grew up with. And it’s not a documentary — it’s fiction. Bodies, reactions, and behavior in porn are performed, not representative of how real sex or real bodies actually work. That gap in expectations can quietly create friction in a relationship if it’s never named out loud. Naming it — gently, directly — matters, even in the uncomfortable conversations you have to have with teenagers navigating their own exposure to this content.

Mind the Gap

A phrase worth holding onto through this whole conversation: mind the gap. The gap between how your brain processes desire and how your partner’s brain processes desire. The gap between what your body wants and what it used to want. The gap between the version of you at 25 and the version of you now — because comparing this season to a decade that might as well be a different lifetime isn’t fair to either version of you.

Desire itself often has rhythm tied to your cycle — many women notice more interest around ovulation or right before their period starts (assuming PMS doesn’t override everything, which, fair). As hormones shift in perimenopause, that rhythm changes too, and it’s not something you’re doing wrong. It’s biology recalibrating in real time.

When Resentment Has Already Set In

If this has been an unspoken issue for years, you’re not just navigating hormones anymore — you’re navigating history. Who initiates. Who gets rejected. How that rejection gets carried forward into the next attempt. This is where outside support becomes genuinely valuable: a therapist, individually or as a couple, gives you a third, objective presence in the room whose job is to help both people feel heard rather than to assign blame.

You don’t need your partner’s buy-in to start. Going to your own appointment first, to get language and clarity for what you’re experiencing, is a completely legitimate first step — even if your partner isn’t ready to join you yet.

The Real Takeaway

Nothing about this season of life comes with a clean instruction manual. Your body is recalibrating, your relationship is recalibrating, and the conversations required to navigate it well are uncomfortable almost by definition. But discomfort isn’t a sign you’re doing something wrong — it’s a sign you’re finally doing the thing most people avoid. Remember: Growth doesn’t happen without discomfort.

Say the thing. Even imperfectly. Even if your tone is off or the timing isn’t ideal. Saying it matters more than staying silent, and you can always repair a clumsy delivery afterward. What you can’t repair is five more years of a conversation you never had.

 

This is just a piece of what Elizabeth and Megan Bayles Bartley dug into on this episode of Shifting Our Shit — go listen to the full conversation for the parts that don’t translate to a page (trust us, there were laughs). And stay tuned for our next episode, where they’re picking this thread back up to talk about bridging the gap with your partner in perimenopause — the relationship side of everything they touched on here.

You are not alone in this, you are not broken, and you deserve providers, partners, and conversations that actually meet you where your body is right now — not where it used to be.