Sexuality during Menopause
Changes in the frequency of sexual intercourse during menopause can be broadly categorized into three categories; hormonal, personal, and relational.
With regards to hormones, lowered levels of estrogen, progesterone, and testosterone can cause a number of issues pertaining to sexual frequency. The first is lowered libido, and the second is vaginal dryness that leads to pain with sex, known as vaginal atrophy. Lowered libido can be due to less vaginal moisture and from low levels of testosterone. When the vagina feels dry, there is less of a physical stimulus to engage in sex. It just doesn't feel receptive enough due to a lack of moisture and discharge. To compound the problem, low levels of testosterone, the male hormone, also reduces sex drive. Combined, you are just not likely to be in the 'mood.' Speaking of moods, because depression can worsen or first develop in the menopause, sexual desire can be adversely affected. When we don't feel good or are always tired of untreated depression, then sexual desire is the first to take a hit. Furthermore, some of the medications to treat depression have the dreaded side effect of decreased sex drive.
Life Getting in the Way of Sex
Our personal issues can become more complicated during menopause, such as illness, medications for high blood pressure and stress from the 'empty nest syndrome.' Divorce is also more common, and body image from weight gain often also accompanies the menopausal years.
The third cause for concern about sexuality is relationship issues. One question doctor's often ask patients when they report having no sex drive is, "Do you like your partner?" If a couple has communication problems or the woman doesn't feel respected or listened to, there is bound to be trouble in the bedroom. After all, pent up anger and boredom in the relationship can wreak havoc on the bedroom activities.
What can be done to improve sex during menopause?
One solution is to correct the underlying hormonal imbalance by supplementing with estrogen, progesterone, and sometimes testosterone. These hormones can be administered orally, topically (transdermal or intravaginally) in the form of tablets, creams, patches, or rings for use in the vagina that slowly release estrogen.
Gordon et al. have conducted a trial of 172 perimenopausal and menopausal women age 45 to 60 years. They were randomly assigned to 12 months of transdermal estradiol and intermittent oral micronized progesterone. Their findings mirrored the psychological findings previously reported by the Perimenopausal Estrogen Replacement Therapy (PERT) Study, indicating that perimenopausal and early postmenopausal women treated with this regimen had an almost 50% decrease in depressive symptoms compared to placebo-treated women, as measured by the Center for Epidemiological Studies-Depression Scale.
Vaginal dryness and thinning cause the elasticity, collagen, and lubrication to diminish. Remedies for that are straight forward in the form of lubricants, moisturizers, topical estrogen, and non-hormonal pills such as ospemifene, a once-daily pill to treat moderate to severe vaginal atrophy.
Intrarosa, a form of topical DHEA, is a once-daily insert that remedies vaginal dryness, and both of these are prescription medications.
Replens, Astroglide, KY liquid beads can be bought over the counter and are temporary solutions for improved lubrication before sexual encounters.
Replens can be used on a regular basis to help those with the irritative vaginal symptoms that occur on a daily basis and acts as a vaginal moisturizer.
Vitamin E and A oils can provide added relief as can oral omega-3 fatty acids, and Vitamin D. Seabuckthorn oil was shown in one study to improve vaginal elasticity and integrity. Avoid petroleum products in the vagina.
Oral or topical estrogen and testosterone can also improve libido, as well as vaginal atrophy.
A product called Vylessi in approved for hypoactive sex drive in premenopausal women but may be considered off-label in women who have tried other options that failed. Hormones and antidepressants can help battle depression as a reason for sexual dysfunction. Be wary of some antidepressants that lower libido like Prozac and Paxil and Zoloft. Improved sleep and less fatigue are also a boon towards a healthy sex life.
Relationship Issues tend to be the most difficult to treat and require professional help in most cases. A sexual therapist, psychiatrist and a physician can help you, in that regard, helping you evolve a treatment plan that will work long term.
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2. Soares CN. Perimenopause-related mood disturbance: an update on risk factors and novel treatment strategies available. Meeting Program and Abstracts. Psychopharmacology and Reproductive Transitions Symposium. American Psychiatric Association 157th Annual Meeting; May 1-6, 2004; New York, NY. Arlington, Va: American Psychiatric Publishing; 2004. 51-61.
3. Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: a randomized clinical trial. JAMA Psychiatry. 2018;75(2):149–157.
4. Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006 Oct 18. CD001500.
5. Hlatky MA, Boothroyd D, Vittinghoff E, et al. Quality-of-life and depressive symptoms in postmenopausal women after receiving hormone therapy: results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. JAMA. 2002 Feb 6. 287(5):591-7