What are some tips to help my libido during menopause?
In menopause, estrogen and testosterone levels plummet negatively affecting your sexual desire, vulva, vagina, bladder, and clitoris, making sexual activity challenging. Estrogen plays a key role in women’s sexual function, maintaining the genital tissue sensitivity, elasticity, secretions, pH balance and microbiome flora, urinary continence, pelvic muscle tone and joint mobility. When you enter menopause and lose estrogen and testosterone, physical and mental changes occur, some symptoms faster than others. Pain with vaginal penetration, trouble having orgasms and inadequate vaginal lubrication are some of the reasons women’s sexual desire is decreased.
Over 60% of women will report losing their libido and 30% will stop having sex all together. Women are being bombarded with physical and emotional symptoms that directly affect their mood in the bedroom. The truth is many women rather be doing laundry than having sex with their partner.
Menopause is brutal for the sexual wellness of the 50-60 million dealing with this normal hormonal cycle. Using vaginal estrogen, vaginal dilators, a great lube helps with some of these disruptive symptoms caused by menopause. Even though testosterone is not FDA approved, it can help with sexual desire and arousal for some women. One of the FDA approved medications, Addyi, can also be used to help increase sexual desire for peri-menopausal and menopausal women.
Since there is less blood flow to the vulva and clitoris. Orgasms can take longer to happen and may not feel as intense. Keeping the vulva and vagina moisturized is a step in the right direction. There is some truth to “if you don’t use it, you’ll lose it”. The more stimulation the vagina gets the more natural lubrication will occur which is helpful to maintaining a healthy vagina. A vibrator is also a great way to improve sexual function, satisfaction, sexually related distress and genital sensation…it’s a win-win in my opinion!
Give your vagina a voice so you can continue to have a healthy sexual relationship with yourself or a partner during perimenopause and menopause.
What is Hypoactive Sexual Disorder?
Hypoactive sexual disorder, the most common female sexual dysfunction, is characterized by a complete absence of sexual desire. For the sixteen million women who suffer from this disorder, the factors involved may vary since sexual desire in women is much more complicated than it is for men. Unlike men, women’s sexual desire, excitement, and energy tend to begin in that great organ above the shoulders, rather than the one below the waist. The daily stresses of work, money, children, relationships, and diminished energy are common issues contributing to low libido in women. Other causes may be depression, anxiety, lack of privacy, medication side effects, medical conditions such as endometriosis or arthritis, menopausal symptoms such as a dry vagina, or a history of physical or sexual abuse. It’s not a myth after all that women are more complicated than men.
What are some of your recommendations for addressing a loss of libido?
The medical community and female patients have a difficult time bringing up problems related to sex and what common concerns they are experiencing. 40% of women never share this information with their health care provider.
Communication with you partner is so important. Your partner has to be involved during perimenopause and menopause to understand the hormonal reasons your libido is negatively affected. It can be difficult and challenging to talk about sensitive sexual issues but it is so important in dealing with how a low libido which can interfere with normal intimacy. The more your partner is informed about why you are experiencing a low libido, the easier it will be for he/she to be supportive and helpful in finding treatment options concerns leading to a healthy sex life. The most healthy and natural method to improve a women’s sex drive is having a close connection, emotionally, mentally and physically, with your partner. Having good communication with your partner is the best foreplay a woman could ask for.
Psychotherapy is also recommended to help a woman and their partner overcome some of the emotional struggles associated with a low libido.
In order for women to be heard, doctors also need to help guide and ease them into talking about this sensitive issue and it’s just not happening. The medical system is failing women with sexual dysfunction.
How can Testosterone help with my libido?
Testosterone works in the brain to improve sexual arousal, improve vaginal lubrication and increase blood flow to the clitoris, vulva, labia and vagina.
Testosterone can be used safely to treat fatigue during menopause. This sex hormone produced by women has often been overlooked in treating fatigue, low libido, changes in cognition, vasomotor symptoms, bone loss and decreased muscle strength. Testosterone can be prescribed with hormone therapy to help with all the disruptive symptoms of menopause including fatigue. Adding Testosterone to hormone therapy can improve fatigue, sexual functioning and general wellbeing for women in menopause.
Tell me more about Testosterone
Testosterone matters for women, especially in perimenopause and menopause when levels naturally fall. It affects libido, energy, mood, bone and muscle strength, pelvic‑floor health, and even cognition. In our 20s and 30s we produce a lot of testosterone—often more than estrogen—and production slowly declines about 1–2% a year starting around age 30, with a steeper drop after surgical removal of the ovaries. Because testosterone receptors are found throughout the body, that decline can show up as low sex drive, weaker orgasms, vaginal dryness, fatigue, loss of strength, thinning hair, dry skin, or depression.
Standard HT with estrogen and progesterone helps many menopause symptoms, and more women and clinicians are now considering testosterone supplementation as another tool to restore vitality. Testosterone is a Schedule III controlled substance, so it’s prescribed in limited amounts and needs regular follow‑up. If you’re curious whether testosterone might help you, talk with a menopause specialist who can review your symptoms, risks, and treatment options.
Isn’t Testosterone a male hormone and prescribed for men only?
Women produce testosterone as well — and in your 20s and 30s women make three to four times more of it than estrogen. Testosterone decline with age. This hormone quietly supports my libido, muscles and bones, pelvic‑floor health, energy, thinking, and many other parts of how you feel and function.
I am worried about the side effects of growing a beard, bulking up and having a deeper voice.
These side effects are uncommon when testosterone is kept within a normal physiological range and generally occur only with doses that are too high. The more common side effects include acne, more oily skin, , and hair growth at the site of application.
Isn’t Testosterone only to help my libido?
The most proven benefit of testosterone in women is improvement in libido, but newer research shows that it may also help maintain muscle mass and bone density, improve cognitive abilities, and increase energy levels.
Won’t Testosterone make me more aggressive?
It’s true that higher doses of Testosterone can lead to aggression but the dose recommended for women will not increase aggression or rage. Women take 1/10 of the Testosterone dosing prescribed for men. It’s important to find healthcare providers who are experienced and comfortable treating libido with Testosterone.
Is Testosterone FDA approved for women?
Testosterone is not FDA approved for women who have a low libido…not yet anyway! There are more medical studies to be done but there is adequate date to support using Testosterone to improve libido in women. The Menopause Society sited a large study from 2019 looking at 8,500 postmenopausal women and found that testosterone “significantly increased sexual function” which included sexual desire and pleasure, arousal and orgasm. Perimenopausal women are also able to use Testosterone with improvement in sexual functioning.
Does health insurance cover Testosterone for women with low libido?
Since Testosterone is not FDA approved and considered “off-label”, insurance companies do not cover this prescription for low libido. Typically, you can find it for as low as $59/month. You can get it prescribed through a telehealth visit at Quickmd. com
How is Testosterone prescribed for women?
Women use 1/10 of the dosing that is given to me. Testosterone supplementation is prescribed as a cream or gel, used daily on the upper thigh, back of calf, buttock or behind the knee. I like to instruct women to apply it to the back of the knee since there are no hair follicles there so there will not be any hair growth at the site of application The most common side effects include more oily skin, acne, facial hair, hair loss, and hair growth at the site of application.
Other forms of Testosterone include infections, pellets and troches. Once you are given Testosterone (ranging from 1-6mg), your Total Testosterone blood level needs to be check to make sure it is not high, 6 to 8 weeks, starting therapy. Blood tests do not reflect dosing of Testosterone but making sure Total Testosterone levels are not high is recommended.
If you have normal Total Testosterone levels and are not seeing an improvement in your libido, your dose is increased, to find the right dosing. Most women will notice a benefit within the first 3-4 months of initiating therapy.
Who cannot take Testosterone?
You cannot take Testosterone if you have liver, heart disease, high cholesterol, pregnancy, breastfeeding, or a history or hormone sensitive breast or uterine cancer.
Doesn’t a blood test tell me about my Testosterone status?
Serum Testosterone levels do not correlate with the presence or absence of Hypoactive sexual desire disorder (HSDD) or it’s severity. But there is a correlation between testosterone levels during therapy and improvement is sexual desire.
What about the “pink pill” for low libido?
Foreplay begins in our greatest erogenous zone that sits on our shoulders. Addyi, a non-hormonal medication, is the first and only FDA-approved pill, for perimenopausal and menopausal women in women <65yr. It works at the core of where Hypoactive sexual desire disorder (HSDD) begins…in the brain. Medical studies show there are areas in the brain that control women’s sexual response for those suffering from HSDD.
Addyi is thought to work on neurotransmitters in the brain including serotonin, dopamine and norepinephrine, which are all thought to be involved with sexual desire. The “pink” pill for women encourages the chemicals in the brain to get excited about sex and inhibits those that have a negative effect on the desire to have sex.
You take one pill at bedtime. Side effects include dizziness, sleepiness, nausea, fatigue and low blood pressure. Rare but serious risks include severe hypotension and fainting, especially when combined with alcohol or certain medications. You are not meant to drink alcohol while taking Addyi nor is it recommended if you are pregnant, breastfeeding or have liver disease.
It is not typically covered by your health insurance which makes it tricky to get prescribed by your healthcare providers. I would suggest speaking with your health care provider if interested in exploring this “pink pill” alternative for low libido in women.
What’s can be done with the debilitating vaginal dryness of menopause?
Genitourinary syndrome of menopause (GSM) is the newer term that describes vaginal dryness, burning and irritation and sexual symptoms including lack of lubrication, discomfort or pain with sexual intercourse and urinary symptoms including urgency, pain and frequency with urination. Only 25% of women with GSM talk about their symptoms with their healthcare provider. 33% of women don’t discuss GSM at all. Skin dryness involving any part of your body is uncomfortable and annoying, especially when it comes to the sensitive skin of the vagina. Persistent vaginal dryness causes itching, burning and pain can create emotional and physical disruptions in your daily life activities.
GSM also impacts the bladder causing urinary urgency, frequency and urinary tract infections…sometime even recurrent infections. Vaginal estrogen will prevent these symptoms.
GSM does not have to ruin a sexual relationship with your partner if you start using vaginal estrogen or vaginal hyaluronic acid regularly. Keeping the vulva and vagina hydrated and moisturized with products designed specifically for this sensitize pH balance area must be a priority. I have always said that women need to treat their vulva and vagina like their face, using specially designed products to clean, hydrate and moisturize these delicate areas every day.
Vaginal dryness and painful sex, what’s the connection?
Hormonal changes over the decades influence the integrity and elasticity of the vagina. Vaginal dryness is a common consequence of the hormonal collateral damage to the vagina. Estrogen fluctuations during perimenopause and menopause, can cause vaginal dryness. As you age and lose subcutaneous fat in your body, the fat in the vagina also decreases, making the lips look thinner and the tissue more prone to dryness.
In perimenopause and menopause there is the loss of estrogen nourishing and hydrating the vagina, the tissue becomes dry, pale and dehydrated. The labia of the vagina can become fused and the vagina and clitoris shrink. The labia become less full, losing its fatty pads and the skin loses its collagen. The result is lighter or darker appearing labia that sag. The medical term for this is vulva-vaginal atrophy and genitourinary syndrome of menopause (GSM).
Keeping the skin clean, hydrated, and moisturized will help prevent dryness externally on the vulva. Other helpful daily hygiene rituals include using a gentle, non-fragranced soap and natural skin moisturizer daily especially ones made specifically for the vulva. Taking a 20-minute warm bath with a handful of extra virgin coconut oil 3 to 4 times a week will also rehydrate the skin of the vulva. Adding oral or vaginal pro-biotics to your daily regimen will also keep the vagina hydrated, balanced and in harmony.
Using vaginal hyaluronic acid every 3 nights will help moisturize the vagina.
Sexual lubricants, moisturizing gels and extra virgin coconut oil are great additions to intimacy. Dryness can also occur in menopausal women who are not taking estrogen which results in a burning sensation inside the vagina, especially with sexual contact and penetration.
Ideally all vagina’s over 50yr should be given prescription vaginal estrogen or DHEA to prevent GSM from interfering with your sexual and bladder functioning. Discussing prescription options with your healthcare provider to get started on medications that will prevent GSM from creating chao in your everyday life. If it’s predictable, it’s preventable!
What can be done for vaginal dryness during menopause?
Vaginal dryness is a common and disruptive symptom of menopause. It’s a hallmark sign of genitourinary syndrome of menopause (GSM), formally known as atrophic vaginitis. The tissue of the vagina becomes thin, dry, irritated and tears easily with vaginal penetration with the loss of estrogen. You will also develop symptoms of bladder frequency, urgency and urinary tract infections.
It’s important to remember to moisturize the vulva and vagina in the same way your take care of your face. Ideally, you want to start moisturizing your vulva and vagina at an earlier age.
Helpful remedies for vaginal dryness and painful intercourse caused by GSM include vaginal estrogen, which is the most effective treatment for GSM. Non-hormonal prescription Ospermifene (Osphena), DHEA suppositories and laser therapy are also treatment options. Other over the counter vaginal moisturizers, hyaluronic acid, and lubricants can be effective if you are looking for more natural remedies but vaginal estrogen or DHEA will prevent GSM from taking control of your vagina and bladder.
The old adage, “if you don’t use it, you’ll lose it” can apply to GSM.
Regular sexual activity and vaginal stimulation — with or without a partner —helps maintains healthy vaginal tissues in women after menopause.
What else can I use to treat a low libido?
Menopausal women may benefit from vaginal estrogen, vaginal DHEA or Osphena, an FDA-approved, non-hormonal oral treatment for painful intercourse, Testosterone and Addyi. The Morpheus laser is an exciting new treatment for vaginal dryness caused by menopause that restores the collagen, elastin, and blood flow of the vagina.
Women simply want the same attention in sexual health and responsiveness from the medical community as men have had. With that in mind, the FDA is finally showing support for the challenges faced in female sexual health. Whether you choose a medical alternative, a little self-love in the afternoon, or a romantic weekend without electronics or distractions, the choice should be yours.
I am the only person over 50year finding it hard to orgasm?
During menopause there is less blood flow to the vulva and clitoris. Orgasms can take longer to happen and may not feel as intense. Keeping the vulva and vagina moisturized is a step in the right direction. There is some truth to “if you don’t use it, you’ll lose it”. The more stimulation the vagina gets the more natural lubrication will occur which is helpful to maintaining a healthy vagina. A vibrator is a great way to improve sexual function, satisfaction, sexually related distress, and genital sensation…it’s a win-win in my opinion!
What about vibrators to help improve libido?
Several devices can help menopausal women with sexual difficulties, either on their own or alongside sex therapy and topical or systemic treatments. Vibrators and dildos, for example, can boost genital blood flow, assist with arousal and orgasm issues, and help you explore your sexual response. They’re also useful for communicating preferences to a partner. These tools are widely available without a prescription, affordable, and can be used solo or with a partner to enhance pleasure or add variety to a routine sex life; working with a sex therapist can make their use even more effective.
Aren’t vibrators for sex fiends?
The vibrator was not originally intended to be a sex toy. Vibration therapy was originally used to treat sexual problems for women and men. In the late 1800’s, vibration therapy was used to treat erectile and ejaculation dysfunction, low desire and inability to have an orgasm. You may be surprised to learn that up to 20% of women have never had an orgasm. Vibrations delivered to the vulva, vagina, testicles, scrotum, perineum and anus significantly and positively improves sexual desire, sexual arousal and orgasm. Vibration increases blood flow and stimulates the complex nerve fiber pathways-superficially on the skin and deeper in the erectile tissue.
Clitoral and erectile tissue sensation fades as women grow older due to less blood flow to sensitive and fragile genital tissue. As a result, it can take longer to become aroused, along with longer stimulation and the need for lubrication, to have an orgasm. This is where vibrators can help. They can provide the needed stimulation in order for you to orgasm.
Vibrators have long been a taboo and the best kept secret. Vibrators are not typically regarded as a medical device by mainstream society but can be classified by the FDA as therapeutic devices to treat sexual dysfunction/sexual problems—because vibrators have been shown to provide sexual health benefits for people!!…The time is now to bring the vibrator out of the closet. Genital vibrator use is associated with increased openness in people’s thoughts and attitudes about sexual activities generally and about themselves as sexual beings
It’s time to embrace our sexuality and enjoy using whatever type of sex toy turns you on.
How can vaginal dilators help with my libido?
Vaginal dilators are smooth, rounded plastic or silicone rods sold in graduated sizes—from about ¾ inch up to roughly the diameter of an erect penis. They are used to gently stretch and relax the vaginal muscles over time to treat vaginal stenosis (narrowing) or vaginismus (involuntary tightening). By reducing pain, easing tension, and restoring comfort with penetration, dilator therapy can help rebuild confidence, reduce anxiety around sex, and, ultimately, improve sexual desire and satisfaction.
