Have you found your attitudes about sex changing with age? With so much change occurring in our bodies (and our lives!) during the years of perimenopause and menopause, it makes sense that our sexual experiences may be changing as well. Hot flashes and mood swings may impact how we feel about sex, while weight gain may leave us feeling less sexy. We may discover we want sex less often, or enjoy it less than we used to due to vaginal dryness and discomfort.

There are so many changes that happen in this period of our lives. In addition to physical changes, we may have an “empty nest” as our children grow older and transition out of our homes, or maybe our house is filled with hormonally-charged teenagers.

There is a “settling in” that can sometimes occur in a relationship after being together for a while that can shift our view of sex, or there may be unresolved relationship issues that are suddenly entering into the bedroom for the first time. Some women may be single again, and re-entering the dating world may lead them to revisit their sexual desires and values – or maybe even become overwhelmed and retreat!

Often there are concerns and challenges around aging parents to manage, stresses at work and our own personal transition. Menopause is a time for us to question our priorities and our desires, and find our true voices,  as we head into the second half of our lives.

Not surprisingly, all of this can lead us to a place where sex just isn’t top priority. But it shouldn’t just fall by the wayside. I believe it’s important for you to define the role you want sex to play in your life and to know that that role may well change over time. So if sex is on the back burner by choice right now, that’s totally ok. But even if it’s less frequent, sex shouldn’t be any less enjoyable.

A healthy sex life is an important part of who we are and research shows staying active sexually can bring both physical and emotional benefits. At marcellepick.com, we want you to know that you deserve a satisfying sex life if you want one and that you CAN continue to have pleasurable sex at mid-life — and beyond. Just ask some of my patients in their sixties!

Read our article, “Safe (and Enjoyable) Sex In Your Middle Years,” for more on this topic.

Let’s look at what’s going on in our bodies and what we can do to maintain or restore a healthy sex life at any age.

Why Does Sex Drive Decline?

Patients sometimes ask me, “If it’s normal and natural to desire sex, then why does that stop or change as we get older?” It isn’t hard to see how that can happen when you look at all of the changes we just mentioned that are occurring in our bodies and our lives at this time – there’s a lot going on!

Sex drive is affected by our physicality and the changes occurring within our bodies as well as by emotional factors. As with most things in our bodies, the physical and the emotional issues are interconnected and interdependent so we need to address both. Let’s begin with the physical factors, as I know so many of my patients struggle there.

One of the most obvious triggers of lower sex drive is hormonal imbalance (Click here to read our many informative articles on this topic). In addition to the common symptoms of insomnia, hot flashes, mood swings and weight gain that we see in perimenopause, sex drive is also affected by our changing estrogen, progesterone and testosterone levels. Usually, once hormonal balance is restored, so is libido. Let’s look at the key hormonal players and how they impact your sex drive.

Click here to take our Hormonal Imbalance Quiz.

One of the most important drivers of libido is the hormone testosterone. Many women in perimenopause have lower testosterone levels that can impact their sexual interest, arousal and response as well as lubrication and orgasms.

Our ovaries produce both  testosterone and progesterone (which is a building block for other hormones including testosterone). But to do so they require cholesterol. If you are eating a low fat diet, you may not have enough cholesterol to support production of all the hormones we require because your brains and cells need cholesterol too.

Testosterone can also be made through the conversion of DHEA, a hormone secreted by the adrenal glands. But if stress is present, then DHEA will be diverted into cortisol instead.

Both healthy eating and a low stress environment are required for optimal hormonal balance.  In my practice I often see that women who are able to maintain good testosterone levels through perimenopause typically have better nutrition and more balanced adrenal function.

Click here to take our Adrenal Health Quiz.

Hysterectomy and Surgical Menopause

We just learned that the ovaries are key to hormonal function. This poses a challenge to the almost one in four women who will reach menopause as a result of surgery or medical treatments that can result in a loss of normal ovarian function. When this happens, sexual issues very likely result, as testosterone production will be reduced or eliminated completely.

This will definitely be the case with a total hysterectomy, in which both the uterus and the ovaries are removed. It may also occur with a partial hysterectomy since even if you maintain your ovaries after surgery, ovarian circulation is compromised in more than half of these cases.

For more information, read our many informative articles in the Hysterectomy section of our Health Library.

Since testosterone is so important for arousal, response, lubrication, and orgasm, low or no production of this hormone impacts the sexual experience of millions of women.

If you have your ovaries removed, or find your ovarian function to be reduced after surgery, you’ll want to work with your practitioner to explore your hormonal options such as prescription testosterone. But don’t be fooled, as many women are, into thinking taking prescription testosterone is an easy and quick fix to increasing your sexual desire.

I never encourage jumping to prescriptions as the easy answer. That’s because low testosterone isn’t the problem – it’s a symptom of another problem. Addressing that concern, whether it is physical or emotional, is always a better first step. Most of the time, low testosterone can be rectified with nutrition, supplements and stress management.

Vaginal Dryness

Another physical cause of lower sexual drive is the discomfort that many women feel as they experience physical changes in their vaginas. As estrogen levels decline during perimenopause, thinning, tightening and dryness may occur in the vagina and the vulva. In some cases, this can lead to discomfort – or even intense pain – during sex.

Vitamin E suppositories twice a week can make a huge difference for many women and water based lubricants can help reduce friction during intercourse. Dietary changes, supplements, and in some cases, natural progesterone cream are usually helpful as well.

If your body has adequate support, it can make estrogen from secondary sources even if your ovaries are compromised, so treating both the cause (hormonal balance through better nutrition and lifestyle changes) and the symptom of vaginal dryness is important.

Of course, drinking lots of water can help as well. Any time you are experiencing dryness, whether it’s in your vagina, your mouth, or your skin, it’s a sign that your mucous membranes are dry. Drinking more water is a great way to keep them moist from within.

In some cases, good nutrition, hydration and lubrication should do the trick. But sometimes, they just aren’t enough. When this is the case, there are prescription estrogen products that can be applied topically to the vagina. Low-dose estriol vaginal cream can be made by compounding pharmacies and does not carry the health risks of oral synthetic HRT.

We’ve had incredible results in our practice using a prescription testosterone, DHEA, and estriol product in these cases, so be sure to work with your practitioner to find the right solution for you. Don’t give up until you find it!

For more information on this topic, read our article, “Treatments For Vaginal Dryness“.

Other Physical Causes of Low Sex Drive

We’ve already mentioned that nutrition and stress play a role in your sexual desire. But before we discuss emotional causes, I want to talk a little more about diet and stress and why they are so important for hormonal balance. We saw that low fat diets can wreak havoc on your hormones since hormones, including testosterone which is needed for sexual response, require the presence of lipids or fats such as cholesterol for development.

In addition, mid-life is the time where many of our poor dietary choices begin to take effect cumulatively, as nutritional deficiencies can create the preconditions that lead to hormonal imbalance. In our article, “Sweet Poison – Kicking Your Sugar Addiction,” we saw how mineral deficiencies can occur from eating sugar and how this can impact our health.

There are so many ways our bodies get out of alignment based on our own unique food patterns, views and habits. The way we see food and the role dieting plays in our lives shapes the way we feel about how we look (which impacts our sexual desire) and drives our overall health and energy levels as well.

Years of chronic dieting have depleted necessary nutrients and our non-dieting eating habits, such as consuming sugar or processed foods, leave our bodies playing a continual game of nutritional catch up. By the time we reach perimenopause, our bodies have been compensating for these imbalances for quite some time.

The good news is that eating healthy combinations of vegetables; fats such as olive oil, coconut oil, butter and avocados; and proteins such as grass fed beef, bison, or wild Alaskan sockeye salmon can help our bodies to heal. A high-quality multivitamin and a fatty acid supplement are virtually essential these days. Marcellepick.com has formulated these high-quality, pharmaceutical-grade supplements.

You can’t eat enough fish, for example, to get the essential fatty acids we need for hormonal balance without excessive mercury risk. And even if you eat well, there will still be nutritional gaps due to the reduction in nutrients in today’s food based on current farming practices. (I recently read a study that to get the same nutritional value from 2 peaches that we’d have gotten in the 1950’s, today we’d have to eat 53!)

Stress also plays a huge role, as when your body is under constant stress and in fight or flight mode, it becomes all about survival. Estrogen and testosterone, which drive desire and sexual response, may not be produced at optimal levels in a high stress environment because the overtaxed adrenal glands will latch onto the necessary building blocks of hormone production that it requires to function, such as cholesterol, making them unavailable for hormone production.

We all face stressors in our lives. But if you feel constantly bombarded by stress you’ll want to examine it more closely and find ways of coping and releasing it before it wreaks havoc on your adrenal system. (If you are under constant stress, you’ll want to consider adrenal support such as our Feeling Tired Adrenal Program or Feeling Wired Adrenal Program, depending on your situation.)  Click here to take our Adrenal Health Quiz to gauge where you are.

Look at the sources of stress in your life that you can actually control. Can you manage them better to reduce where your stress comes from, and can you find healthier ways to react to stress when it does occur?

There will always be sources of stress that are outside of our control as well. If you feel most of the stress in your life is beyond your control, then I’d encourage you to look deeper. Can you find ways to reduce it that are in your control? Can you develop better ways of managing it? Are there things in your life that you can release and learn to let go?

Maybe it’s time to buy a copy of the song “Let It Go” from Frozen and make that your new theme! Can you find new ways to nurture yourself, such as a candlelit bath or a massage? Could you get support from your partner or someone close to you who will just sit and listen so that you can vent and release?

Maybe you can find creative release or new forms of self-expression such as painting, journaling, singing, meditating, yoga or tai chi to help you cope? There are many ways to reduce stress. You just need to find practices that engage you, fit into your life and bring you peace and joy.

Emotional Causes of Low Sex Drive

Now that we’ve looked at some of the many physical causes for reduced sex drive, let’s look at a few of the emotional ones. The brain is the biggest and most important sexual organ; what we think about sex, and how we feel about ourselves and our partner plays a huge role in our sexual experience. Many women tell me that the emotional aspects are  as – sometimes even more – important than the physical.

It’s fascinating to me that we are the only species and gender that is sexually aroused by our own pheromones. In other words, for us to feel sexual desire, we women have to feel sexy. Many women tell me that as their body changes in perimenopause, so does their feeling of attractiveness, which is often still tied to youthful images that are no longer realistic to attain or maintain.

Some women connect sex with reproduction and find that sex in the post-pregnancy years may seem inappropriate or even shameful. Others have been willing to let their partners drive the sexual process for so long that now they are unwilling or unable to be assertive and ask for their own sexual satisfaction.

Today more and more women are finding themselves single in their midlife and the idea of dating intimacy with someone new can feel overwhelming or scary. Perhaps you are  still with the same partner, but find you’re facing struggles working through some issues. If there are unresolved issues in your relationship, they will likely emerge during perimenopause and may lead you to question your sexual relationship as well.

Relationship dynamics often play out in the bedroom. Issues of control, respect, consideration, and communication, along with your problem solving abilities and styles, can impact intimacy and trust, which in turn makes it challenging to sustain sexual desire.

Often dynamics that have been in place for years suddenly take on more meaning or impact, surprising women who wonder why all of a sudden they are bothered by something they had previously accepted. Menopause is a time for women to find their voice and reach clarity on who they are and what they want. It’s no surprise that part of that process involves our intimate relationships and sexual experiences.

If your relationship is struggling, in or out of the bedroom, now is the time to begin to talk to your partner and work through your unresolved issues. If you need help, find a relationship or sexual therapist to guide you. Don’t assume that these issues will go away; menopause has a way of bringing issues to the surface and if you don’t address them, your body will face them sooner or later.

It’s also important to mention that if you are carrying around guilt, shame or trauma from a previous sexual experience, it’s time to deal with it and get some help. It’s estimated that one in three women experiences some kind of sexual trauma during their lives so there is no need to carry guilt or shame. Seeking professional help can have benefits far beyond your sex life.

Staking Your Sexual Claim

Sexuality and sex drive aren’t constants throughout our lives. What feels right and good to us in our twenties will morph as we settle down and raise families and then will shift again as we transition through menopause and find our true selves again, or perhaps for the first time!

Menopause is a great time to reflect on who we are and what we want, in all aspects of our lives, including our sex lives. It’s also a time to grow and explore and try new things, so don’t be afraid to think or talk about what you might want with your partner. A sexy movie, a juicy book, a candlelit bath, or a trip to sex boutique may be just the ticket to rekindling your desire.

Whatever you decide, it’s a part of your journey. Feel free to express your sexuality and choose what is right and best for you, now and throughout the second half of your life. But know that if you are experiencing physical issues that make sex painful or less pleasant or if your desire has started waning without an obvious emotional reason, there is help available.

If you take away one thing from this article, I hope it’s the message that both good nutrition and a low stress environment are required for optimal hormonal balance. Women who are able to maintain good hormone levels through perimenopause typically have better nutritional support and more balanced adrenal function.

In addition to specific products to target your physical concerns that you can discuss with your practitioner, our Menopause Program or our Feeling Tired Adrenal Program or Feeling Wired Adrenal Program can go a long way to laying the nutritional foundation required for restoring hormonal balance and increasing your pleasure and desire, now and in the years to come!