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Guide to Menopause
|My Libido Has Disappeared!
As menopause can cause so many physical and emotional changes in a woman, it is no surprise to learn that libido is yet another area that is commonly affected. A woman's sexual drive naturally declines with age. Most scientific have found very little difference in sexual activity in women between the ages of 45 and 55. The slow down typically occurs between 55 and 65. That said, although frequency may slow down in the late 50s or 60s age group, most women report very little difference in the intensity of orgasm. So although they may have sexual intercourse less frequently, it is still as satisfactory when they do have it. Still, menopause can introduce physical changes to the body that can interrupt a good sexual relationship. For example reduced estrogen levels can cause vaginal dryness and a reduction in the production of natural lubrication leading to painful intercourse. In other instances women report a sudden lack of interest in sexual relations with their partner and would rather do anything BUT have sex. This can cause significant strain in any relationship. Yet, for some women, who never really enjoyed sex in the first place, this new phase is quite welcome and does not constitute a medical concern. Or, yet again, other women discover a renewed interest in sex midlife because they are worried about fewer issues - the children have left home, pregnancy is not a concern and retirement might be on the cards. For the purpose of this article, we are aiming advice at those women who traditionally enjoyed sex and who are experiencing a decline in libido which they would like to address. Don't forget at the end to also take a look at our article on the effects of menopause on the body.
What Causes Low Libido In Menopause?
According to some experts, while emotions are frequently behind a low libido in younger women, the aging process is the primary culprit in those over 45. Women in the perimenopause phase, approaching menopause start ovulating less regularly, until eventually ovulation stops altogether and the postmenopause phase begins. This is a significant point, as a woman's libido typically increases just before ovulation and continues for several days after. This is nature at its best because not coincidentally it also happens to the time when she is most likely to fall pregnant. When she stops ovulating, she will notice that the sexual energy boost associated with ovulation will disappear with it.
Hormone changes play a significant role in libido levels. New studies indicate that shifting levels of estrogen, progesterone and testosterone all play a role. While the relationship between these hormones is complex evidence is coming to light that testosterone, as well as other androgens (male hormones) such as DHEA promote sex drive in women. They also contribute to overall mood and feel good factor. If a woman has a history of menstruation disorders such as irregular periods, she should ask her doctor for a blood test to check her hormone balance – they may be more off balance than can be expected for menopause. It is also a way of testing for menopause. You may find it interesting to read about the effects of estrogen on the body.
Hormone changes can cause the lining of the vagina to become thinner and more fragile. The vagina then becomes more vulnerable to tearing and produces less lubrication. The result of all this, is that sexual intercourse can become more painful and may also leave the woman open to urinary tract infections. Naturally, if sex becomes associated with pain and discomfort, this will reduce any person's desire.
Ask yourself, whether or not you become aroused when you think of sex. The answer is important because the desire for sex and arousal are two different things. If you become aroused at the idea of sex, then usually the only thing holding a woman back is mood and disinterest. However, if you desire to have sexual intercourse and you are in the mood, but your vaginal area will not respond by lubricating and preparing for the act, then you may have an arousal disorder. This may have nothing to do with menopause, but may in fact be caused by:
• Heart disease in women or diabetes.
• Certain blood pressure medications.
• Sleeping pills.
• Antidepressant medications, especially SSRIs.
• Smoking constricts blood vessels making it more difficult for blood to rush to the vaginal zone.
• Previous pelvic surgery such as hysterectomy or bladder lift can damage nerve endings in the vaginal area.
• Hysterectomy side effects- during this operation the uterus is removed. This means the woman will no longer have the sensation of it becoming engorged during sexual activity.
If you suspect you may be suffering from an arousal disorder, talk to your doctor about switching medications. Some drugs are more likely to cause this disorder than others.
How Is A Low Libido Treated?
Depression is one of the most common menopause symptoms. It is easy to understand why a woman who is feeling depressed, fatigued, with an inability to concentrate and suffering from anhedonia (an inability to take pleasure in hobbies or things that previously you enjoyed) should also show a distinct lack of interest in sex (read about the side effects of depression). Treating the symptoms of depression with medications may improve all these symptoms. Conversely, women who are not suffering from menopause depression but who are treated for hot flashes with higher doses of SSRI antidepressants sometimes actually develop female sexual dysfunction. This is why some doctors prescribe lower SSRI dosages to women suffering hot flashes who cannot or will not use HRT. Researchers are continually trying to develop an antidepressant that will not impact on sexual function. Currently they are studying the 5-HT1A agonist called Flibanserin. Tests so far have demonstrated that its ability to act as a fast working antidepressant that may also stimulate sexual drive.
Local Hormone Therapy
Although it is testosterone that triggers the sexual drive in women, it is estrogen that keeps the vagina in working order. For this reason, localized estrogen therapy is the best way to treat vaginal dryness or atrophy. Unlike oral estrogens (estrogen replacement therapy) which still carry some potential health risks, estrogens which are applied topically and secrete hormones gradually are generally considered safe.One option is a vaginal ring (brand names FEMRING or ESTRING) which is inserted into the vagina and gradually secretes estrogen. FEMRING secretes higher dosages which means it can affect the whole body. ESTRING is a better option for women who cannot use systemic (all over the body) hormones such as those with blood clots or breast cancer. Estrogen Creams are another option (brands PREMARIN and ESTRACE). They are inserted into the vagina with an applicator. Other estrogen creams can be applied to the skin and may help prevent menopause skin problems. Vaginal Tablets (brand name VAGIFEM) are small pills which are inserted with an applicator into the vagina. The pill gradually releases small amounts of estrogen. Read our article on menopause treatment.
Testosterone Hormone Therapy
Studies now show it is testosterone and not estrogen as previously thought, that is primarily responsible for libido levels. Testosterone is produced by the ovaries and also has an impact on a woman's feeling of well being, mood and vitality. After menopause women produce 50 percent less testosterone than they did in their reproductive years so it is not surprising that libido (and mood) declines. This is why some doctors promote testosterone hormone therapy. However, it remains a controversial treatment because too much testosterone can cause liver or breast cancer as well as cause unpleasant side effects such as excess body hair, acne and fat redistribution to the tummy area. The aim of testosterone HT is to give just enough not to upset the delicate estrogen/testosterone balance and cause unpleasant side effects, but still give enough to create an impact. Compounded testosterone creams and gels are an alternative. They are applied locally to the vagina and may help the general area become more easily stimulated.
Non-Hormone Therapies Replens or Silk-E
These are non-hormone containing vaginal moisturizers which can be rubbed internally several times a week. They have not been proven, but some women seem to find relief.
Vitamin E or Olive Oil
Used locally it can help to rehydrate tissues and soothe the area. No need to buy any special medications for this. Use a pin to burst a vitamin E capsule and rub the liquid inside the vagina a few times a week. Your regular cooking olive oil is also another option. If applied before sexual intercourse they can also act as a natural lubricant. You can of course also buy commercial lubricants such as Astroglide and K-Y Jelly.
Other Ways To Improve Libido
Do It Anyway
If you suffer from vaginal dryness and soreness, one of the best ways to keep blood flow circulating is to have sex regularly. If you are not in the mood, try to force yourself anyway. The less we have, the less we want it. The reverse is also true – use it or lose it. Gradually your sexual desires should return. It may take one month, six months, a year. Try not to worry, there is nothing 'wrong' with you. Your body is adjusting to a new hormone balance and may take some time to 'settle down' again. Have a quick look at books on menopause for a list of useful guides in this area.
Practice kegels exercise to strengthen the pelvic floor muscles. This can help blood flow to the area and enhance sensuality during intercourse. See our questions:
What are pelvic floor exercises?
How do you do pelvic floor exercises?
How many pelvic floor exercises should you do a day?
A botanical genital massage oil, Zestra may significantly improve arousal and desire, according to one study published in the Journal of Sex and Marital Therapy in 2003. It contains evening primrose oils, vitamins C and E and angelica root and should be applied during foreplay. Topical arginine, which is also available over the counter, may also be as effective.
This is a daily supplement of vitamins designed to improve blood circulation to increase arousal and lubrication. If you are going to feel its effects, you should do so within 2 to 4 weeks. Always discuss taking new supplements with your doctor if you are taking other medications as interactions can occur.
Talk To Your Partner
Many men are not aware that hormone fluctuations can trigger changes in the female body, especially in the vaginal region. For this reason you may need to explain this and figure out new bedroom strategies together.