How to Fire Up a Lackluster Libido

By Colleen McCleery, MD
Virtua Ob/Gyn and Bioidentical Hormone Replacement Therapy, Exuberan by Virtua

As a woman ages, so do her ovaries and the hormone-producing glands housed within them. Most women know that this decrease in estrogen is the chief culprit for menopause. What many DON’T know is that decreasing testosterone is what may have the greatest impact on the loss of interest in sex.

Here’s how your hormones may be working against your sex life.

Low T and orgasms: Aging ovaries slow down the manufacture of testosterone, just as they do estrogen or estradiol. Like men, women’s testosterone serves as a critical driver to libido. Unlike men, women’s testosterone impacts libido AND her ability to have an orgasm.  

Vaginal dryness: Low estrogen levels reduce natural lubricants in the vagina, which can make sex dry and painful.

Add to this the reality that women are choosing to become mothers later in life, and you’ve got a menopausal woman with low libido, painful intercourse and a set of 8-year-old twins hanging off her arms. And, women are hardwired to take care of their children’s needs first before those of their spouse. Add that into the mix, and it will feel like your sex life is doomed.

But it doesn’t have to be.

How to Keep an Active Sex Life

Women can maintain a satisfying sex life as long as they pursue a healthy lifestyle that allows them to feel good about their image; communicate with their partner about their bodies’ changes; and maintain a loving relationship.

I recommend over-the-counter lubricants to temporarily relieve vaginal dryness. But for a long-term medical solution, you have to address the root problem by replacing lost estradiol and/or testosterone.

And, there are a number of ways to do it:

• Creams and gels: These are good for estrogen delivery when vaginal dryness is an issue but they usually aren’t absorbed systemically enough to help with hot flashes, insomnia or night sweats.
• Pills: Available for estrogen replacement therapy, pills got a bad rap in the early 2000s when a Nurses’ Health Study found them to increase risk for breast cancer. Today, the medical field supports their short-term use if the patient is healthy overall.
• Patches: Again, this delivery mechanism is only available for estrogen, but I recommend using the patch over taking pills.
• Injections: Testosterone injections are given for testosterone replacement only, mainly in men. Woman have responded well to injections but controversy continues over whether they’re as beneficial as more traditional estrogen and progesterone therapies.
• Bioidentical hormone replacement therapy (BHRT): I believe BHRT to be the future of hormone replacement therapy – so strongly that I’ve dedicated my practice to it. An individualized amount of bioidentical hormones is delivered through a pellet placed under the skin. These hormones, derived from plant-based compounds identically matching human hormones, are released into the body as the body needs them to achieve a proper hormonal balance. As opposed to other therapies that use equine estrogen or synthetic testosterone, bioidentical refers to estrogen and testosterone that “looks” exactly like that of humans. Women feel great on this therapy – and report how terrific it is for their sex lives.

Updated December 28, 2018