About Menopause - 6 minute read

Q & A: Sex and Menopause with Dr. Lisa Larkin

We found the perfect person to talk to our Kindra community about how sex might change for us during menopause — Dr. Lisa Larkin, an expert in menopause AND women’s sexual health.

We’ve heard sex might change for women during menopause? Is that true?

Low sexual desire is one of the most common sexual health concerns for women -- we know that more than half of all women will eventually experience it, yet it is a neglected issue. Sexual health is part of our overall health and needs to be addressed. The good news? There are options and one or more will likely be right for you. 

Why does it change?

The why behind it is complex because desire is influenced by many things, including biology. Our hormones, especially estrogen and testosterone, play a big role, as do our brain neurotransmitters dopamine and serotonin.  And during menopause, our hormonal makeup abruptly does a U-turn. Estrogen levels plummet while testosterone levels fall to about half what they once were. 

How does that impact our bodies?

The loss in estrogen leads to thinning of the vaginal tissues and vaginal dryness, which in turn lead to painful sex - and no surprise, painful sex impacts desire. Who looks forward to something that hurts? But there are many safe and effective therapies available. 

Whew! Say more!

The first priority is to deal with that vaginal dryness. As a physician, I encourage my patients to use a vaginal moisturizer like Kindra’s Daily Vaginal Lotion as first-line therapy. Used regularly, vaginal moisturizers work well to alleviate dryness – similar to how facial moisturizers work. 

For women with mild symptoms, this may be enough to solve the problem, but many menopausal women need more help. Treatments like vaginal dilators, pelvic floor physical therapy, FDA-approved vaginal estrogen and DHEA, and vaginal laser therapy are all proven, science-based options worth exploring with your clinician.

I want to give women a little encouragement here: don’t write off vaginal estrogen therapy out of fear. Low-dose vaginal estrogen is NOT the same as systemic hormones and it’s THE most effective therapy for this issue. Just make sure you work with a clinician experienced in menopause and sexual health. They’ll be able to explain your options and help you find the best one for your body. So, back to testosterone.

Testosterone - isn’t that a guy thing?

We think of testosterone as a male hormone, but it plays a key role for women too – and just like with men, it impacts our sex drive. 

Women’s testosterone levels peak in our 30s and then begin declining. By our 50s and during menopause, our testosterone levels are about half what they once were. When low desire persists in menopausal women even after dryness and painful sex have been addressed, testosterone is often the culprit. 

While there’s no FDA-approved testosterone product for women in the US, there’s clinical support for its use in this situation. If this is you, talk to an experienced clinician who understands the most recent data and guidelines. Don’t give up without exploring all your options!

What else might impact low desire?

It’s important to remember that just as low desire is complex, so can be its resolution. Medication isn’t always the only answer, and biology isn’t always the only cause. Factor in elements like the quality of the relationship, depression and anxiety, and cultural and religious beliefs, and it’s clear that women often benefit from a multi-disciplinary approach that might include options like relationship counseling in addition to medication and other therapies.

I like the idea of starting with a lotion to improve painful intercourse, but sometimes I try something that burns. How do I prevent that?

Vulvas and vaginas are very sensitive and need TLC! That’s why many products that aren’t specifically made for the intimate area can cause burning and irritation.  And of course, our vaginas are just as individual as we are, so sensitivity varies from woman to woman. If you experience discomfort of any kind with any product, stop using it.

I had the opportunity to participate in a patient experience study with the Kindra Daily Vaginal Lotion. The moisturizer worked well for the women I treat in my practice. Now it’s my go-to recommendation for patients struggling with dryness.

How do I talk to my doctor about this? I heard that only 9% of women are getting proper menopausal healthcare. 

Advocate for yourself. We’ve kept menopause in the dark for far too long – it’s long past time to bring it into the light. It’s not shameful or taboo. Women are not getting the care they need or deserve, and it’s up to us to change that! If your doctor is uncomfortable discussing and addressing your sexual health needs, find a new doctor who listens to and takes care of you. There are plenty of providers who specialize in sexual and menopausal health.

A great place to start your search is the North American Menopause Society (NAMS). Look for providers with their certification, NCMP (NAMS Certified Menopause Provider). You can search the NAMS directory at www.menopause.org. Also, all Ms.Medicine providers complete advanced training in women’s health – you can find one in your area at www.MsMedicine.com.

Part of our mission at Ms.Medicine is to empower and educate women so we take control of our health – and that includes our sexual health. We know from surveys that women hope their doctors will initiate the conversation about sex, but the truth is that doctors often wait for patients to bring it up. 

My advice is: Take control. Be direct and say what’s on your mind. This is your doctor you’re talking to – we’ve heard absolutely everything, and there’s no such thing as an awkward topic. You’ll be so glad you spoke up!

Check out Dr. Larkin’s organization, MsMedicine.com, to help find menopause experts near you.

About Dr. Larkin 

Dr. Larkin is passionate about raising the standard of care of women and advancing evidence-based women’s healthcare. She is a national expert in menopause management, sexual medicine, and breast cancer risk assessment and prevention. 

She is Founder and CEO of Ms.Medicine, an innovative healthcare organization of women’s healthcare specialists seeking to raise the standard of care for women through comprehensive, evidence-based care. Ms.Medicine is committed to raising the standard of care in women’s health and addressing unmet medical needs, such as menopause, sexual health, breast cancer risk, heart health, bone health, genetics and nutrition.

Dr Larkin is a certified menopause clinician (NCMP), a Fellow of and past member of the Board of Directors of ISSWSH (International Society or the Study of Women’s Sexual Health), and currently serves on the Board of Trustees of NAMS (North American Menopause Society).

Continue the Conversation

Can I take Premarin vaginal cream and the Kindra daily vaginal lotion? I use Premarin three nights a week. What is your recommendation?

— Mary

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