When approaching midlife and menopause, many women in midlife are trying to figure why and how their body is changing while coping with many demands. A loss of sex drive can be the last straw. Surveys have shown wanting to have sex and feeling sexual is basic to feeling feminine and youthful; while a loss of sex drive can be linked to depression and poor self image. Women tell me, “I avoid cuddling and going to bed because I don’t want to have sex!”. “What do I do?”
Loss of desire, lack of arousal, and difficulty achieving orgasm are not uncommon with approximately 40% of women experiencing one or more of these issues in their lifetime. Hypoactive sexual desire disorder (HSDD) is a real medical problem when not related to relationship or other medical conditions, is consistent, and causes distress. Women who experience this feel as if a brain switch gets flipped and the results are devastating. Thankfully more is being done to understand and treat sexual health disorders. Many women just want to want again.
Sexual desire problems can be associated with many issues including a stale relationship, a woman not feeling respected or safe, poor self image, pain associated with medical conditions such as “Genitourinary Syndrome of Menopause” i.e. vaginal dryness or lichen sclerosis, hormone changes associated with perimenopause or menopause, fatigue, chronic illness, and depression. Many women now survive cancer, but suffer long-term affects of early menopause from chemotherapy or radiation including vaginal dryness and severe pain with intercourse.
Sara (not her real name) was 52, and came in for her annual gynecologist visit. Her periods were very irregular, she was having predictable night sweats and hot flashes, and she was not sleeping well. Concentration was difficult, and she felt moody and intolerant of all around. She stopped working out, and ate carbs. On top of everything, her sex life had dwindled to once or twice a month, and having an orgasm was becoming work. While husband was trying to be supportive, he recently asked if she loved him. When she told me this, her tears started to flow, “How could he put that on me and I cannot believe he asked the question. Can’t he see how hard this is?”. She asked, “Can you fix this with hormones?”
My next step in the visit was to catalog her symptoms and lifestyle to start to clarify her life picture and be able to track changes. We reviewed her habits with a tool called SEEDS, or Seven Essential Elements of Daily Success. This list includes water, sleep, vitamins, food groups, exercise, fiber, and gratitude practice with metered breathing. As we drew the picture, she could start to see how her irregular cycle and symptoms affected her habits, and she could see hormone changes were only part of the picture.
After an assessment of her medical and obstetrical history, making sure to understand her risk factors for heart disease, stroke, blood clots, diabetes, and obesity, which she had none, Sara was able to take advantage of the option of a Mirena IUD for birth control as well as treatment of her heavy periods, and started a low dose estrogen patch for 3-6 days before her periods. This option was effective within 2 months, and her cyclical symptoms resolved. Sara started sleeping better which gave her energy for exercise. After she left our first visit, Sara resolved to get back to her healthy habits, tracked her SEEDS, and saw the value. At her follow up visit, she was relieved and elated at the newfound understanding of her body. She and her husband talked out the prior year, and he was able to see her love for him was not the question, but her feeling of loss of control, fatigue, and poor self image were to blame. They were both relieved and felt close again.
Loss of libido can be a valuable flash point for important conversations about health and relationships. Depending on the cause of sexual health concerns, there are many treatment options. Finally a drug has been approved for HSDD and many more are in the pipeline. Many healthcare providers are becoming aware and comfortable with the causes and treatment of sexual health problems. If an individual is not comfortable treating, a referral can be made to a provider trained by NAMS or ISSWSH. As a complex interaction of many factors, libido can be a vital sign of healthy aging. Many women before and after menopause are having good sex, it is possible!
Dr. Diana Bitner
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