There are a number of factors that can cause your sex drive to decline during menopause. But one that often gets overlooked, is stress.
Feelings of tension and anxiety can skyrocket throughout the menopausal transition, causing a cascade of emotional and physical effects that can lower libido, explains Dr. Michael Krychman, MDCM, a gynecologist specializing in sexual health with an interest toward menopausal care.
We talked with Dr. Krychman to learn more about how stress during menopause can impact interest in sex, plus the steps women can take to manage any negative emotions that could be affecting their desire to have sex. Read on to view more of the insights from the complete interview.
Question: Are your menopausal patients having less sex as they transition through menopause?
Answer: Many women notice a decline in their sexual activity during menopause. Dr. Krychman notes that, as a sexual medicine gynecologist, all of the patients he sees are seeking help to address issues related to their sex lives. But "if you ask the right questions, you’ll find the vast majority of these women are having some changes in their repertoire or function," Dr. Krychman says.
Question: What factors are most likely to impact a woman's sex drive during menopause?
Answer: Physical side effects of menopause, like vaginal dryness or vaginal discomfort, are cited as common reasons as to why women become less interested in sex during the menopausal transition. But stress is a very common underlying factor as well, explains Dr. Krychman.
"Menopause is a very chaotic timeframe from psychosocial standpoint," he continues. "Issues like retirement, divorce, the death of a spouse, the loss of a job, kids at home or coming back home or leaving home, financial struggles, as well as chronic medical conditions – those are severely impactful on a woman's sexual function."
Question: How does stress affect a woman's desire to have sex during menopause, both emotionally and physically?
Answer: The brain and the body are intricately connected, and stressful thoughts can culminate in physical effects. "Chronic stress leads to changes in your cortisol levels and testosterone, which leads to lower libido and even more stress," says Dr. Krychman. Stress can also exacerbate sleep problems brought on by menopause symptoms like hot flashes, which in turn can also affect a woman's sex drive. "There's a lot of good data to support poor sleep being tied to other things that are downstream, like daytime fatigue, changes in memory, and lower libido," he adds.
Question: Are certain kinds of stress more impactful on sex drive than others?
Answer: A few stressful days here or there aren't likely to have a long-term negative effect on sex drive. But chronic stress that doesn't ease up can have a significant impact on sexual function, Dr. Krychman says. He compares it to how you might feel if you were being chased by a lion – 24 hours a day, seven days a week. "Your body is on sustained readiness, there's heightened anxiety, and the effects of stress affect other systems’ hormones," he explains. "When you're being chased by that lion, you're not supposed to stop and smell the roses and be sexual."
What's more, the libido-lowering effect of chronic stress can quickly turn into a vicious cycle. "It's the proverbial circular pattern," Dr. Krychman says. "You're stressed because of X,Y, or Z. That leads to lower libido, and then you're like, oh my gosh, I have this problem with my sex drive, and now I'm anxious about that too."
Question: How do you recommend managing low sex drive during menopause, when it's caused by stress?
Answer: "I take a conservatively aggressive approach," Dr. Krychman says. "What that means is, I start off with the least aggressive intervention and move towards more aggressive ones."
Behavioral changes typically come first. "That might include talking with a partner about your sex life; taking a break from stressors with yoga, rhythmic breathing, or exercise; and interacting more on a relationship level rather than using the kids as a means of interaction," he advises. Regular date nights might sound cliché, but they can be a valuable means for refocusing a relationship. Prioritizing healthy sleep habits is important too, Dr. Krychman notes, since sleep deprivation can quickly zap your sex drive.
Next up are nutraceutical supplements like Ristela®, which Dr. Krychman recommends frequently. "These are non-medication, non-prescription products that can help women through improving blood flow to the genitals to increase sensation and orgasm potential* – they have science that supports them, so they're quite helpful and safe, as well," he says.
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In some cases, women may benefit from prescription medications. Hormone therapy, like estrogen or testosterone, can both be used to address low sex drive, Dr. Krychman says, while in other cases, antidepressants may be more appropriate. "Precision medicine should be the goal, we have to tailor what works for you," he points out. It’s always a good idea to speak openly and honestly with your healthcare provider so that you can determine the best treatment option(s) for you.
Dr. Krychman also often encourages his patients to speak with a mental health professional about chronic stressors too. "A lot of women feel like, I can handle it on my own. But this is a comprehensive approach. And if stress is impactful on your sex drive, we need to make sure it's addressed appropriately," he says.