Dr. Patricia Bearnson, Gynecologist practicing at St. Mark’s Center for Women’s Health, discusses lowered sex drive that sometimes accompanies menopause. Find out the causes and ways to treat this common issue. Depression, menopause and exhaustion can all contribute to a loss of sexual desire.
Low libido just means a loss of sexual desire. In large surveys of women,that have been done both in the US and Europe,about 40% of women, at any given time,will report that they are having loss of libido, that their sex drive is diminished or it’s less than they would view it as optimum. But then if you ask those women if they are distressed about that,that number drops by about half.
Causes of low libido are huge. You know, for women, our sexuality is very complex and very contextual. Most often, in my practice,I find that, you know, it’s usually not just one thing. That, for most women, who come reporting that they have lost desire, it’s multiple things and, sort of, you have to look at their life and see what pieces of the pie are contributing. In someone who is menopausal and having vaginal dryness you may treat that and if she’s having sexual pain from some other reason you treat that. About anywhere from 15 to 25% of women who have low libido have depression. So you need to treat the mood disorder.
Sometimes I’ll see women who have been so busy taking care of other people that they’re just worn down. I’ll see them and they’ll have this variety of things from, you know, sinusitis to hyperthyroidism to, you know, you just have to improve overall health. Things like getting more sleep and all that true things so that wellness is improved so that there’s something left over for sex. The time to consider seeking evaluation for loss of libido would be if it’s persistent and pervasive and if it’s causing distress for you and for your relationship. Those are indications that, in evaluation, might be helpful.
There’s a variety of things that can cause pain with intercourse. And when someone is having difficulty with pain, the first thing we do is get a history as to how long that has occurred, if it happened with the first episode of sexual activity. Or if she did fine for some period of time and then started to have pain. Because that will help give clues as to why pain might be occurring.
We’ll evaluate where the pain is happening. Is the pain right at the vaginal opening, or is it occurring with deeper penetration into the vagina? And does it occur with every episode of intercourse? Is it only intermittent? I see women every day in my practice with these conditions. Those conditions are treatable and we can manage them. They may not be cured, but most women can be managed such that they’ll be able to be in a sexual relationship and have sex that’s comfortable. I think for younger women who have pain with sex, such a good thing to come and get it figured out. Because when women have pain with sex, that can’t help but affect their sexual desire.
Nobody looks forward to sex when it’s painful. And that starts to spill over into the rest of their relationships,especially if they’re just young and new relationships. And so even those women very young, I think it’s important for them to be seen early on. There’s some data that says that women who are on birth control pills may be at higher risk for vulvodynia. So we may need to manage their contraception in a different fashion. But the key is to get it evaluated. Because if it hurts, there’s something wrong. And we need to treat it.
Abnormal Uterine Bleeding
Abnormal uterine bleeding can refer to either heavy menstrual periods or bleeding that happens in between periods. Any bleeding in a woman who is menopausal and not on a hormone therapy is abnormal, and we need to investigate that and figure out why it’s occurring. In women who are on hormone therapy, we still need to evaluate that, although most commonly that’s related to the hormone therapy. To evaluate abnormal bleeding in a woman who is postmenopausal, we rely on sampling the endometrium to obtain tissue from the endometrial cavity and send that biopsy to a pathologist to make sure about issues related to endometrial cancers or pre-cancers. Abnormal bleeding that happens in a postmenopausal woman is related to endometrial cancer only about 10% of the time.
But when that bleeding occurs, that’s sort of the thing that you need to make sure that it’s not related to endometrial or uterine lining cancer. Treatments for abnormal uterine bleeding will be sort of age-dependent and based on the severity of it. If it’s very mild, sometimes observation is okay. But for women who need treatment,there’s a range of therapies from birth control pills,which may be given cyclically,or we might consider a progesterone-releasing IUD,what’s called the Mirena IUD. Another option that’s available is endometrial ablation. With endometrial oblation, a device is advanced through the cervix and into the uterine cavity, and contact is made through the whole endometrial cavity to bring energy of some sort.
In the case Nova Sure, it’s radio frequency. But the idea is to destroy or damage those endometrial glands so that they can’t regenerate. So a woman will maintain her normal ovarian function. She’ll still have hormonal function just as she did before,but there’s just no response with this uterine lining to build up and have a period each month,or the period is greatly diminished. So, fibroids can happen in the muscular wall of the uterus,and they can even be pretty large as long as they’re not close to the interior wall of the uterus and really not cause a problem. But if the fibroid is close to the inside lining of the uterus,what’s called a submucosal fibroid, then it interferes with that uterine lining,sort of squeezing off and the glands closing when she’s trying to stop bleeding with a period.
And these kind are the ones that will cause problems. Abnormal bleeding is such a common problem in women throughout their reproductive age range and into their menopausal years even and can be a source of such frustration. But the good news is that we have lots of therapies that we haven’t had in the past. We just need to evaluate the cause of why it’s happening, and they can offer those women a choice about how they prefer to be treated.