Menopause and Sex Drive: More Than Just Hormones

Dr. Greg Banks shares helpful information on menopause and sex drive, and why factors other than hormones can affect one’s midlife experience. He shares this information in answer to the following question from a Family Savvy reader.

QUESTION: Dr. Banks, since I began nearing menopause, my sex drive has decreased somewhat. I’ve heard that hormones are the main reason for this and that I need to get my levels checked. Can you please advise?

Dr. Greg Banks, Birmingham, AL

Dr. Greg Banks, OB/GYN

Hormonal issues and complaints take up much of the day for a gynecologist. Everything from weight gain to low or no sex drive is often blamed exclusively on hormones.

Although hormones do play into these issues, there are other factors which surround the response to hormones and what their levels mean for our well being. Hormonal balance is extremely important, and many factors must come together to achieve this balance.

We should never underestimate the power of diet and exercise for hormonal balance and overall well being. Exercise increases endorphins and enkephalins in the central nervous system and can lead to increased satisfaction with one’s body image. Frankly, women who are happy with the way their bodies look tend to experience improved mental well being and an increased sex drive.

We should also give appropriate attention to the importance of the adrenal gland~another important player in hormonal balance. Fat converts adrenal hormones into a weak estrogen~estrone. Women who lose weight have less fat and therefore less estrogen. This is why women who lose a bit of weight during the menopause might experience more hot flashes. Whether being hot from the insulation of excess weight or experiencing hot flashes from too little fat, either scenario can lead to decreased desire for sex.

Adrenal “fatigue” is often seen in women over 35 who experience loss of DHEA (made by the adrenal gland). When someone is fatigued or has hormonal imbalance with decreased libido, I recommend checking for testosterone, DHEAS, and for menopausal hormones. If significant elevations or depressions occur in the DHEA levels, an Endocrinologist should be contacted. DHEA can be given in compounded form if supplementation is needed.

If testosterone is too low, some women may want to do little other than sleep in the bedroom. Testosterone cream is often useful in decreased libido if compounded at 2 to 3 mg per day. I like to check levels in one to two months following initiation to make sure the levels aren’t getting too high. Testosterone is best followed by levels especially when received in injection form or with pellets. If too high, this hormone can cause acne, hair growth in unwanted places, and voice changes.

It should be stressed, however, that testosterone alone cannot serve as a love potion. Women have an extremely complex sexuality that goes far beyond a single medication.

True hormonal balance is best achieved in how the patient feels rather than levels alone, especially when talking about estrogen and progesterone. In addition to all of these factors that I have mentioned,  I feel that women across the board should have adequate sleep, exercise, vitamin D, calcium and a multi-vitamin with folate. Again, the whole idea is balance.

The bottom line is that there are no quick fixes or magic potions. The key is understanding the different elements that come into play and working to achieve a healthy, balanced lifestyle. This will ultimately have a positive affect on libido as well.