Getting an Invite to the Libido Party

Any hope for diminished (or nonexistent) sexual desire in a postmenopausal woman?

— SW

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Short Take

Yes! While some women do report a decreased libido with menopause there are some interventions to consider, depending on the cause.

Tell Me More

Libido is complex and depends on emotional, psychological and physical factors. It can also change over time. Seeking sexual satisfaction is also not the only reason someone might agree to or initiate a sexual encounter with their partner. For example, emotional intimacy, sharing mutual pleasure, bonding and many other reasons often become valid motivators for sex, especially in a long-term relationship.

At times libido may be spontaneous (meaning you actively seek sex from a partner), but libido may also be receptive (meaning a person initially feels sexually neutral, but after sexual stimulation of some kind, becomes aroused). Consider it this way: you can have a strong urge to go to a party and seek out festivities (a spontaneous libido) or need an invitation to want to go (receptive libido). Many people confuse receptive libido with a lack of libido.

Relationship issues are often the cause of a loss of interest in sex, especially for women who need emotional intimacy for their sexual response cycle. A family therapist, psychologist or sex therapist may be helping in identifying relationship issues and help devise a strategy for working on those concerns.

Pain with sexual activity should also be addressed. If sex is painful, losing interest is an expected consequence. In this case, a visit to a gynecologist or other provider familiar with the physical changes of menopause and managing pain with sexual activity is in order. While low estrogen from menopause is a common cause of pain with sex, there are many other possible causes.

Stress and lack of sleep can be part of a libido problem. If someone has a higher sex drive while on vacation, then situational factors and sources of stress should be considered.

Depression can affect libido, so screening and treatment is important if mental health is a concern.

Some blood pressure medications and antidepressants can negatively affect libido. If you take medications for these reasons ask your health care provider or pharmacist if they could have sexual side effects.

Things to Try

Learning about the mind-body connection libido-wise has been proven to be helpful for many women. I recommend the book “Better Sex Through Mindfulness: How Women Can Cultivate Desire,” by Dr. Lori Brotto. A sex therapist may also be helpful with mindfulness-based techniques.

For a menopausal woman who is distressed by her lack of libido and cannot identify any relationship issues, pain, depression or other medical causes, some providers may consider a trial of a pharmaceutical such as a low dose of transdermal testosterone or the oral medication flibanserin (Addyi). Neither therapy is approved by the Food and Drug Administration for postmenopausal women, so this is off-label use. There are some unresolved safety issues regarding heart disease and breast cancer with long-term use of testosterone for low libido for postmenopausal women, so it is important to ensure that the therapy is working sufficiently and the side effects are minimal to justify its continued use beyond a few months. Testosterone therapy should be monitored closely to avoid side effects, such as acne, facial hair growth and lowering of the voice.

A word of caution

There are no over-the-counter products — creams, oils or supplements — that are effective for low libido for menopausal women. These products are unregulated and so their ingredients and safety may not be accurate. Testosterone pellets are commonly advertised for improving libido, but the doses are too high to be safe, says the North American Menopause Society, so this therapy is not recommended.

Dr. Jen Gunter, often called Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.