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Why does a woman's sex drive decrease after menopause?

Menopause does not mean your sex life is over. A survey found that most people between the ages of 57 and 85 consider intimacy a vital part of their life. Still, midlife changes can pose new challenges. Menopause is the end of menstrual periods. Physical changes can also hamper the urge to get frisky. Lower levels of estrogen can cause vaginal walls to become dry, thin, and fragile, and sex may become less comfortable. Known as genitourinary syndrome of menopause, the condition affects around half of women. The good news is, postmenopausal women said factors such as stress or relationship issues had a bigger impact on their sex lives than biological changes, such as decreased hormone levels.

Ian Kerner, PhD
Sexual Health Specialist

Working with the hormonal and other changes of menopause is the key to staying sexually active. Hormone replacement therapy and other treatments can help with vaginal dryness and pain, as well as other common menopausal symptoms. It’s also helpful to explore different types of stimulation during sex, whether it be vibrators, different intercourse positions, or oral sex, and to spend more time in foreplay.

Don’t assume that what’s worked in the past is going to work now, and do focus on how you can adapt to your body’s changes and continue to have a fulfilling sex life.

Staness Jonekos
Health Education Specialist

Factors that can affect sexual health during menopause include one or more of the following:

  • Emotions: Feeling unattractive, being depressed, feeling tired, suffering from lack of sleep, moodiness, feeling isolated, and not being happy
  • Fluctuating hormones
  • Medications: Antidepressants, mood stabilizers, contraceptive drugs, antihistamines, sedatives, anti-hypertensives and blood pressure medications
  • Medical conditions: Depression, thyroid disease, androgen insufficiency, diabetes, cardiovascular disease and neurological disorders
  • Cultural issues
  • Relationship satisfaction
  • Midlife stress: Career change, relationships, loss, divorce, caring for parents and financial concerns

If you are suffering from hot flashes and a poor self-image, combined with taking antidepressants and blood pressure medications, you have a recipe for a declining libido.

Menopause, or the change in life ending your fertility, produces a variety of changes that can lower your sexual energy. During menopause, your estrogen level drops. The decreased estrogen can cause sadness, fatigue and other emotional problems that dampen your sex drive. Physical changes, including breast sensitivity and vaginal dryness, make it even more challenging to maintain your sexual energy.

Each woman experiences the changes in sexuality that occur with menopause differently. While many women become less interested in sex after menopause, others find they enjoy intimacy more because they no longer have to use birth control. If menopause-related physical changes, such as vaginal dryness or thinning, are making sex uncomfortable and less pleasurable, your doctor can suggest treatments that will help.

Sari Cooper
Sexual Health Specialist

Loss of libido is one of the most common complaints women have during menopause. During perimenopause the body is basically going through withdrawal from the hormones that were distributed on a regular basis during your childbearing years.

It's important to develop a variety of ways to get turned on whether it's reading erotica, watching movies that have sexy scenes that trigger your erotic desire. The phrase "use it or lose it" is what we sex therapists and gynecologists tell our patients because the longer you go without sexual arousal the easier it becomes the last thing on your list of hobbies. This can lead to problems in your relationship if your spouse is still very much interested in having a vibrant sexual life.

While some women are able to utilize hormone therapies, many can't due to an increased risk of some cancers. It is important to have frank open discussions with your gynecologist about the pros and cons of this type of treatment.

A woman's sex drive is partially dependent on her level of testosterone-like androgens. When women enter menopause and cease to ovulate, 50 percent of their androgens disappear, leaving only the androgens produced by their adrenal glands to stimulate their sex drive. But adrenal production can decrease with age or medications, too.

Half of all women between ages 42 and 52 lose their interest in sex, are harder to arouse, and experience much less frequent and less intense orgasms, because they have lost 60 percent of the testosterone-like substances they had at age 20. Plus, they have fewer receptors for hormones, so the effects are compounded.

You: Staying Young: The Owner's Manual for Extending Your Warranty

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Dr. Bonnie Lynn Wright, PhD
Geriatrics Nursing Specialist

There are some sexual changes you may need to learn to manage:

  • Reduced sexual desire and prolonged response time due to hormone level changes
  • Tissue dryness that may increase discomfort during intercourse
  • Symptoms such as hot flashes that may occur at the most inconvenient times
  • Grieving for the loss of womanhood or your self-image as a fertile woman

Generally, whatever your sex life was like before menopause should return when your symptoms are over or managed. Life may change but it still goes on.

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

Some people think that sex drive decreases as you age. But this isn't the case, and some women say sex gets better with age. Because there are so many physical and mental factors that go into a person's sex drive, it is hard to blame just one thing for a waning libido. If your desire for sex changes, it may be related to menopausal symptoms. Your vagina can become dry and thin and that can cause painful intercourse after menopause due to estrogen loss. Hot flashes and night sweats can keep you from getting a good night's sleep, and when you are fatigued, down and sleep deprived, it hardly puts you in the mood for sex. And some women become depressed as they age, although, it may not be directly related to menopause.

If you enjoyed sex before menopause, don't give up on it. Strategies for dealing with menopausal changes that affect sex will depend on what's causing it. Most often we focus on the vaginal symptoms, which can most interfere with a satisfying sex life. When estrogen declines it can cause the lining of the vagina to become thin and less lubricated. Some women won't be bothered much by these changes, but for many, the changes will be severe enough to affect her sex life. You may also experience itching, develop a condition called vaginitis and have increases in vaginal infections. These problems can make sexual intercourse painful. If the vaginal symptoms are minor, you can try an over-the-counter lubricant during sex to see if that helps. But the best chance at relief is estrogen cream, tablet or vaginal ring, which delivers estrogen right in the vagina. If, however, you have other disabling menopausal symptoms you can decide along with your doctor if you are a candidate for oral menopausal hormone treatments, or transdermal hormone treatments like a gel, patch, spray or even injection. But this is not usually the best approach for women who only have vaginal symptoms because hormone therapy carries potentially dangerous health effects.

No two women experience menopause the same, so talk to your partner to better understand what she is going through during this change of life. Also talk to your doctor to help you determine the cause.

Sexual changes during menopause can lead to problems for many women. Before you throw up your hands in despair (or throw out your lacy lingerie), here are some ideas worth considering:

1. Physical therapy for pelvic discomfort.

2. Kegel exercises.

3. Regular sexual activity, which promotes vaginal health and blood flow. To make it easier, you may want to consider:

  • vaginal dilators
  • over-the-counter vaginal lubricants (for temporary relief of dryness before and during sex)
  • over-the-counter vaginal moisturizers (for longer-term relief from dryness)
  • low-dose vaginal estrogen therapy in cream, ring or vaginal tablet form (reverses underlying atrophy and dryness)
  • higher-dose hormone therapy throughout the body via pills, patches and other preparations (reverses underlying atrophy and dryness, but generally reserved for women with bothersome hot flashes)

4. Laser therapy. A non-hormonal therapy, the MonaLisa Touch uses a fractional carbon dioxide (CO2) laser to help restore vaginal health in postmenopausal women. It works by delivering controlled energy to the vaginal tissue to make more collagen (which is an essential ingredient in vaginal cell health).

5. Ospemifene (Osphena). This drug was approved by the Food and Drug Administration in 2013 for postmenopausal women who experience pain or discomfort during sexual intercourse. The once-a-day pill, which works by acting like estrogen in some parts of the body, helps make vaginal tissue thicker and less fragile.

This content originally appeared on HealthyWomen.org.

Boston Women's Health Book Collective
Administration Specialist

Our libido, or sexual energy, fluctuates throughout our lives. There is no agreement about whether sexual interest declines chiefly because of declining hormones, other aspects of aging such as poor circulation, or the influence of other life circumstances, such as the quality of a woman's sexual relationship, her overall emotional and physical health, financial stability, and family and cultural values. Furthermore, researchers report that even if our libidos decline, we can find satisfaction with our sexual lives once we have adjusted to this change.

Vaginal dryness becomes more prevalent during early postmenopause. Nearly 50 percent of women report bothersome vaginal dryness even three years after menopause. Some of the sexual problems women report, such as pain with intercourse, may be related to vaginal dryness.

Other changes, such as lower sexual interest and responsivity, increase in prevalence as women make the transition to menopause. Lower estrogen levels, but not lower testosterone levels, have been associated with sexual problems in a large longitudinal study of women during the menopausal transition in Australia. Recent reports from the Study of Women Across the Nation (SWAN) study indicate that testosterone levels have minimal influence on sexual desire, a finding corroborated by another study of Australian women. Your prior sexual experiences and factors related to your partners, your relationships, and other aspects of your lives influence your sexuality as well as the biological changes associated with menopause.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.