In the office this week I saw a frazzled soccer mom, a newlywed, an executive empty nester and a marathoner all with the same symptom: low sex drive. All wanted their “hormone levels” checked, convinced that their ovaries were most surely to blame for their lack of mojo. With 40% of women experiencing low sex drive at some point in their life, this is an issue I see a lot.
Having adequate hormones is helpful to sexual function. Estrogen encourages blood flow to the vagina and enables adequate lubrication, and testosterone prompts sexual urges. But sexual desire in women is often more complex than a simple lab value. Stress, emotional health, body image and relationship issues also play a huge role.
When I asked the women mentioned earlier how often they were actually having sex, the answers ranged from once a month to 5 times a week. To me, “5 times a week” seems like a pretty good week, but to her it was less than normal and that was upsetting.
While hormones are not always the issue, there are instances where they could be the culprit for low libido.
Irregular or absent menstrual cycles
Cycles that come consistently every 24-34 days are usually a sign that your ovaries and hormones are working properly. Irregular, infrequent or absent periods are the biggest clue that a woman’s hormones are wacky. Periods that disappear for more than 6 months are particularly concerning, and may signal an imbalance of estrogen. This can have a negative effect on sexual function, but more importantly, can cause other health problems so should prompt a doctor visit.
Menopause
After menopause, women’s ovaries stop making hormones, so their overall levels of estrogen and testosterone are minimal to none. Many women transition to menopause with no sexual issues, but others struggle with vaginal dryness and low desire. The drop in estrogen often results in a thinning of the vaginal tissue, dryness and painful intercourse. If sex hurts and is not enjoyable, women are not going to want to do it as often, and then the less they do it the worst their symptoms get. (Use it or lose it!) Sometimes these symptoms can be treated with simple lubricants such as KY jelly or coconut oil. If that doesn’t work, prescription topical estrogen cream can usually return vaginal tissue to its premenopausal splendor.
Testosterone supplementation, while not FDA-approved for women, has been studied “off label” and been shown to be effective for improving libido in ladies near and after menopause, though not without side effects. Acne and hair growth are often bothersome, and other side effects like elevated cholesterol, which theoretically could cause future heart disease, have also been observed. I prescribe testosterone cream often to my menopausal patients and most are thrilled with the benefits, but I am always careful to caution them that we don’t have long term studies and aren’t sure what the possible long term side effects might be.
The Pill
The birth control pill binds excess testosterone in the body, and for some women that drop in testosterone can affect their libido. If you feel like your pill might be hampering your mojo, then talk to your provider about a non-hormonal option. Don’t simply stop taking your pill though, because what zaps your sex drive even more than the pill is a new baby.
If you have regular periods, no pain with intercourse, and you are not on any hormonal contraceptive, then the source of your low sex drive is likely not as straight forward as “your hormones.” There are several drugs in the pipeline for women with normal hormones (you may have heard buzz recently about a drug called flibanserin, which has been resubmitted to the FDA for approval). But for most women, sexual desire is not a simple physical issue like it is for most men. The answer is usually as multifaceted as the problem.
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