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Menopause can lead to symptoms that can impact sexual desire and satisfaction, including vaginal dryness and decreased libido.
Menopause can also cause the walls of the vagina to become thin and dry, a medical condition known as genitourinary syndrome of menopause, or GSM. GSM is caused by a decrease in sex hormones and a change in the vaginal pH (acidity). GSM symptoms include vaginal dryness, shrinking of tissues, and itching and burning, which can make intercourse painful. GSM affects up to half of post-menopausal women, and can contribute to bladder and urinary tract infections as well as incontinence. Experts may use one or a combination of several approaches to treat GSM.
Normally, doctors recommend lubricants and vaginal creams to reduce symptoms related to GSM as the first treatment for women who have medical reasons to avoid systemic hormones. Vaginal lubricants and moisturizers are widely available and do not require a prescription. Lubricants (e.g. K-Y, Astroglide, and others) can help make sex less uncomfortable, vaginal moisturizers (e.g. K-Y Liquibeads, Replens, Hyalo GYN) are designed to be used on a regular basis (not related to sexual activity).
Systemic hormone replacement therapy (e.g. oral tablets or skin patches) can also improve vaginal dryness. Some doctors prescribe low-dose local vaginal estrogen medications such as Estring, Vagifem tablets, or Estrace or Premarin cream. Research suggests that only a small amount of estrogen applied vaginally is absorbed by the rest of the body; it may be safe for breast cancer survivors who cannot take systemic hormones.
For those whose symptoms persist, vaginal estrogen therapy is often recommended. Several societies, including the American College of Obstetricians and Gynecologists suggest that vaginal estrogen can be used, even for women treated for breast cancer.
Women with, or at high risk for breast cancer may be worried about taking any form of estrogen, especially if they were diagnosed with a hormone receptor-positive breast cancer. For these patients, Carbon Dioxide (CO2) laser treatment such as MonaLisa Touch and radiofrequency treatment such as ThermiVa may help. Researchers are studying how well these non-hormonal vaginal treatments work. Visit our Research Study Search Tool to find clinical trials studying ways to improve vaginal health after menopause.
“Libido” refers to an individual’s level of sexual desire. Many women experience decreased libido as a side effect of menopause. Hormones can improve libido in women who are surgically menopausal. Some physicians recommend the addition of testosterone replacement for women who have loss of libido with menopause that isn't alleviated by estrogen and progesterone alone. Conflicting data, however, raises questions about the safety of testosterone, and whether it may increase the risk for breast cancer. In addition, testosterone is not approved by the FDA for use by women.
Some small studies looking at the effects of the antidepressant bupropion (Wellbutrin) on libido suggest that the drug may improve sexual arousal, overall sexual satisfaction, and satisfaction with intensity of orgasm. Larger studies are needed to validate these findings. Visit our Research Study Search Tool to find clinical trials studying ways to improve libido after menopause.