Menopause Sex Problems: Blame Hormones

Last Editorial Review: 1/31/2005

Some Women Need Estrogen Plus Testosterone

WebMD Feature

Reviewed By Charlotte Grayson

If you're over 50 and yawn about sex, it's not just your (dwindling) hormones talking.

"Libido is very complicated," says Lila E. Nachtigall, MD, a reproductive endocrinologist and director of the Women's Wellness program at New York University School of Medicine in New York City.

After all, not every menopausal woman loses interest in sex, she says. "In lectures, I often show a slide of two women chatting. One says, 'I was on hormone replacement for two years before I realized I needed Steve replacement.'"

Just as in the early years of your relationship, "chemistry" with your partner has much to do with sexual desire, Nachtigall tells WebMD. "You need to have good memories of sex," she says. "If sex was uncomfortable or a little painful the last few times, you're not going to want it."

She's talking about the "dry vagina" problem that plagues some women. "Even if your brain is responding, the nerves in your vagina can't respond. The female's lubrication is part of the male's turn-on. That's why it's so complicated. It gets down to needing those secretions. I think this is ignored time and again."

Estrogen therapy can help with that, she adds.

To punch up your libido -- especially if your ovaries have been removed -- you may need estrogen plus testosterone. While there are very few studies of women taking testosterone, one study of a testosterone patch is now in large human trials; the patch is for women already taking estrogen or estrogen-plus-progestin.

Also, one hormone therapy includes both estrogen and testosterone. And, researchers are looking into the benefits of drugs like Viagra for the treatment of some forms of sexual problems in women.

But a woman's overall life -- her career, family responsibilities, distress about hot flashes -- also play a role in sexual functioning, says Nancy Fugate Woods, PhD, dean of nursing and an epidemiologist at the University of Washington in Seattle.

"Is it lack of hormones or is it that her life is affecting her libido?" she asks.

And if she's married to someone her own age or older she may be simply responding to her partner's waning interest, which is quite normal in long-term relationships, Woods tells WebMD.

Other factors that may affect your sex life as you age:

But don't be shy. Talk to your healthcare provider about any sexual or intimacy concerns that you may be having.

Originially published Oct. 7, 2002
Reviewed by Charlotte E. Grayson, MD

©1996-2005 WebMD Inc. All rights reserved.

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