Changes in Libido (Menopause-Related)
A decrease in sexual desire or interest (libido) is common during and after the menopausal transition. Contributing factors are complex and include hormonal changes (lower estrogen and testosterone), physical discomfort like vaginal dryness (GSM) making sex painful, fatigue, sleep disturbances, mood changes (depression/anxiety), medication side effects, relationship issues, body image concerns, and psychological factors. Addressing physical discomfort, optimizing overall health and well-being, and open communication with a partner are key steps. Various treatment options exist depending on the underlying causes.
Management Strategies
- Eros Clitoral Therapy Device (improves blood flow)
- Hormone Replacement Therapy (HRT) - systemic estrogen may help indirectly; testosterone therapy (off-label in many regions for women) may directly improve libido but requires careful consideration/monitoring
- Flibanserin (Addyi) - FDA approved for premenopausal HSDD
- Bremelanotide (Vyleesi) - FDA approved for premenopausal HSDD
- Open communication with partner
- Scheduling intimacy
- Focusing on sensuality/non-penetrative intimacy
- Stress management
- Regular exercise
- Adequate sleep
- Body image work
- Sex therapy or counseling (individual or couples)
- Treating GSM effectively (moisturizers, lubricants, local estrogen)
- Managing other health conditions
Impact
- Personal distress
- Relationship strain
- Reduced quality of life
Diagnostic Considerations
Based on self-report of distressing low desire. Rule out/address contributing medical, psychological, relationship factors. Assess hormone levels if considering testosterone.