Sex & fertility
Low sex drive in women — causes and solutions
by Marcy Holmes NP, Certified Menopause Clinician,
& Dixie Mills MD
New patients at Women to Women are often surprised when we ask about their sex drive, quality of orgasm, and satisfaction with their sex life. Some women are embarrassed and feel awkward. But most welcome this chance to talk about what’s happening to their bodies, their vitality and their interest in sex itself.
The years of perimenopause and menopause are a time of so much change. Our bodies may be in an uproar — hot flashes, mood swings, weight gain. Our priorities are changing too, especially as we reflect on our lives and find our real voices. At the same time, we’re often under more stress, with teenagers in the household, aging parents, greater demands at work, and relationship problems with our partners. Sex may not seem as important as it once was.
In truth, a woman’s sexuality has to change in perimenopause and menopause. Instead of giving up, or trying to hold on to how things were in the past, we encourage you to welcome this change in your sexuality. You really can find your way to a sexuality that suits you now — hopefully better than ever. With no fear of pregnancy, and the kids out of the house, that’s a real possibility.
As we explore the changes in your sexuality at this time in your life, keep in mind that your sex drive reflects and helps sustain your overall well-being. It’s perfectly natural for a woman to be sexually active throughout her life. And there’s a great deal of evidence that it’s good for your health.
If sexual desire is natural, why does it go away?
There are physical and emotional factors that affect your sex drive — and they’re interdependent. Let’s look at the physical factors first. Sometimes they’re the easiest to straighten out.
Hormonal imbalance is the simplest cause of low libido. Most often we see low libido accompanied by other common symptoms of perimenopause — hot flashes, insomnia, fatigue, mood swings, and weight gain. When those women get their hormones back in balance, their desire often returns as well. (That’s what our Personal Program is designed to do.)
Stress is an enormous factor. The body naturally puts survival ahead of pleasure. Your over-burdened adrenal glands can rob your body of the building blocks it uses to make estrogen and testosterone, which are vital to desire and sexual response. Many women in the Personal Program tell us they feel surrounded by stress; they are at significant risk of adrenal fatigue.
Oftentimes the major sources of stress in our lives seem beyond our control. If you feel that’s true for you, we encourage you to explore several questions. How might you reduce the stress at its source? Can you cope with another way, or shield yourself from it? Can you compensate for it by nurturing yourself? Changes in your routines, a new form of creative self-expression, help from your partner, working on unresolved problems, time you devote to yourself — the positive effects can be profound.
Very few of us recognize the connection between nutrition and libido. A lifetime of nutritional deficiencies creates the preconditions for hormonal imbalance. Chronic dieting has a terrible impact on your energy and self-image, and therefore on your sex drive. Low-fat diets are a special problem, because your body needs lipids to make its hormones, including the testosterone needed for sexual response.
Look beyond the physical
It’s been said that the brain is the most important sexual organ. Certainly we see in our patients that desire and satisfaction depend as much on emotional and psychological factors as on the purely physical — sometimes more so.
A woman’s sexuality often emerges as an issue in perimenopause. For many of us, our sexual identity is rooted in our sense of attractiveness to men, which is typically based on having a youthful body. As our bodies change at mid-life we may feel undesirable and therefore less interested in sex. Biologists say humans are the only species in which females are sexually aroused by their own pheromones — so “feeling sexy” is necessary to feel desire.
Some women were raised to believe that sexual desire is shameful or inappropriate as they get older. Women who’ve been unassertive about their sexuality in the past may prefer to sacrifice their sex lives rather than become assertive now about what’s required to satisfy their sexual needs. And women without partners may be daunted by the prospect of “dating” again and so just wall themselves up.
Your relationship with your partner may be a vortex of issues. If your needs aren’t being met in the relationship, if the two of you don’t deal with problems openly and constructively, if you aren’t treated with respect and fairness, if your partner is self-absorbed or self-destructive — these common patterns destroy the intimacy and trust that keep sexual desire alive over the long term.
Women ask us why they react so strongly now against behavior their spouse has exhibited for years. The reason is that in menopause women often stop putting the interests of others first, and start paying more attention to themselves — that is, they find their voices. If we don’t, among other things, it will adversely affect our health.
We should add that many women have been traumatized sexually at some point in their lives, and that experience may need to be dealt with now. It’s estimated that one in three women are sexually assaulted in some way during their lifetimes. If this is an issue for you, you deserve to explore your experience with professional help for many reasons beyond your sex drive.
Physical changes in the vagina
As perimenopause progresses, the drop in estrogen can create thinning, tightening, and dryness in the vulva and vagina. These changes can lead to such discomfort that some women come to dread sex because of the pain.
In our practice we’ve observed that former Premarin and Prempro users are more likely to suffer such changes to the vaginal area. The problems may take 6-12 months to develop after stopping the drugs. We believe it’s because of the strong horse estrogens they contain.
We treat both the symptoms and the underlying causes of vaginal dryness and vaginal thinning. Vitamin E vaginal suppositories used twice weekly can help enormously. There are a number of water-based lubricants to reduce friction during intercourse that are highly effective as well.
Dietary changes, nutritional supplements, and gentle endocrine support — key parts of the combination approach we use in the Personal Program — are very helpful in redressing the underlying causes of vaginal dryness over time. Remember, your body can make adequate estrogen from secondary production sites despite the decline in production by your ovaries, provided it’s given adequate support.
Hydration is an easy remedy that’s often overlooked. The best way to moisten any of the mucous membranes in your body is from within, so drinking plenty of water daily needs to be a long-term consistent habit.
If these measures don’t redress the atrophy of vaginal tissue, there are also many prescription estrogen products that can be applied vaginally. Compounding pharmacies make the most natural ones such as low-dose estriol vaginal cream. Vaginal application of these low-dose estrogens does not appear to carry the health risks of synthetic HRT that is taken orally.
The role of testosterone in women’s sexuality
Testosterone is one key player in your sex drive: it affects interest, arousal, sexual response, lubrication and orgasm. And many women in perimenopause don’t have enough testosterone.
Before menopause, our testosterone comes primarily from our ovaries, both directly and indirectly via their production of progesterone, which serves as a building block for many hormones, testosterone among them. DHEA, a hormone produced from progesterone in the adrenal glands, also partly converts into testosterone (as well as estrogen). If our adrenals are healthy as we approach menopause, they’ll smoothly take over more of the sex hormone production from our ovaries. If we’re under too much stress, though, the adrenals work overtime, favoring cortisol instead of DHEA production. This can lead to low testosterone levels and resultant low libido, among many other health problems. Moreover, all hormones have their beginning as cholesterol — another problem for women who adhere to fat-free diets.
Some women maintain good levels of testosterone throughout perimenopause and menopause, and have no complaints. Their bodies probably compensate better by making testosterone from the pathways of other steroidal hormones, through more balanced adrenal function, and a healthy metabolism supported by good nutrition.
After a total hysterectomy (i.e., uterus and ovaries both removed), women may have very low or nearly undetectable levels of testosterone. Even women who keep their ovaries may suffer this outcome post-hysterectomy, as the surgery compromises ovarian circulation in over half the cases. Since nearly one in four women enter menopause as a result of surgery or medical treatment that causes their ovaries to lose normal function, this creates sexual issues for millions of women.
Should you take prescription testosterone?
Some women jump on prescription testosterone in the hope of seeing fast improvement in their sex drive and sexual response. In our experience — based on well over 100,000 patients in the last 25 years — this reflexive reliance on prescription drugs is a mistake.
The reason is simple. The lack of testosterone isn’t the problem — it’s merely a symptom of the problem. This is especially true when emotional factors such as relationship issues are involved. That’s why we prefer you start with the most natural, least-invasive approach, then add appropriate additional methods as necessary.
A natural approach such as our Personal Program helps balance your hormones through a combination of methods: nutritional supplements, gentle endocrine support, a healthy dietary plan, and lifestyle changes. (Click on this link to learn more about the Personal Program)
Gentle endocrine support is especially helpful because it’s a building block — your body converts it into the derivative hormones it needs, as it needs them, whether that’s cortisol, estrogen, or testosterone. Improvement may be relatively quick or take a month or more, but it will be long-lasting.
If your symptoms don’t respond to the Personal Program, you should have your hormone levels tested before going on prescription testosterone. We often find that hormone levels are normal, which indicates other factors are the issue, not a lack of testosterone. But if you are found to need testosterone supplementation, you will benefit from it quickly.
Remember — change can be good!
Your sexuality is meant to change in perimenopause and menopause. It’s natural to experience a period of change, followed by a new course. In the period of change your desire may diminish or disappear — but it can and will come back. We hear it from our 60–something patients all the time!
We encourage you to welcome these changes and make the most of them. Rediscover your body. Schedule a night to take a long bath. Watch a movie with your favorite sexy star. Make a date with your partner to explore new ways to have sex. You both might find a sex book or movie helpful. If you feel a little shy about this, put the book under their pillow with a note. If you’re not, perhaps you might check out an upscale sex shop together. And laugh!
As you embrace these changes, trust your intuition to reveal what’s best for you. Your sexuality is an expression of your life force, with great influence on your health and well-being. It’s up to you to choose the sexuality you want at this turning point in your life.
Frequently Asked Questions
Question: I have no interest in having sex; how soon will the supplements help me?
Answer: Every woman is different and the time it takes to notice a change will vary. Many women notice significant improvement in hot flash reduction, mood stabilization, and vaginal tissue improvements before feeling an enhanced sex drive. Some women feel a difference in their overall vitality for life and sex drive within just weeks. The bottom line is that you need to start somewhere, and supporting your nutritional and emotional health is a critical foundation.
Question: I have no ovaries since my surgery and no testosterone according to my doctor, so I am going to use a prescription testosterone product. Can I still use the Essential Nutrients in the Personal Program?
Answer: The dietary and nutritional support from the Personal Program is universally helpful. Women who take supplemental hormones still greatly benefit from all the support the Program offers. The Essential Nutrients also support healthier metabolism of the hormones so they are removed from the body as appropriate.
Question: I have read so much about the female orgasm, but I don’t think I’ve ever had one. Is that normal?
Answer: If you’re not sure, then you probably have not. Many woman and men are under the misconception that vaginal penetration alone will lead to orgasm. As we wrote earlier, there are many phases and prerequisites to the female sex drive. Every woman’s erogenous geography is unique to her. The phases of the sexual response are desire, arousal, plateau, orgasm, and refractory period. Re-arousal is possible and many women are multi-orgasmic. Stress, fear of pain, or other factors can inhibit a woman at any of these phases, when the brain focuses on other things instead of total relaxation. There are many books to start you on your journey of finding your orgasm, and sex therapists available to guide you as well.
Question: How can I help my partner understand why I don’t feel like having sex? The pressure is making me so uncomfortable.
Answer: Open communication is so important in a relationship, and this is especially true during this confusing time. You know you love your partner but have absolutely no feelings of sexual desire toward him or her. It feels as though that wonderful part of you has died. Don’t let your partner wonder and speculate about why the relationship with you has become one without intimacy and passion. Be open and share what you have learned about changing hormones and the feelings that seem beyond your control. Help your partner be part of the solution by asking for patience and encouragement while you work toward becoming healthy and balanced again. Be sure to show your love in other ways that have been meaningful to both of you in the past. Remind your partner that you need time and space to feel warm and comfortable without the pressure for sex. Facing this issue with openness and respect for each other will foster a mutual understanding and bring you closer.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.
Related to this article:
References & further reading on low sex drive
Original Publication Date: 11/30/2003
Last Modified: 08/17/2009
Principal Authors: Marcy Holmes, NP, Certified Menopause Clinician
& Dixie Mills, MD, FACS