Published On: Wed, Feb 20th, 2013

Menopause & Sexual Function

Woman DancingMenopause & Sexual Function

-by Andrea Purcell, NMD

Women’s health is all about hormones. So it makes sense that if hormones are shifting into decline as they do in menopause, then sexual desire will change as well.

Female complaints of sexual function related to hormones are most commonly seen in peri-menopause and menopause.

Hormonal decline can begin around age 40, and is referred to as peri-menopause. Women in their 40’s can have 50% lower testosterone than women in their 20’s. Decrease in sexual function is directly related to estrogen and testosterone decline.

When menstrual flow has stopped for more than one year, a woman is officially in menopause. The average age of menopause is 51 years old.

It is extremely common for women to have sexual complaints beginning before menopause and continuing into their golden years.

Estrogen is the most powerful hormone in a woman’s bodyand is responsible for many of the symptoms of menopause including; hot flashes, vaginal dryness, irritation, incontinence, loss of elasticity in skin, mood swings, loss of libido, and depression.

Testosterone is the hormone that affects sexual desire. Just like estrogen, testosterone is produced by the ovaries and adrenal glands and will gradually decline over a woman’s life. Some women will notice a big decrease in libido when her testosterone drops and others will notice almost nothing, as it will be a slow and steady decline.

Testosterone replacement improves sexual desire and responsiveness…

How important is the presence of testosterone in a woman’s body? Extremely! There is no amount of sexual stimulation that will make up for the absence of testosterone.

Loss of libido is mostly linked to low testosterone.

Women have 1/40th the amount of testosterone of men but it is still an important component of women’s health.

Even though testosterone in women is only a tiny fraction of the testosterone that men have, it makes a big difference. Testosterone is responsible for muscle strength, appetite, energy, memory, sexual desire, and sexual responsiveness.

Hormonal decline affects lubrication, decreases libido, and reduces blood flow and sensation in the genital area.This results in the inability to reach orgasm or the reduced intensity of orgasms leading to unsatisfactory sex.

Bio-identical Testosterone and estradiol/estriol are great treatments for pain with intercourse related to thinning of the vaginal walls. These are used topically in cream on the labia or in vaginal suppositories to increase lubrication and enhance tissue stimulation.

The only way for women to access a personalized prescription is through a compounding pharmacy.

A note about testing…

Eighty percent of the testosterone in the blood is bound and cannot be utilized. Only measuring total testosterone does not give an accurate reading of how much the person actually has available for utilization. Free testosterone is a more accurate indicator, and should always be measured along with total testosterone. Reference ranges are also important. There are optimal readings that are in the middle to high end of the range. Having a reading that is at the low end of the range does not mean that your levels are optimal.

Estrogen promotes blood flow to the vaginal lining. When estrogen levels decrease, vaginal walls thin, and can become easily irritated; this makes sexual intercourse painful and increases the risk of both vaginal and urinary infections.

A normal vagina has a pH of 4. Thisallows it to be slightly acidic and promotes the growth of healthy bacteria, specifically Lactobacillus acidophilus, which protects the health of the vagina.

In menopause, the pH of the vagina becomes less acidic, allowing for yeast and other bacteria to take hold. This increases the risks of both vaginal and urinary tract infections in women over 60 years of age.  It is a good idea to supplement with a high quality probiotic that contains a blend of healthy bacteria such as lactobacillus and bifidus.

In one study published in the New England Journal of Medicine, estriol was shown to reduce the rate of urinary tract infection ten-fold in postmenopausal women prone to frequent urinary tract infections and restored the vaginal pH to 4. Side benefits included increased vaginal lubrication and less pain with intercourse. The results of this study show that estriol vaginal suppositories are an effective way to treat vaginal health, reduce dryness, and decrease infection rates.

Woman are often concerned about hormone replacement and any negative effects that may result.

All hormone replacement should be bio-identical and have the exact chemical structure of a woman’s own hormones; this decreases any unwanted side effects. Small amounts of estriol and testosterone applied vaginally are extremely safe. Estriol is the weakest of all the estrogens and because vaginal application isn’t absorbed systemically into the bloodstream, it stays in the local area only.

Hormones decline with age and as hormones fade sexuality tends to fade with them. You can safely restore sexual function and vaginal health with bio-identical hormone replacement therapy and a good probiotic.


Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N. England J med. 1993;329:753-756



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