During the menopausal transition, some people find that their libido, or sex drive, changes, and they no longer feel spontaneous desire. Often, libido decreases because of shifting hormone levels and other changes in the body. While there’s no “normal” libido—everyone has a different standard—decreased sex drive can be treated in a number of ways if it’s a problem for you.
Lowered libido is a complex issue with many causes. A major factor is the decline of the sex hormones estrogen and testosterone during menopause. Lowered levels of these hormones can hamper desire and arousal and lead to physical changes that might make you less interested in or uncomfortable during sex. Mental and physical health challenges that are common during menopause, such as mood changes, anxiety, or body image concerns, in addition to changes in your personal, social, and professional life can also lower sex drive.
Dropping levels of estrogen lead to changes in the body that may make sex less enjoyable. Some common changes include vaginal dryness, which is due in part to decreased blood flow to the vagina, and vaginal atrophy, which can make the vagina feel dry, irritated, and inflamed. These changes can cause pain during sex.
Hormone-driven shifts elsewhere in the body can reduce your sex drive, too. Lowered testosterone levels in the brain contribute to the loss of spontaneous sexual desire that many women start to experience during the menopause transition. Fluctuations in weight may make you uncomfortable about how you look and feel. Hot flashes and night sweats may sex seem unappealing. Insomnia may leave you feeling tired or uninterested in sex. Mental health issues that are common during menopause, like anxiety and depression, can also decrease desire.
Some factors involved in decreased libido aren’t directly related to menopause but are common as people age. Body aches and injuries, for example, can lead to decreased mobility, making sex challenging. Serious illness and some medications can cause a decline in sex drive as well.
Many factors can decrease libido, so the first step to treating it is to pinpoint its root causes with the help of a physician or other health professional. If it’s a physical issue caused by changing hormone levels, your doctor might prescribe a medication to treat the symptom, recommend menopausal hormone therapy (previously known as hormone replacement therapy), or suggest a non-medical intervention to alleviate the problem.
Physical ailments that aren’t related to menopause but hamper sex drive should be addressed, and mental health problems that pose an obstacle to engaging in sexual activity can be addressed with medication, therapy, or both. Individual or couples therapy can also help partners adapt to the impact of menopause on sexual activity.
Menopausal Hormone Therapy (aka, Hormone replacement therapy or HRT): Both systemic and vaginal estrogen therapy can help you deal with vaginal dryness and atrophy that may cause discomfort during sex. Testosterone therapy can also help improve sex drive in women. Although it is not FDA-approved for use in women, it is often used for this reason with the support of several medical societies, including the North American Menopause Society
Dehydroepiandrosterone (DHEA): This hormone is prescribed in the form of an FDA-approved vaginal suppository to treat painful sex caused by menopause-related vaginal atrophy. In the US, it’s sold under the brand name Intrarosa.
Ospemifene: This daily oral pill, sold under the brand name Osphena, is also FDA-approved to treat vaginal dryness and painful sex caused by menopause-related vaginal atrophy.
Medications for mental health: Your doctor can help you identify whether your lowered sex drive is due to mental health issues, like anxiety or depression, and recommend medications and/or therapy to treat it. It is important to keep in mind that some medications used to treat depression can also cause low libido.
Vaginal moisturizers and personal lubricants: If pain during sex caused by vaginal dryness or atrophy is lowering your interest in sex, a non-hormonal vaginal moisturizer or either a silicone-based or water-based lubricant can help make sex more comfortable.
Create the mood: During perimenopause and after menopause, many women may not experience spontaneous desire, but they can still feel responsive desire. This means that while you may not start out feeling in the mood, you may be able to get there with some up front effort. Consider listening to, reading, or viewing some erotic material or getting started with a vibrator before your partner joins in.
Kegel exercises: The pelvic floor, which includes the muscles encircling the vagina, uterus, and bladder, can weaken during menopause, making sex less enjoyable. Kegel exercises, when done correctly and consistently over several months, can increase the strength and tone of the pelvic floor muscles, leading to more intense orgasms.
Exercise and yoga: Physical activity can help boost your sex drive because it triggers the release of endorphins that improve your overall mood and self-confidence and helps you stay healthy overall. If changes in your body shape or size during menopause are hindering your sex drive, exercise may help enhance your self-image.
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