Low libido and menopause: What you should know

It’s no secret that menopause — the end of menstruation in women — can bring many changes. But one of the most overlooked and under-discussed is menopause’s impact on sexual desire.

If you’re a woman approaching or going through menopause and you’ve noticed a drop in your libido, you’re not alone. More importantly, there are treatments available.

“Desire and libido involve more than hormones — they concern the whole person,” says Dr. Shereen Binno, a board-certified OBGYN affiliated with Sharp Mary Birch Hospital for Women & Newborns who is credentialed in menopause care by The Menopause Society™ and is the lead physician with the new Sharp Wellness and Menopause Care program. “Fortunately, these topics are now discussed openly, and research is emerging to support women alongside their health care teams.”

Understanding decreased sex drive

There are three common conditions related to decreased sexual desire. But because their names are often used interchangeably, they can be hard to understand:

• Female sexual dysfunction (FSD):

  This is a broad umbrella term for persistent problems with sexual desire, arousal, orgasm or pain that cause distress.

• Low libido:

  A reduced interest in sex, low libido may not require treatment unless it causes emotional or relational strain.

• Hypoactive sexual desire disorder (HSDD):

  This is a medical diagnosis for low libido that causes ongoing personal distress or difficulty in relationships, and cannot be explained by another condition, medication or life circumstance.

In short: Low libido is a symptom, HSDD is a diagnosis, and both fall under the broader category of FSD.

Female sexual dysfunction: Causes and concerns

Low libido and HSDD have many contributing factors, including:

• Hormonal shifts during menopause, causing a drop in estrogen and testosterone

• Genitourinary syndrome, occurring due to decreased estrogen, which causes vaginal dryness and pain

• Mental health concerns, such as anxiety or depression

• Medications, especially SSRIs and birth control

• Relationship stress, including emotional disconnect or sexual dissatisfaction

Low libido can be very common. So, it’s often hard to know when it is significant enough to see a doctor. This is especially relevant during menopause, when hormonal changes and related conditions may begin to affect desire.

Some indicators that it could be time for a consultation include when low libido:

• Persists for at least three months

• Affects most sexual experiences (75% or more)

• Causes emotional distress or interpersonal issues

• Cannot be explained by another medical, psychological or relational factor

Ways to treat hypoactive sexual desire disorder

Hypoactive sexual desire disorder is due to an imbalance in brain chemicals like serotonin, dopamine and norepinephrine. All three of these brain chemicals influence desire and reward. HSDD is more than just a lack of interest in sexual activities. It’s persistent, distressing and not due to another health issue or medication that may be exacerbating symptoms.

While there’s no one-size-fits-all solution to HSDD, many people benefit from education, counseling and therapy specific to sex and the emotional and relational dynamics. There are also FDA-approved medications for premenopausal women, including:

• Flibanserin (Addyi): A daily pill that works by adjusting serotonin and dopamine levels to help restore sexual desire.

• Bremelanotide (Vyleesi): An injection taken as needed to activate brain receptors involved in arousal. It is taken around 45 minutes before sexual activity.

Some providers may also use medications like bupropion (an antidepressant) or buspirone (an anti-anxiety medication) during perimenopause, menopause and post menopause, which may enhance libido.

Lastly, though not FDA-approved for women, testosterone therapy is sometimes used off-label for postmenopausal women with HSDD. It may improve sexual arousal, frequency of orgasm, overall satisfaction and reduced sexual distress. While long-term safety data is still being studied, current research suggests it is well-tolerated when taken as prescribed.

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