TABLE OF CONTENTS
How to Navigate
Changes at Midlife
Sexual Problems at Midlife
Causes of Sexual Problems
Reminders & Resources
Frequently Asked Questions
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Many changes during the years leading up to menopause (perimenopause) are brought on by changing levels of hormones produced by the ovaries, mainly estrogen.
Estrogen. As the primary “female” hormone, estrogen promotes the growth and health of the female reproductive organs and keeps the vagina moisturized, elastic (stretchy), and well supplied with blood. Estrogen levels generally decline during perimenopause, but they do so in an irregular fashion. Sometimes there can be more estrogen present during perimenopause than in the past.
Estrogen levels generally decline during perimenopause, but they do so in an irregular fashion.
As detailed in the table below, the reduced production of estrogen beginning in perimenopause can affect your sexual function directly, such as through vaginal dryness. It can also do so indirectly, in the form of hot flashes and night sweats, which can drain your energy and undermine your desire for sex as a result. These effects are discussed in detail in the “Causes of Sexual Problems” section of this program.
Progesterone and testosterone. In addition to estrogen, levels of other hormones produced by the ovaries—progesterone (another female hormone) and testosterone (a male androgen hormone produced at lower levels in women)—are also changing during your midlife years, as explained in the table below.
Intermittent decreases in progesterone affect menstrual periods more than they affect sexual function, but age-related declines in testosterone may dampen libido (sex drive) in midlife women, although this remains controversial. The fact that estrogen declines more than testosterone leads some to believe that libido should not decline at menopause. The decline in testosterone in women is solely age-related, not menopause-related, and begins years before perimenopause.
Although known as the “male” hormone, testosterone is also important to women’s sexual health:
Adapted, with permission, from Shifren JL, Hanfling S. Sexuality in Midlife and Beyond: Special Health Report. Harvard Health Publications, Boston, MA. Copyright © 2010 Harvard University.
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