Menopause is often called “the change.” This is an accurate name for many women who experience symptoms that change many aspects of their lives. For some women, one unpleasant side effect of perimenopause and menopause is lack of sex drive. It is not uncommon for women to lose interest in sex during menopause. It is also not uncommon for women who are not menopausal. There are a number of things that can contribute to decreased libido. The causes of the lack of sex drive can be split into three main categories: hormonal changes, physical conditions, and mental/emotional issues.
1. Hormonal Changes
During menopause, estrogen levels decrease. This causes a variety of symptoms that can be lead to a lack of sex drive. There are symptoms that cause physical issues and there are symptoms that can affect mood and therefore decrease interest in sex. These symptoms include:
- Dry vaginal tissues that result in painful or uncomfortable intercourse
- According to the North American Menopause Society, vaginal atrophy affects between 20% and 45% of midlife and older women.
- Lower hormones can lower sex drive and make it more difficult to become aroused
- Sleep disturbances that cause fatigue or irritability
- Hot flashes that cause a desire not to be touched
- Body changes like a weight gain that can lead to a loss in confidence or image issues
During the menopausal transition, testosterone levels often drop and this can cause decreased libido. Many women with low libido have an almost undetectable testosterone level. The ovary makes estradiol, progesterone, and testosterone, but in the US we tend to focus only on estradiol and progesterone. Women’s testosterone levels are far lower than men’s levels, but they are important. The Menopause Society (formerly The North American Menopause Society) now endorses the use of testosterone supplementation as a treatment for HSDD (Hypoactive Sexual Desire Disorder). A testosterone patch for women is available in Europe, but not in the United States. As there are no proprietary testosterone products available for women in the US, testosterone must be made by a compounding pharmacy.
2. Physical Problems
While hormonal changes are the most common cause of lack of sex drive in menopausal women, there are physical issues that may be the root of the problem. Talk to your doctor about any of the below issues:
- Sexual or intimate issues: If you have pain during sex or can\’t reach orgasm, it can reduce your desire for sex.
- Medical conditions & diseases: Many nonsexual diseases can affect sex drive, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease, and neurological diseases.
- Medications: Certain prescription drugs, especially antidepressants called selective serotonin reuptake inhibitors (SSRIs), are known to lower the sex drive.
- Lifestyle habits: A glass of wine may put you in the mood, but too much alcohol can affect your sex drive. The same is true of street drugs. Also, smoking decreases blood flow, which may dull arousal.
- Surgery: Any surgery related to your breasts or genital tract can affect your body image, sexual function, and desire for sex.
- General Fatigue: Exhaustion from everyday life can cause libido to decrease. Fatigue from illness or surgery also can play a role in a low sex drive.
3. Mental and Emotional Causes
No matter what stage of life you’re in, your emotional and mental state contributes a great deal to your sex drive. Some women are more susceptible to depression during menopause. Since the body changes during perimenopause and menopause, some women have body image issues or lose confidence. Other psychological causes of decreased libido include stress and relationship issues. As mentioned above, some women struggle with connection during menopause because they are going through a major physical and emotional change. This can lead to a lack of connection with their partner. There may also be a breakdown in communication about needs and preferences that may have changed.
Talking to Your Doctor
Your doctor can help you identify what is causing your lack of sex drive. They can also help with treatments and solutions for your issues. Treatments include:
- Hormone therapy for vaginal atrophy
- Testosterone supplementation
- Switching medications like antidepressants
- Sex education and counseling
But, you need to be comfortable enough with your doctor to discuss your sex life. Being open and discussing all of your symptoms and feelings is necessary for finding a solution and improving your sex drive. Finding the right doctor is crucial.
Dr. Karen Clark of Chapel Hill Gynecology is an experienced OB/GYN that specializes in menopause management and sexual dysfunction. You can feel confident that she can provide you with the best treatment and advice. If you are experiencing a lack of sex drive, call Dr. Clark at (919) 960-2720 to schedule an appointment.