Will menopause affect my sex life? For some people desire increases when hormones change in perimenopause and menopause, and for others it can reduce, to a point that they would like to talk about it and get further support. At Rowena Health Menopause Clinic we talk openly about this with you, and are delighted to give you all the support you need.
Sexual wellbeing is complex, and many other personal factors in your life can be involved if your desire is changing. Talking about can help.
What may affect your sexual desire?
- Lack of oestrogen can cause vaginal dryness, which can lead to discomfort and even pain during sex
- Night sweats and hot flushes can cause an intolerable heat, so you may not want to be touched
- Irregular periods can interfering with the spontaneity
- Joints can become sore and stiff
- You may be self-conscious because of physical changes that are occurring in your body
- Emotional changes can affect your mood: mood swings, low mood, the feelings of wanting to be alone, anxiety and loss of self-confidence
- Your partner may be experiencing problems with their health, they may be taking medication which can lead to difficulty getting erection, or cause them reduced sexual desire
- Taking prescribed drugs like antidepressants, betablockers and Gabapentin, or drinking too much alcohol can affect desire
- Pregnancy, recent childbirth can affect desire.
- Having problems with your relationship
- Desiring a change in your sex life, if sex is not bringing you pleasure then you may not want to do it.
- Stress, tiredness, exhaustion
- Worry over pressures of life: balancing caring for young children, teenagers, work, elderly relatives etc
Sexuality being so complex, the cause of loss of libido is likely to be due to a combination of a multitude of factors. It is thought that the decline in testosterone level in women can also lead to loss of libido.
How have things changed?
Changes in your sexual wellbeing might include:
- Lack of interest in sex (low libido) – it may be that you don’t ever think of having sex (spontaneous desire) or you don’t feel like having sex like you usually would when stimulated (responsive desire).
- Difficulty becoming aroused, it might take longer to build up
- Difficulty having an orgasm or the quality of the orgasm might have changed
- Vaginal pain during intercourse because of vaginal dryness or pelvic floor muscle problems
Things to ask yourself
- Has my sexual desire changed for me?
- If I was happy with my sexual desire in the past, when was this and why?
- If my sexual desire has reduced does this bother me and/or my partner?
- Would I like my level of sexual desire to increase?
- If I have a partner can I talk with them about it?
These are just some questions to start but we can start to discuss pleasure and what brings pleasure in ways that are not sexual and this article only touches the surface of the conversations which can follow. The challenge of menopausal sexual dysfunction is exacerbated by the fact that people often hesitate to seek help as they may find it embarrassing to do so. Some may consider that it is just part of the ageing process, for which nothing can be done. With talking and support we can guide you to help in this area which is right for you, your body and your relationship.
What is Hypoactive Sexual Desire Disorder? (HSDD)
Hypoactive Sexual Desire Disorder (HSDD) is a diagnosis made when a woman has a lack of interest in sex, no sexual thoughts, is unlikely to initiate sex, has reduced pleasure from sex, has little interest in masturbation and these symptoms have lasted more than 6 months. If you are diagnosed with HSDD, then there are lots of things which can help. Starting with lifestyle, focusing on quality time with your partner where you can connect and honestly discuss your personal sexual needs, if you are able to do this. I often talk about putting things in a circle, the things you are happy with, intimacy, pleasure and sex, and adding things into the circle, as and when you feel ready. It may also help to see a qualified psychosexual counsellor who is an expert in this area.
Hormone Replacement Therapy
Hormone replacement therapy can be effective, many people find their libido increases when they start taking HRT, for a number of reasons, they also find local oestrogen cream is very effective at relieving vaginal dryness and therefore the discomfort during sex. Systematic HRT can eradicate many of the symptoms described above that contribute to the sexual dysfunction – the hot flushes and night sweats, the mood lability, the dry skin etc.
Vaginal oestrogen
Vaginal oestrogen can help with vaginal dryness and the bladder symptoms which could be affecting your enjoyment of sex. This is long term low dose oestrogen, applied to the vagina, it is a long term treatment and can be used by almost every woman.
Testosterone for women to support sexual wellbeing
Some women benefit from a trial of the hormone testosterone. Many women think that testosterone is a male hormone, but before the menopause women also produce testosterone from their ovaries and their adrenal glands. It plays an important role in female sexual function, muscle and bone strength, cardiovascular health, cognitive function and energy. The levels of testosterone can decline steadily with age from your 30’s, and levels will fall suddenly if you have your ovaries removed, during an operation.
Guidance for testosterone in women
Testosterone is not licensed for use in women yet in the UK, but the NICE guideline NG23 (2015) supports the use of testosterone supplementation in women who despite taking an adequate dose of HRT, continue to have symptoms of low libido or desire, low sexual arousal, low sexual satisfaction and who are distressed by these symptoms. This is called Hypoactive Sexual Desire Disorder. It is important to make sure you are not experiencing vaginal dryness and soreness before starting testosterone supplementation.
Currently, these guidelines recommend the use of Testosterone only for hypoactive sexual desire. However, many women who use Testosterone supplementation also report improved muscle strength, increased energy levels, better cognitive function, improved mood and concentration and have reduced brain fog and better sleep. It might be something to consider, if you have good control of your other menopausal symptoms, but continue to have low libido, low sexual arousal, reduced sexual desire and less satisfaction when you have sex.
Do I need any tests to start testosterone?
A blood test is recommended before your treatment is started. This is not to make the diagnosis, as actually testosterone levels in themselves do not correlate with sexual desire, but rather it is to ensure that adding testosterone to your HRT treatment will not lead to Testosterone levels that are above the normal female range .
Testosterone medication in women
Testosterone is usually given as a gel that is applied once daily to the thigh. Testim® and Testogel® are gels formulated in a dose appropriate for men, so dosage adjustment is required for use in women.
AndroFeme® 1 is a Testosterone cream and holds a license for use in women in Australia. It is imported into the UK under special MHRA guidance. It is formulated for women and therefore no dosage adjustment is required. AndroFeme® 1 is not currently available on the NHS and must be prescribed on a private prescription. I tend to prescribe Testim and Testogel as these are cheaper and essentially the same.
How long will it be before I notice a difference in my libido?
It can take up to 3-6 months to notice an improvement in your symptoms. If at the end of 6 months there has been no improvement, then the Testosterone will be stopped as it is not necessary to continue.
What follow up will I need?
You will need to have a repeat blood test after 3 months, and if you continue on treatment this blood test will need to be repeated every 12 months. This is to ensure that your Testosterone level remains in the normal range for females, and where you are less likely to experience side effects (although this is not impossible).
What are the possible side effects?
Side effects are uncommon as long as the Testosterone level is monitored and kept in the normal female range. Some women notice a little hair growth at the site of application. This can be avoided by varying the site of application and applying the gel in a thin layer. Other side effects such as weight gain, appetite increase, acne, greasy skin, hair growth on the face and body, hair loss on the scalp, voice changes, enlargement of the clitoris etc are rarely experienced if normal female levels are maintained.
Is it safe?
There is a lack of long-term data in using testosterone in women, but data up to two years shows no adverse effect in healthy women after menopause. At Rowena Health we are not able to prescribe testosterone to women who are, or are planning to take part in competitive sporting activities.
AndroFeme® 1 contains almond oil so please do not take this if you have an allergy to almonds. I tend not to prescribe this product at Rowena Health.
Women’s health concern leaflet: Testosterone
Other measures can help improve sexual desire including relationship counselling and complementary activities such as yoga and acupuncture.
Websites for further information about sex
These websites are recommended by speakers at the British Menopause Society and recommendations include online courses, information about pelvic floor awareness, use of vaginal dilators.
- Age, Sex and You – promoting better sexual health and wellbeing in older adults.
- Joan Price Senior Sex Tips – Joan Price is an author, speaker and advocate for ageless sexuality.
- Jean Hailes Sex & Sexual Health – this is a health website full of fantastic information.
- Will menopause affect my sexlife? – article
- OMGYES – a one off payment for advice and information about exploring sex techniques
Talking with your partner
- It might be helpful to give your partner some information to help them understand how you feel. Information for partners about menopause
Psychosexual Therapy
Please enquire, I have details of therapists for you to consider. This website can help you find a therapist, COSRT
Books, audios and podcasts
- ‘Come as you are‘ by Emily Nagoski
- ‘Mind the Gap‘ by Dr Karen Gurney
- The podcast with Dr Karen Gurney: Sex in long term relationships
- ‘Naked at our age- speaking out loud about senior sex’ by Joan Price (Seal Press, 2011). Excellent, sex-positive read from the US about enjoying a healthy sex life after the age of 50. The same author has also published the ‘Ultimate Guide to Sex After Fifty, The: How to Maintain – or Regain – a Spicy, Satisfying Sex Life’ (Cleis Press, 2020) andis the editor of “Ageless Erotica” (Seal Press, 2013), an anthology of erotic stories written for a “mature audience”. Some books also available as audiobooks.
- ‘Sex Ed: A Guide for Adults’ by Ruby Rare (Bloomsbury Publ, 2020, also as audiobook). Illustrated sex education book by a queer non monogamous body-positivity advocate and sex educator from the UK. Includes an introduction to the “dual control model” of sexual desire and uses frank language.
- ‘The Sex Book’ by Suzi Godson (Cassell, 2006). Beautifully illustrated (pop art style) and well researched book full of information about sex. Includes lots of personal quotes from the UK.
- ‘Pussy Yoga: Pelvic Floor Training for Radiance, Confidence, and a Fulfilling Love Life’ by Coco Berlin (Aleksandra Kettelhoit-Lohmann, 2021) Self-study program to become more sensual, strong, and confident. Also has YouTube channel and offers (payable) online courses.
- ‘Mating in Captivity. Unlock erotic intelligence’ by Esther Perel (Hodder & Stoughton, 2007, also as audiobook).
- ‘Sexual Intelligence- What we really want from sex and how to get it’ by Dr. Marty Klein (HarperOne, 2013, also as audiobook). Essential read to review your concept of sex and sexuality and how to lead a happy sex life.
- ‘Massage Secret for Lovers- the ultimate guide to intimate arousal’ by Dr. Andrew Stanway (Quadrille, 2002). Well illustrated guide about of sex, intimacy and sexual connection beyond intercourse. Out of print but worth looking for second hand. Similar guides are ‘Art of Sensual Massage’ by G.Inkeles (Arcata Arts, 2011, re-edition) and ‘New Sensual Massage’ (Arcata Arts, 2013- re-edition)
Payable online courses and apps
- Shush online courses – to explore better sexual wellbeing
- The pleasure possibility course
- We are ferley – an app to support you to enjoy sex more
Self help for sexual problems
- “Becoming orgasmic- a sexual and personal growth programme for women” by J.R.Heiman and J.LoPiccolo (Piatkus, 2009). Excellent book about sexual self discovery. The books by Betty Dodson including “Orgasm for Two: the Joy of Partnersex” (Harmony, 2003; also as audiobook) and “Sex for One: the Joy of Selfloving” (Random House, 1996) also come recommended.
- “Rekindling desire” (3.ed.) (Routledge, 2019), “Couple Sexuality After 60: Intimate, Pleasurable, and Satisfying” (Routledge, 2021, also as audiobook), “Enhancing Couple Sexuality: Creating an Intimate and Erotic Bond” (Routledge, 2019), “Sexual Awareness- your guide to healthy couple sexuality” (5.ed) (Routledge, 2015) and “Discovering your couple sexual style: sharing desire, pleasure and satisfaction” (Routledge, 2009) by Dr. Barry and Emily McCarthy. Highly regarded guides to help couples to improve or rediscover their sexuality.
- “Intimacy & Desire. Awaken the passion in your relationship” (2nd ed.) ( W.W. Norton & Company, 2020) and “Passionate Marriage: Keeping Love and Intimacy Alive in Committed Relationships” (W.W. Norton & Company, 2009, also as audiobook) by David Schnarch, another widely recognised sex and couple therapist from the US, suitable for any couple in a long-term relationship.
- “Relate Guide To Loving In Later Life: How to Renew Intimacy and Have Fun in the Prime of Life” (Relate Series) by M.Thoburn (Vermilion, 2014). Guide includes case studies.
- “Better Sex Through Mindfulness- how women can cultivate desire” by Dr Lori Brutto (Greystone Books, 2021). Includes exercises that readers can do on their own to increase desire and sexual enjoyment, whether their goal is to overcome a sexual difficulty or simply give their love life a boost.
- “The Cognitive Behavioral Therapy Workbook for Menopause: A Step-by-Step Program for Over-coming Hot Flashes, Mood Swings, Insomnia, Anxiety, Depression Symptoms” by Sheryl Green (New Harbinger Publications, 2012). Very useful guide on how to use CBT to help with menopause symptoms. Includes a chapter about sexual problems. Out of stock but worth getting second hand. Another excellent CBT book (from the UK) is “Living Well Through The Menopause: An evidence-based cognitive behavioural guide” by Myra Hunter/ Melanie Smith (Robinson, 2021, also as audiobook).
- “Taking Sexy Back: How to Own Your Sexuality and Create the Relationships You Want” by relationship expert Dr Alexandra Solomon (New Harbinger, 2020, also as audiobook). Offers a “powerful and holistic approach to help you reclaim your sexuality”.
- “My Broken Vagina: One Woman’s Quest to Fix Her Sex Life, and Yours” by Fran Bushe (Hodder Studi, 2021). Despite its unfortunate title: part memoir- part moving but funny self help book about the difficulties the author had with painful sex and the various treatments she explored.
Toys and vaginal trainers
- Vaginal dilator exercises for psychosexual therapy
- vaginal dilation ‘Top Ten Tips for dilation”- by the British Society for Paediatric and Adolescent Gynaecology, written for young patients but useful tips for anyone using vaginal trainers.
- Pelvic floor awareness for psychosexual therapy
- ‘Jo Divine’: www.jodivine.com. Online UK-based luxury sex toy shop, co-founded by a nurse, Sam Evans, who was in the first Davina show, selling a range of sex toys for people of any gender, including graded vaginal dilators made of silicone. Also includes lots of sexual health information (see above).
- ‘Sh!’: UK first women friendly sex shop (and now online shop). Sells vibrating silicone vaginal dilators/trainers, Ohnut penile rings for women with deep pelvic pain at penetrative sex and includes articles with sex advice. www.sh-womenstore.com
- ‘Coco de mer’: www.coco-de-mer.com
- ‘Stress no more’: health and wellbeing online shop which sells the recommended soft and silky graded “Inspire Silicone Dilator Kit” (CalExotics) www.stressnomore.co.uk/inspire-silicone-dilator-kit-11438.html
We are delighted to offer you this support through Rowena Health Menopause Clinic, to make an appointment with us for support with Dr Carys Sonnenberg who is a BMS Menopause Specialists and is FSRH trained in sexual wellbeing please click the link.
Updated January 2024 Dr Carys Sonnenberg
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