When Hormones Hijack the Show
You wake up at 3:12 a.m., drenched in sweat, only to realize you’re also inexplicably furious at your partner for breathing too loudly. You haven’t had a solid night’s sleep in weeks. Your sex drive has ghosted you. And you’re starting to wonder if you’re losing your mind—or if this is just what getting older looks like.
If this sounds familiar, welcome to perimenopause. And no, you’re not crazy.
Perimenopause is a biological transition, but it often feels more like an identity crisis, a relationship test, and a very rude hormonal rollercoaster all rolled into one. The changes can be subtle or dramatic, physical or emotional. And when it starts to affect your intimate life, it can be confusing, disorienting, and even a little heartbreaking.
As a sex therapist who specializes in supporting women through this phase of life, I want to offer a simple truth: you are not alone, and you do not have to white-knuckle your way through this.
What Is Perimenopause (and Why Didn’t Anyone Warn Us)?
Perimenopause is the stage before menopause when hormones like estrogen and progesterone begin to fluctuate. It can start as early as your late 30s and last several years—sometimes a decade. Common symptoms include:
- Hot flashes and night sweats
- Irregular periods
- Sleep disturbances
- Mood swings
- Vaginal dryness or irritation
- Changes in libido
What they don’t always tell you is how these symptoms can mess with your identity, your relationships, and your connection to pleasure. You might suddenly feel like a stranger in your own body—one with less energy, more irritability, and a shrinking sense of desire.
Spoiler alert: It’s not just you.
The Sexual Side of Perimenopause
Let’s talk about sex. Or rather, the sudden lack of interest in it. Or the discomfort. Or the confusion about what used to feel good but now… doesn’t.
Here’s what many women experience during perimenopause:
Lower libido: Hormonal shifts can decrease spontaneous desire, especially if you’re exhausted or dealing with physical discomfort. For many, this presents as low libido during perimenopause, even if they used to feel sexually vibrant.
Pain during sex: Vaginal dryness or thinning of the tissue can make penetration feel irritating or even painful.
- Body image issues: Weight gain, bloating, or a general feeling of “blah” can affect how you see yourself—and how much you want to be seen.
- Emotional disconnect: Feeling distant from your partner or irritable during intimacy is incredibly common and can impact perimenopause and intimacy in ways no one prepared you for.
Sometimes your partner doesn’t get it. Sometimes you don’t even get it. And when the sexual spark fades or becomes confusing, it can strain even the strongest relationships.
How Sex Therapy Can Help (It’s Not What You Think)
Let’s demystify sex therapy. This isn’t about sitting in a room talking about positions or watching videos (unless you want to!). It’s about creating a safe space to talk about:
- How your body is changing—and how to stay connected to it
- What desire really means (hint: it’s not always about being “in the mood”)
- Ways to communicate with your partner without shutting down or getting defensive
- Grieving what’s shifting, and embracing what’s possible
- Bringing curiosity, compassion, and even humor back into intimacy
I help women understand the difference between spontaneous desire (the kind that just shows up) and responsive desire (the kind that emerges once you’re already engaged). Most of us have never learned that distinction—and it’s a game-changer.
I also help couples navigate mismatched libidos, rekindle emotional closeness, and find ways to make intimacy feel nourishing rather than obligatory. This is especially important when you’re trying to reclaim desire in midlife after it’s taken a long vacation.
And yes, we talk about lube. Because there is no merit badge for enduring painful sex.
Anecdotes from the Couch (Names Changed, Details Tweaked)
One client—let’s call her Lisa—came to me after realizing she hadn’t initiated sex in over a year. “It’s not that I don’t love him,” she said. “I just feel…disconnected from that part of me.”
We worked together to understand how her stress, sleep issues, and shifting hormones were playing into her avoidance. We explored what pleasure meant now—not what it used to mean in her twenties—and slowly rebuilt intimacy with touch, humor, and real conversations.
Another client found that sex was painful and started avoiding it altogether, which created tension with her partner. We brought in education about arousal, lubrication, and pacing. We also looked at how her perfectionism and people-pleasing had impacted her ability to speak up—about sex and beyond.
These stories aren’t rare. They’re common. And they’re deeply human.
What’s Normal—and What Deserves Support
It’s normal for desire to shift. It’s normal to feel emotionally raw. It’s normal to wonder where the old version of you went.
But that doesn’t mean you have to suffer in silence.
You deserve:
- Pleasure
- Connection
- Rest
- Touch that feels good—not obligatory
- A space to process what this phase of life is stirring up emotionally and relationally
If you’re feeling isolated, confused, or frustrated, that’s a sign you might benefit from support—not that anything is broken.
Working with Me
I’m Dr. Kristin Zeising, a clinical psychologist and certified sex therapist based in San Diego. I work with individuals and couples navigating the complex terrain of intimacy, identity, and change—especially during perimenopause and midlife transitions.
My approach is warm, collaborative, and grounded in both science and soul. I believe in laughter and tears, depth and practicality. We can talk about hormones, vulvas, relationship dynamics, and everything in between. If you’re looking for a sex therapist in San Diego, you’re in the right place.
If you’re in the thick of this transition and wondering where your sex drive—and maybe your sense of self—went, let’s talk.
Final Thoughts: You’re Not Crazy. You’re Transforming.
Perimenopause can feel like a betrayal. But it can also be a portal—a chance to renegotiate your relationship with yourself, your body, and your pleasure.
You don’t have to figure it out alone. And you don’t have to settle for less intimacy, less connection, or less joy.
If you’re curious about how sex therapy can support you, reach out. I’d be honored to walk this part of the journey with you.
