Intimacy is important in all relationships, but what happens if menopause impacts your libido? What causes this drop in sex drive, and are there ways for women to treat it? We sat down with Vhi Clinical Lead for Women’s Health, Dr Fiona Belton, to discuss the details and understand women’s options when they are affected by decreased libido.

What is libido, and what influences it?

Libido is essentially our sex drive and our sexual desire. Dr Belton explains that it’s multi-factorial and is influenced by a range of things, such as hormones (the drop in oestrogen that occurs during menopause can impact libido), medications, medical conditions, mental health, relationship issues and lifestyle.

What causes a decreased libido during menopause?

Decreased libido can be caused by both the physical and emotional symptoms of menopause:

Physical causes:

• Vaginal dryness, which can cause painful sex.
• The drop in oestrogen that happens during menopause can cause changes to the vaginal walls and canal, and this can also cause painful sex.
• Incontinence, which can start or become worse around menopause.

Emotional causes:

• Fatigue.
• Low mood and irritability.
• Low self-esteem or body image (how we feel and think about our bodies).

Circumstances will also influence your libido; if you have a busy house or have family members staying over for an extended time, this will influence your libido too.

Is painful intercourse common during menopause?

For some women, sex can become painful during menopause. Vaginal dryness is common and can often be treated with simple over-the-counter lubricants. Genitourinary syndrome of menopause is a condition that causes vaginal and vulval dryness and irritation, with thinning and shortening of the vaginal canal. This can make intercourse painful and penetration can become more difficult if the vagina shortens and narrows. It can also cause urinary urgency (a strong sensation of needing to pass urine suddenly) and urinary frequency. This condition is easier to manage at the early stages with local/vaginal oestrogen. As the condition progresses it can be harder to restore the thinned tissues, so you should visit your healthcare provider if you notice these symptoms.

Pelvic floor dysfunction is another cause of painful intercourse. The pelvic floor muscles in some women can be tense or in spasm, which reduces the mobility of the vagina and surrounding area during sex. This can cause pain. This is often managed with pelvic floor physiotherapy. It’s important to note that pelvic floor dysfunction can occur in women of any age. Be sure to visit your healthcare provider if you’re experiencing painful sex.

How common is loss of libido/sex drive during menopause?

Some studies have reported that up to a third of women in menopause have issues with libido, and Dr Belton says it’s “certainly not uncommon” with her patients during menopause, and how problematic a decreased libido is depends on the individual. For some women, it’s low down on their list of worries, and for others, it’s very distressing.

Any tips for approaching a conversation about decreased libido with a partner?

Dr Belton reminds us that the situation may also be difficult for your partner and it is possible they don’t understand what you’re experiencing. For some couples, intercourse is a very important part of the relationship and is a significant factor in intimacy. Having a conversation with your partner can help to reassure them.

When having these conversations, it’s helpful to set aside time when there will be no interruptions. It can help to acknowledge what your partner may be feeling, and starting on a compassionate note can help lead to a more constructive chat. Try to explain what you’re experiencing and listen to what they are feeling.

Keep in mind, there are lots of ways to maintain intimacy with your partner outside of intercourse like starting or sharing a hobby together, date nights, words of affirmation―the list goes on! Spend some time trying new things and eventually you will figure out what works best for both of you in this new phase.

What can women do to cope with a decreased libido?

Taking a holistic approach and treating both the physical and emotional issues that may be causing a low libido, including symptoms of menopause, is what Dr Belton finds beneficial. It’s important to try to figure out what could be creating a dip in your sex drive, because that will inform how it’s treated. Speaking to your healthcare provider is best, so you can figure out the possible causes together and find the most suitable treatment.

Can hormone therapy improve libido?

Hormone replacement therapy (HRT), or menopause hormone therapy (MHT), replaces the female hormones that decrease during menopause. The oestrogen in HRT can directly help improve libido for some women, whether it’s taken orally, as a gel, patch or spray. When symptoms like hot flushes, night sweats, vaginal dryness and irritability are managed with hormone therapy, women can find their quality of life vastly improved, and their libido follows suit as a result. Testosterone might be prescribed for some women, with levels of success varying from woman to woman. Dr Belton highlights that ‘trialling and assessing’ responses to treatments may find the best outcomes for some women.

What about libido after menopause? Can it return to previous levels?

As we age, both men and women often experience a natural decline in libido. Some women can find that their circumstances — having no periods to deal with, having kids move out of the home — provide a sense of freedom and positively impact their libido. For other women, their sex drive can stay at a fairly consistent level post-menopause. Dr Belton explains that it’s not possible to predict this for each woman because it’s so personal and every woman’s hormone levels and circumstances are different.

If you are dealing with a decrease in libido and it’s affecting your quality of life or impacting your relationship, it’s important you speak to your healthcare provider. There is no wrong time to seek professional advice, and there are certainly no symptoms of menopause that don’t warrant a chat with your healthcare provider. Help is always there when you need it.
 

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately. 

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