Low Libido

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Low Libido In Menopause

Women’s levels of sexual desire can change over time. It’s common for highs and lows to happen along with the start or end of a relationship. Or they can happen with major life changes like menopause. With low libido, you may experience:

• Less or no interest in any type of sexual activity, including masturbation.
• Never or only seldom having sexual fantasies or thoughts.
• Being sad or concerned about your lack of sexual activity or fantasies.

Why Does Low Libido Happen in Menopause?

Estrogen levels plummet during both perimenopause and menopause, which can significantly affect sexual function. This hormonal shift can reduce sexual desire, complicate arousal, and decrease vaginal elasticity, leading to vaginal dryness that might make intercourse uncomfortable or even painful. Consequently, over a third of women in perimenopause or post-menopause report experiencing sexual challenges, including a diminished interest in sex and difficulties achieving orgasm. [1]

The genitourinary syndrome of menopause (GSM) is a term that describes various menopausal symptoms and signs associated with physical changes of the vulva, vagina, and lower urinary tract. The GSM includes not only genital symptoms (dryness, burning, and irritation) and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function), but also urinary symptoms (urgency, dysuria, and recurrent urinary tract infections [UTIs]). [2]

What Can You Do About Low Libido in Menopause?

To address low libido during menopause, consider the following strategies:

Symptom Relief Strategies:

• Lubricants: Utilize lubricants to minimize discomfort during intercourse.
• Counseling: Seek support for managing menopause-related mental health issues like depression and anxiety.
• Frequent Sexual Activity: Regular sex can improve vaginal blood flow and tissue health.
• Arousal Techniques: Engage in foreplay to enhance natural lubrication and make sex more enjoyable.
• Innovative Sexual Practices: Experiment with sex toys or alternate forms of intimacy to enrich your sexual experience.
• Stress Reduction: Pursue activities that foster closeness outside the bedroom, including date nights or shared hobbies.
• Masturbation: Explore personal sexual preferences through masturbation to better communicate your desires to your partner and increase comfort with sexual activity.

Hormonal Treatments:

• Estrogen Therapy: To alleviate vaginal dryness and discomfort, estrogen is available in various forms, including pills, patches, sprays, gels, creams, and vaginal suppositories or rings. Vaginal estrogen therapy can alleviate vaginal dryness and discomfort, thereby enhancing libido and sexual function, contributing to a healthier sex life and improved intimacy. Studies have shown there is no evidence of increased early breast cancer risk in patients who used vaginal estrogen therapy, compared with patients who did not use HRT. [3] That said, always consult with a healthcare provider to understand your personal risks and benefits.
• Testosterone: Although not FDA-approved for sexual dysfunction in women, testosterone therapy may be prescribed off-label to enhance libido after menopause. It’s applied through the skin for potential benefits, with treatment monitored by a healthcare professional due to possible side effects like acne and mood changes.

Non-Hormonal Treatments:

• Prasterone (Intrarosa): This vaginal insert is a non-estrogen treatment that provides dehydroepiandrosterone (DHEA) to the vagina, alleviating pain during intercourse due to GSM.
• Ospemifene (Osphena): A daily pill that eases painful intercourse for women with moderate to severe GSM, not recommended for those at high risk for breast cancer.
• Bremelanotide (Vyleesi): Vyleesi is used as needed by administering an injection under the skin of the abdomen or thigh at least 45 minutes before anticipated sexual activity.
• Flibanserin (Addyi): Addyi, is an FDA-approved medication specifically designed to treat Hypoactive Sexual Desire Disorder (HSDD) in pre-menopausal women.

These approaches offer various ways to mitigate low libido during menopause, enhancing sexual health and satisfaction.

References:

1. West SL, D’Aloisio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med. 2008 Jul 14;168(13):1441-9. doi: 10.1001/archinte.168.13.1441. PMID: 18625925.
2. Kim HK, Kang SY, Chung YJ, Kim JH, Kim MR. The Recent Review of the Genitourinary Syndrome of Menopause. J Menopausal Med. 2015 Aug;21(2):65-71. doi: 10.6118/jmm.2015.21.2.65. Epub 2015 Aug 28. PMID: 26357643; PMCID: PMC4561742.
3. McVicker L, Labeit AM, Coupland CAC, Hicks B, Hughes C, McMenamin Ú, McIntosh SA, Murchie P, Cardwell CR. Vaginal Estrogen Therapy Use and Survival in Females With Breast Cancer. JAMA Oncol. 2024 Jan 1;10(1):103-108. doi: 10.1001/jamaoncol.2023.4508. PMID: 37917089; PMCID: PMC10623297.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.