Women and Menopause: Livening Up Libido

Interest in sex often cools after the Change. Learn some ways to put the heat back in your sex life.

According to Angela, she used to be "a wildcat in bed. Sex was a big part of my life. It's what my husband and I did for fun. Now, I'm more like a housecat. I'd rather just curl up next to him and watch a good movie."

One change many women encounter during and after menopause is a lower sex drive (libido). When men have problems with sex drive or performance, they can turn to medicine such as Viagra to give them a boost. It's not so easy for women. That's because women's sex drive is complex, involving both physical and emotional factors.

Do hormones play a role in libido?
Hormone levels drop during menopause, but it's not entirely clear how much these changes influence sex drive. During menopause, falling estrogen levels lead to changes in the vagina. Vaginal dryness and thinning can make intercourse uncomfortable. Reduced estrogen can also cause hot flashes and night sweats, which may interfere with sleep. Being tired may make a woman less interested in sex.

In addition to estrogen, a woman's ovaries also make a tiny amount of androgens (male sex hormones), including testosterone. Androgens are a known player in a woman's sex drive throughout her life. And androgen levels also decline during menopause, although not as much as estrogen. This may lead to less sexual desire. The decrease is more extreme in women who have their ovaries removed than in women who go through natural menopause.

What other things affect sex drive?
Many factors can affect a woman's sexuality at midlife and beyond, including:

  • Body image. Changes in appearance may occur during menopause and chip away at self-esteem. A woman may feel less sexy if she is not happy with her body.
  • Physical changes. Vaginal thinning and dryness may make intercourse painful, causing a woman to avoid it.
  • Health problems. People who have chronic diseases are more likely to have sexual problems.
  • Sleep problems. Not sleeping well may result in feeling tired, irritable and less interested in sex.
  • Mental health issues. Depression and anxiety can sap a woman's sexual energy. Life stresses, such as losing a job or caring for aging parents, may leave little energy for intimacy.
  • Medication side effects. Some antidepressants and blood pressure medications are known to depress libido.
  • Relationship issues. Hidden resentments can drive a wedge between partners. Or sometimes couples just drift away from each other over time.

How can I improve my sex drive?
There is no surefire way to jump-start libido, but here are some ideas that might help:

  • Make a date for sex. Choose a time when you are rested and won't be disturbed. Think about sex beforehand to help get yourself in the mood.
  • Communicate. Let your partner know what feels good. This is especially important if something you used to like is uncomfortable now.
  • Try a vaginal lubricant if you're avoiding sex because it hurts. Or ask your doctor about low-dose vaginal estrogen.
  • Put the focus on intimacy. Sex can be more than intercourse.Try different ways to give and get pleasure, such as massage or a lengthy kissing session.
  • Get a checkup. Make sure an untreated or poorly controlled condition is not limiting your libido. Talk to your doctor about your sexual issue to see if he or she has ideas that could help.
  • Discuss your medications with your doctor. If medication is the culprit, it may be possible to change your dose or switch to a different medicine.
  • Seek couples counseling if relationship issues are getting in the way of connecting with your partner.

Some doctors may prescribe testosterone therapy to increase sex drive. In a few studies, it has provided a modest boost in desire. At present, though, no testosterone drug has been approved by the FDA for use in women. Testosterone may cause side effects such as excess facial hair and acne, and long-term risks are not known.