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Changes at Midlife
Sexual Problems at Midlife
Causes of Sexual Problems
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Systemic versus vaginal hormone therapy. Estrogen products that raise levels of the hormone throughout the body (systemically), not just in the vagina, may be appropriate therapy for vaginal atrophy and related pain during sex in postmenopausal women who also suffer from other distress-causing symptoms of menopause, such as hot flashes and night sweats.
Systemic estrogen products might also be an option in postmenopausal women who don’t get adequate relief from distressing vaginal atrophy with various forms of low-dose vaginal estrogen. In these women, systemic estrogen may be used for a short period to build up vaginal tissue before trying to transition back to a lower-dose vaginal product for longer-term therapy. Systemic estrogen products deliver higher doses of estrogen than low-dose vaginal estrogen products.
These systemic estrogen products are referred to as "hormone therapy" and contain either estrogen alone or estrogen plus progestogen. Estrogen alone is used only for postmenopausal women who have had a hysterectomy (surgery to remove the uterus) because taking estrogen by itself raises the risk of uterine cancer. Adding progestogen (a version of the hormone progesterone) protects against the risk of uterine cancer, so estrogen plus progestogen therapy is used for postmenopausal women who still have their uterus.
Systemic hormone therapy can be taken in various forms:
Risks and benefits must be weighed. Because systemic hormone therapy has been associated with increased risks of heart attack, stroke, blood clots, and breast cancer, especially in older women and with longer duration of use, healthcare providers generally prescribe the lowest possible dose for the shortest possible time to relieve symptoms of menopause. Whether systemic hormone therapy is right for you depends on your medical history, how comfortable you are with its risks, and how severe your menopausal symptoms are. It’s a decision that you must make in close consultation with your healthcare provider. For more information on hormone therapy, see “The Hormone Therapy Story” on The North American Menopause Society website.
Effect on libido uncertain. Although systemic hormone therapy improves vaginal health and may improve sexual function by restoring lubrication and reducing pain during sex, a beneficial effect on libido has not been documented.
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