Hormones & Libido
Why your sex drive may be taking a nosedive
By Karen Nelson

The body – it’s quite a complicated and ever-changing wonder. For women, especially, the hormonal changes they experience as they age can make them feel like their “normal” has suddenly flipped upside down. Their energy is zapped. Their physical condition isn’t what it used to be, and their mind can sink to new lows. Add all that together, and there isn’t much room (or interest) for an active sex life.  

“Nowadays it’s tough, because in a lot of what we see on TV, everyone always has this raging sex drive. If you’re not having sex three times a day there must be something wrong,” says Roberta Felsenstein, MD, co-founder of Advocare Premier OB/GYN of South Jersey. 

“But as we get older, it’s natural that our hormones change over time,” she says, noting that women will experience a decrease in estrogen as they enter the stages of perimenopause and meno-pause. For some women, that can begin at age 30. “We start to not need as much hormones in our system, and having lower estrogen can certainly decrease a woman’s sex drive.” 

Rachel Kramer, MD, of Virtua OB/GYN, adds that a lack of estrogen can cause changes to the body that can make sex painful.  

“With the loss of estrogen comes vaginal dryness. It doesn’t happen for everybody, but it certainly happens to a lot of women, which leads to painful intercourse – and who wants to have painful intercourse? So their libido then decreases,” she says.  

“If a woman is menopausal,” Kramer continues, “the vagina can look very pale, there’s less blood vessels. Think of it as a carpet: if you have a thick, plush carpet and there are cords underneath, you won’t feel them when you walk on it. But if the carpet is very thin – you feel the cords, and it hurts. Estrogen helps the tissues and gives it more blood supply, so there’s less pain and more lubrication. It can also help with increasing arousal and ability to reach orgasm.” 

Estrogen vaginal rings, pills and creams, or laser treatments that can increase collagen in the vaginal tissue, can all help, says Kramer. And even over-the-counter lubricants may provide some relief.  

But for women who have a serious hormone deficiency, balancing estrogen and testosterone can be key, says William Miller, DO, of Virapel, a bioidentical hormone replacement therapy practice. “Testosterone is the hormone that really increases libido,” he says. Plus, testosterone has other perks. 

“Testosterone not only increases libido, it can help you feel good. It increases your energy, which helps many women continue to work out, so they remain fit and may avoid gaining weight. That makes them feel better about themselves. If you don’t have a good self-image, no matter how much testosterone you take, your libido is not going to be good,” says Miller.  

Miller says he has treated women with a hormone deficiency who were as young as 40, and sometimes even in their 30s. 

“They’re still having good periods, their cycles are regular, they’re not having any estrogen-loss symptoms like hot flashes, insomnia or vaginal dryness, but they’re coming in saying they don’t have any libido,” he says. “When we get their labs back, we see that their testosterone level is significantly lower than what it should be at their age.” 

Women who are experiencing hormone fluctuations are also at risk for depression (think: postpartum depression in new mothers). Sometimes, they are prescribed antidepressants – which includes a class of drugs called selective serotonin reuptake inhibitors (also known as SSRIs) – that can lead to a lower libido.  

Popular SSRI antidepressants like Zoloft and Prozac work to treat depression by balancing serotonin, which is the chemical in our brains that influences mood, appetite, sleep and memory. When serotonin levels are high, you can feel happier, but such drugs are known to negatively impact libido. 

“Particularly, SSRIs don’t allow women to have an orgasm,” says Miller, “so they feel if they can’t have an orgasm, they don’t have a libido. 

While the exact role serotonin plays might not be entirely clear, doctors like Miller and Kramer say it likely plays a part. Plus, other prescriptions, like allergy or blood pressure medication, could also be affecting your libido. 

But Felsenstein encourages women to first take a look at their lifestyle to see if that may be playing a role in a lower libido. Increased responsibilities at work while also caring for children or an aging parent can bring on added stress, or your relationship may be hitting a low point where intimacy is no longer valued. Those external factors can play a role in decreased sexual desire.  

“Many times,” Felsenstein says, “I tell people to increase foreplay and set time aside during the week when you say, ‘Ok, this is the time we’re going to have relations.’ Sometimes just that anticipation – like if you have date night every Wednesday – can help increase libido.”   

May 2018
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