The Nu Guide: Navigating libido changes during menopause

One of the common themes that comes up in consultations is around libido. With menopause and midlife changes women may find themselves less willing to partake in sexual activity. There is no doubt that this is a complex issue with many facets that need to be addressed and 'hormonal' issues will usually only contribute to some of the story. In this Nu Guide we will try and unpick some of the contributing factors to loss of libido around menopause transition and what you can do to address this.

Firstly it is really important to point out that there is no such thing as a 'normal' libido. Your interest in sex, be it thoughts, desires or sexual activity will vary during your lifetime. Try not to benchmark expectation to what is perceived to be usual sexual activity either partnered or non-partnered. Only you know what is right for you.

Often in relationships, particularly around midlife, it is the discordance in sexual desire that causes conflict and friction in a relationship. In other words if a woman experiences a decline in libido and her partner does not. The reduction in desire is often not the primary concern, but the impact on intimate relationship usually is. 

There are many reasons why our sexual motivation changes in midlife and it’s not usually one factor but a combination of multiple small contributors that build up over time. It's important to look at these individual reasons to try and assess if there are any areas for you where changes can be made.

Midlife stress and fatigue contributors 

Midlife is undoubtedly a time of multiple pressures for many females. They may have important roles in the workplace and home as well as the demands of running a teenage curriculum. Ageing parents and personal health concerns compete for any spare time leaving the proverbial 'cup' empty of anything to give to your partner at the end of the day. You may have been in the same relationship for a number of years and the initial spark of your romance seems like a distant memory.

Changes related to hormonal shifts

Whole body changes which could include interrupted sleep, mood changes, weight gain, fatigue. The changing hormone profile in menopause can cause many shifts in our body systems. In perimenopause there may be huge swings in mood, prolonged or heavy menstrual bleeding, luteal phase headaches or fatigue - none of which will help our feelings of sexuality. As we journey through menopause, transition night sweats, insomnia and interrupted sleep or hot flushes and musculoskeletal symptoms may further affect our ability to engage in intimacy.

Local changes - GSM changes affecting sexual function

Women are affected by genito urinary symptoms at varying degrees during menopause. Some develop genital symptoms of dryness and discomfort as soon as periods begin to change. For others it will be five to six years after their last period. Many women have not ever heard of GSM. This three letter acronym stands for genito urinary syndrome of menopause. This describes the global changes in the bladder, vagina and external vulval tissues with falling estrogen levels.

The consequences of vaginal dryness, reduced blood flow to the area, changing anatomy and loss of elasticity can radically change the way our body responds to intimate contact.

It may take longer to become aroused and sexual touch may be uncomfortable particularly any form of penetration. 

What to do about it

If you are reading this article and the above resonates, it may be time to take stock of where things are at in your intimate relationship. Is there a disconnect? Would you like more or less intimacy? What does that look like? Try and make some time to have a conversation with your partner and establish mutual goals. If this sounds like it might be tricky then consider the option of engaging a third party negotiator! Sex Therapy New Zealand is run by trained professionals including clinical psychologists to help you navigate these discussions. Particularly if there are health issues impacting on function, it can be really helpful to have some assistance to review the changing landscape in your relationship.

Lubricants

Choosing the right lubricant is a vital part of your sexual wellness. Many women will benefit from additional lubrication whether they experience vaginal dryness or not. The common water based lubricants that are available can actually draw moisture out of the tissues, changing the pH and bacterial microbiome leading to issues such as thrush or bacterial vaginosis. An oil-based lubricant such as Nu Balm is much kinder on tissues of the vulva and vagina and can be used for both 'outercourse' and 'intercourse'. In other words it can be used on the clitoral and labial region externally or on the penis and vagina for penetrative sexual activity. 

It is always important to patch test any product that you are going to be using on the sensitive genital area. We suggest applying a small amount to the inner aspect of your forearm first. Oil-based products such as Nu Balm will degrade latex and therefore shouldn't be used in conjunction with condoms.

Pelvic floor

Among the many delights of menopause are the significant effects it can have on our pelvic health affecting the muscles, fascia and tendons that provide support to our pelvic organs. We often think of pelvic floor muscles strengthening being the priority to prevent age-related weakening. However, sometimes the hormonal changes actually make the muscles stiffer and less elastic. There are changes to the actin/myosin cross bridges in the muscle meaning the speed that we can activate muscles may change. This means that women may need to ‘down train’ their pelvic floor muscles initially to learn how to relax and release stiff muscles before working on a strength programme.

Pelvic health is like a bank account. Throughout life we should be investing in pelvic health by making small deposits ensuring that the muscles remain strong and functional. A good pelvic physiotherapist can assist you to work out the right type of programme for your rather than a one size fits all 'kegels' style approach.

Medical treatments

If you are suffering from menopausal symptoms, either 'whole body' issues such as night sweats and insomnia or 'localised' effects of GSM you may benefit from a discussion with your health provider about options for hormonal treatments. Transdermal or 'patch' estrogen may be an option for you but needs to be assessed on an individual basis. Low dose vaginal estrogen can be used by the vast majority of women, even those who have had treatment for breast cancer. 

Testosterone is an important female hormone (we have three times as much testosterone as estrogen in our pre-menopausal years). However, along with other hormones, levels fall after menopause and this can have a significant impact on our level of interest in sex and the amount of pleasure you feel from it. Testosterone replacement can be prescribed as a topical cream usually alongside standard hormone replacement. It is safe to use with no adverse side effects providing testosterone levels are monitored.

Conclusion

It is essential to remember that our bodies continue to adapt and change throughout our lives and you are not alone in facing these challenges! If you can take some positive steps to navigate this journey there is no reason why sex should be off the table in the menopausal years and many women find it's even better than before! Please remember that sex should NOT be painful and should always be consensual. Seeking support from empathic healthcare professionals, exploring new avenues of intimacy as well as maintaining open communication with your partner can all contribute to a fulfilling and vibrant sex life. There are many health benefits to both engaging in sexual activity and experiencing orgasm. If we flip the narrative and start to see sexual wellbeing through the wider lens of healthy ageing and longevity, it may help to reframe it as a priority activity if your enthusiasm has been lagging in sexual activity and experiencing orgasm.