For many women, menopause is like The Invasion of the Body Snatchers: The body you've inhabited all these years is mysteriously replaced with one that overheats countless times a day. Your new body also refuses to go to sleep at night. And just when you think you can't bear being scalded and exhausted all day long, you notice something else: You're not feeling so sexy anymore. Just what is the nature of this invasion, and what can we do about it?

It's all about hormones, not alien invaders. A decline in certain hormones can take the blame for the changes in women's bodies during menopause.

The hormones in charge of women's sexual characteristics and reproduction include estrone, estradiol, and estriol -- collectively known as estrogen. Although estrogen production doesn't stop completely, women produce less estrogen as they age. Lower levels of estrogen result in a thinning of the vaginal walls and less lubrication during sex. In fact, in a study of 438 Australian women, about half reported problems with vaginal dryness three years after menopause. This can understandably make sex uncomfortable, if not downright painful.

Low estrogen levels could also play a role in the lack of desire or inability to achieve orgasm that some women experience with menopause. According to Dr. Mindy Goldman, an obstetrician/gynecologist at the Women's Health Resource Center at the University of California at San Francisco, lack of desire could be a natural consequence of physical changes caused by lower estrogen levels. "For some women, thinning vaginal tissues and lack of lubrication mean that touching hurts, so that after awhile they're not going to want to have sex," says Goldman. But she says, "There are a host of other factors to consider as well."

Goldman says it's important to make sure a lackluster sex life isn't caused by a medical issue. For instance, conditions like arthritis can make some sexual positions painful, and the poor circulation and nerve problems that can accompany diabetes may make arousal difficult. Some medications -- especially antidepressants such as selective serotonin reuptake inhibitors (SSRIs) -- can make arousal and orgasm difficult, if not impossible. Some blood pressure, decongestant, and tranquilizer medications can also affect libido. "When you evaluate a woman for sexual problems, you have to look at the whole person," Goldman says.

Emotional issues can also play a huge role in how much women desire and enjoy sex. Relationship problems, self esteem issues, depression, and an unhealthy body image are just a few of the stumbling blocks that can get in the way of a satisfying sex life. In fact, researcher Dr. Rosemary Basson says that emotions have a stronger influence on a woman's arousal than blood flow to the genitals.

Does that mean sexual problems are all in your head? Not at all. It just means that a woman's sexual response is complex. So a single-bullet fix like a Viagra pill may be less likely to work for women.

Goldman advises consulting a doctor who will take into consideration your medical history, the medicines you take (both prescription and over-the-counter), and your emotional state. Though it may feel hard to talk to your doctor about something so personal, the reward can be worth it.

Anne*, 55, overcame her initial jitters and talked to her female endocrinologist about pain and a burning sensation she had been having during sex. "It's not the easiest conversation I've had, but she's a woman my own age and I've known her for a long time, so it wasn't too bad." And once they had a conversation about it, Anne was glad she'd brought it up. Her doctor prescribed a vaginal estrogen tablet, which made sex more comfortable. At first Anne was hesitant about using hormones, but her doctor took the time to sit down with her and go over the major studies, what the statistics really meant, and what her individual risk level was. After considering all the evidence, Anne and her doctor decided that, in her case, the benefit of the treatment outweighed any potential risk.

Now that the pain is resolved, Anne continues to work with her doctor to address other sexual problems she's having, such as difficulty with arousal and orgasm. Anne frequently does her own research and then asks her doctor about remedies she's found. Taking that first step was hard, but now she feels like she has an ally in her search for answers.

If your sex life loses its sizzle during or after menopause, the first thing to ask yourself is how much it matters to you. Some women may not think it's a big deal if their sex life slows down. Psychologist Leonore Tiefer, who has written extensively about female sexuality, says that American women may feel cultural pressure to live up to sexual standards that are unreasonable. "'I have to have a strong sexual desire' may soon be part of our culture, just like 'I have to be thin,'" writes Tiefer in the book Our Bodies, Ourselves.

She also says there is a tendency to look at sexuality in terms of some kind of normal standard of function -- like orgasm -- that doesn't take individual expression and preferences into account. How -- or even whether -- a woman chooses to express herself sexually is highly personal. Or as Tiefer wrote in an article for Nerve magazine, "The fact we are all capable of the thing called orgasm no more dictates that orgasm should be mandatory than the fact that we are all capable of playing the flute should dictate flutes in every home and mandatory participation in flute concerts every Saturday night."

But if sex is an important part of your life and it seems to be losing some oomph, here are some steps you can take that may give it a boost.

Talk to your doctor. It's important to rule out conditions (such as heart disease, diabetes, and high blood pressure) that may be getting in the way of a satisfying sex life. If you do have a chronic condition, getting the right treatment can make a big difference. Your doctor can also review the medications -- both prescription and over-the-counter -- you're taking to see if they could be making arousal or orgasm more difficult.

Get regular exercise. Not only does it help reduce the risk of diabetes and heart disease, but it can improve your sense of well-being, which just might put you in the mood for a little romance. Exercises that strengthen the pelvic floor can also make sex feel better.

Pay a visit to your local drugstore. Vaginal lubricants such as Astroglide and K-Y Jelly are available over the counter and can make intercourse more comfortable. You can also find the supplement DHEA (dehydroepiandrosterone) in the vitamin and supplement aisle at your drugstore. Says Goldman, "DHEA is a precursor to testosterone in the body, and 25 or 50 mg a day may help some women who are experiencing low sexual desire."

Goldman cautions that there are few evidence-based studies showing that the supplement works, and like other supplements, DHEA is not regulated by the government, so there are no standards of purity or production. Study results have conflicted on DHEA and its use in menopause, and no studies on the long-term effects have been conducted. So, as with any supplement, you should check with your doctor before using it.

Let your partner know how you feel. You may have enjoyed a rich, satisfying sex life with your partner for years, but if sex is becoming uncomfortable or feels more like work than fun, you need to talk about it. Rather than make things more difficult, you'll likely find that being honest about how you're feeling can bring you closer. You might try mixing it up a little, too. Give each other sensual massages, or take a shower together. If personal issues are getting in the way, you might consider seeing a therapist, either individually or together.

Practice, practice, practice. Though it may seem counterintuitive to have more sex when you're feeling uptight and worried about how your body will respond, you'll be doing yourself a favor if you allow yourself to relax and just do it. Studies have shown that women don't have to have desire before sex to enjoy it -- they can become aroused once the party gets started. Not only will you benefit from the emotional closeness with your partner during sex, sexual arousal increases blood flow to your genitals and helps maintain sensation and response. And if you don't have a partner, be your own partner. You might find that the more sex you have, the more you want.

Have reasonable expectations and a little patience. Ok, you're not in your 20s anymore, and you may not be able to recapture the rush of sexual excitement you had in your youth, but that doesn't mean you can't enjoy sex. It can take some time to find the right remedy, whether it's taking a massage class with your partner, or working with your doctor to find the right balance of hormone therapy to rekindle that flame. Only you can decide how important it is to you. "The question I'm mulling over," says Anne, "is how much effort I want to put into this."

Goldman would advise her not to give up just yet. She says research into women's sexual response is growing, and clinics that deal with sexual function are being created all over the country. "The whole field is changing," says Goldman. "There's a lot of hope for people out there. You don't have to feel like this is how you have to live for the rest of your life. Talk to your clinician, and if you're not satisfied, ask for a referral. You have options."

-- Nancy Montgomery is a senior editor at Consumer Health Interactive.

* Name has been changed.

References

First published September 29, 2008
Copyright © 2008 Consumer Health Interactive

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