Menopause, libido and the limits of medicine

Date published: 5/20/2007

HOW A WOMAN experiences meno- pause--the time in life when her ovaries stop releasing eggs and her periods stop--depends a lot on her attitude.

For some women, it's a sad time due to the loss of childbearing ability and the prospect of uncomfortable side effects like hot flashes and night sweats.

For others, it represents freedom--from pregnancy fears and from the monthly period.

Unfortunately, at exactly the time when sexual relations can be enjoyed without pregnancy worries, the desire to engage becomes diminished. For some, this can seem like a very cruel joke.

Low libido (low sex drive) is a very common problem for premenopausal and menopausal women. Around the time of menopause, the ovarian hormones decrease considerably, leading to a decrease in libido--along with an increase in hot flashes, night sweats, irritability, fatigue and vaginal dryness.

Libido, for women, can be a very complicated thing involving emotional as well as physical issues. (At the risk of sounding sexist, women's sexual desire seems to be a bit more complicated than men's--thus the dearth of nice little pills like Cialis and Viagra for the girls.)

Although the remedies for women are not abundant, and what is available is not right for all women, there is often something that can be done.

The three ovarian hormones that we see decreasing over time are estrogen, progesterone and testosterone.

We know that testosterone plays a very important role in libido, and so does estrogen.

There is also another important substance to consider. It's called sex hormone binding globulin (SHBG). SHBG is a protein that carries the sex hormones around in the blood. High levels of estrogen cause more of it to be produced, and high levels of testosterone cause less of it.

The higher the level of SHBG, the more testosterone is bound to it, and the less there is freely available to produce a healthy libido.

Many menopausal women are on estrogen replacement therapy, and though this is great for the hot flashes and night sweats, it may cause the little bit of testosterone that's still around to be bound up with that party-pooper SHBG, leading to no or a low desire for sex.

But remember, women's sexual desire is complicated. For some, adequate levels of estrogen are all that's needed to bring the sexual desire back.

If a woman has her ovaries surgically removed, her hormone levels fall immediately. Over time, her estrogen levels end up being about equal to those of women who enter menopause naturally. It's different with testosterone. Women who have their ovaries removed have less testosterone than their ovary-possessing sisters. This is because the ovaries continue to produce some testosterone after menopause, albeit at a much lower level then when we were 20. This matters because hormones affect libido.

Date published: 5/20/2007