“Doctor, I love my husband. But at this point, I will do anything to avoid being intimate with him. We go to bed at different times, or I tell him I’m too tired. I feel horribly guilty. He feels rejected. It is tearing us apart.”

One of our menopausal patients, Francis, was in tears as she shared this embarrassing secret. We reassured her that she wasn’t alone in having these thoughts—nearly 50 percent of menopausal women privately confess to similar feelings. Yet, this decrease in sex drive is rarely brought out in the open to be discussed or treated.

Where Did My Sex Drive Go?
The average age for menopause is 51. Often, women will first notice an irregularity to the menstrual cycle—skipping periods, lighter flow. During this stage, called perimenopause, the production of hormones—estrogen, progesterone and testosterone—by the ovary declines significantly. In fact, testosterone production actually starts to decline after age 30.

Women in this phase of life can experience hot flashes, night sweats, sleep disturbances, vaginal thinning, depression and decreased libido. It is during this erratic and unpredictable transition from normal hormone levels to low hormonal levels that the symptoms are the most pronounced. The severity of symptoms varies from woman to woman, but nearly 80 percent will experience them to some degree.

Stress Factors
Adding to the complexity of this issue is that the time of the menopause often coincides with several other major transitions in a woman’s life. Her children move away from home, she experiences changes in career, or she takes on the role of caring for aging parents. Stress levels go through the roof, also resulting in a lack of interest or desire. Metabolism slows 10 to 15 percent at this time of life as well, and the resulting weight gain and lack of energy can make sex the last thing on a woman’s mind, compounding the decrease in libido. The symptoms of menopause itself—insomnia, hot flashes and depression—also contribute to libido decline. Vaginal thinning can lead to painful intercourse, which then causes tension and fear, and subsequently less desire.

Isn’t It Normal to Lose Interest?
While there is a clearly defined physical response to arousal, there is also a large psychological component. Many of my patients assume it is “normal” to lose interest in sex as they go through menopause and, therefore, do not seek out help in this area. They attribute the lack of libido to strain within the relationship or familiarity with their partner—being bored. They feel like they can take it or leave it, and unless their partner is pushing them, they may never broach the subject with anyone. We tell them it is common, but it doesn’t have to be mandatory.

Learn to Live with It?
Most of our menopausal patients have learned to live with it. They essentially have given up on that aspect of their lives, and their relationships take on new dynamics. But, when asked, most of our patients say they would love to have fulfilling, fun, passionate sex lives with their partners. So, often in desperation, they ask what can be done.

5 Ways to Boost Your Libido

• Do Something Nice for Yourself
  Getting into the right mind-set can do wonders. This may mean exercising, getting a good night’s sleep and making time for intimacy. Try clearing a special space for intimacy away from the stresses of everyday life.
• Review Your Health History and Medications
  Some of the most commonly prescribed medications in the United States have decreased sex drive as a side effect. These include common antidepressants like Prozac and Zoloft, as well as blood pressure medications such as beta-blockers. In addition, corticosteroids and oral estrogen can decrease the levels of testosterone in the blood. If you are taking any of these medications, talk to your doctor about alternatives.
• Consider Testosterone
  There have been more than 20 prospective studies that have shown that testosterone improves sex drive. Interestingly, though, the FDA has not approved any medications for this use in women. For this reason, patients must get the testosterone from compounding pharmacies or use medications designed for men in lower doses. These are available in pill, patch and cream forms. The main risks associated with testosterone use in women are increased hair growth and acne. However, these risks are quite small and are reversible.
• Vaginal Estrogen
  Vaginal dryness and subsequent painful intercourse can be treated with vaginal estrogen preparations. These can return the vaginal tissue to its premenopausal state, which is more elastic and less dry. They come in the form of creams or inserted tablets. It usually takes about six weeks before maximum benefit is obtained.
• Couples Therapy
  Open dialogue with your partner, often guided by a therapist, can bring to the surface other issues that might be contributing to the problem, including stress within the relationship, self-image problems and guilt. A trained sex therapist can help with relaxation and communication techniques as well.

Remember, there is no quick fix for loss of sex drive, but there are things that can help. First and foremost is speaking honestly with your partner about your feelings. Next, talk to your doctor.

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