HOW A WOMAN
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.
HOW SEX DRIVE WORKSThe 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.
So, if a woman comes in complaining of no sex drive, we'll try estrogen replacement first if she's a good candidate for it.
If this fails to produce the desired results, testosterone replacement is an option. There's even an estrogen/testosterone combination pill, but many of the other forms of testosterone currently available are made for men. And unless your partner finds chest hair and a receding hairline attractive, these high levels are not appropriate for women.
Despite this, many doctors use these preparations in much lower doses to better attain a normal female testosterone level.
There's also a testosterone patch in the pipeline specifically intended for women, but it's not yet available.
For women who have had their ovaries removed surgically, the same combination of estrogen and testosterone may bring back some of the pre-surgery desire, but both may need to be started at a younger age depending on when the ovaries are removed.
A lack of testosterone can diminish a woman's sense of well-being and energy levels in addition to her sex drive. Testosterone replacement can help, and it's believed to improve bone density as well.
As with most medical treatments, however, this one is not without its potential downside.
LIMITS OF TREATMENTTestosterone can cause the "bad" LDL cholesterol level to increase and the "good" HDL level to decrease, potentially affecting cardiovascular health. This can be monitored, however, and in women with good baseline cholesterol levels, it should not be the sole reason to avoid this hormone.
Excessively high levels of testosterone can also lead to abnormal, male-pattern hair growth (on the face and body) and hair loss (on the head, underarms and pubic region), as well as acne. So it's very important to keep the dosage at a level that will produce a normal female concentration of the hormone.
Unfortunately, we do not have a huge number of choices to combat low female libido. However, for some women, testosterone does offer some relief from this very common and often frustrating problem.
Dr. Arlene Lewis welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail at|
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. |