Sexuality is a critical issue at menopause for many women. The longest duration population-based study ‘The Melbourne Women's Midlife Health Project' found a significant decrease in women's desire, arousal, orgasm and frequency of sexual activity throughout the menopausal transition^[1]. The women studied in the trial also reported an increase in vaginal dryness and pain throughout the peri-menopausal transition period.

In contrast to this information, many other women report heightened sexual desire and activity during and after menopause.

So who is right?

The truth is that sexual desire and sensuality can change for a woman throughout her life. A woman's experience with sexuality during menopause is a very individual experience. What a woman believes about herself, her sex life, sex drive and their relationship with menopause has a lot to do with her sexual experience during this time.

As hormone levels start to decline in the peri-menopause, many women begin to experience changes. Low libido is a frequently heard complaint. In fact, so common is this complaint that it is estimated at least 50% of women have diminished libido around this time. But don't despair if you are one of these women. With the right help there is no reason why you cannot enjoy a satisfying sex drive and sex life during and after menopause.

So what contributes to diminished libido?

A woman's sexual desire or libido is a complex condition produced by a combination of biological, personal and relationship factors. These may negatively affect the entire sexual response cycle, inducing significant changes in desire, arousal, orgasm and satisfaction. Commonly cited reasons contributing to diminished libido include:

v       Ageing^[2]

v       Adrenal exhaustion

v       Hormonal loss or abnormalities

v       Stress³

v       Sleep disturbances

v       Night sweats, mood changes and hot flushes^[3]

v       Psychological issues such as depression and anxiety³

v       Relationship quality/conflict with partner (e.g. how interested and responsive your partner is)

v       Feeling tired and ‘worn out'³

v       Vaginal dryness which contributes to pain and lack of arousal during intercourse

Experiences that come into play long before menopause that also influence libido include:

v       Genetic upbringing^[4]

v       Life experiences⁴

v       Early childhood upbringing⁴

So why does low libido occur during menopause for some women?

For women who had normal sexual function prior to perimenopause, one of the most common causes of diminished libido is hormonal. As perimenopause progresses, drops in oestrogen can create thinning, tightening and dryness in the vagina walls. This causes pain and discomfort during sexual intercourse which in turn affects sex drive. Progesterone levels are also dropping at this time and may also contribute to lack of sexual desire as well as menopausal symptoms such as anxiety and depression.

So how can a woman get her mojo back?

Restoring hormonal balance

Sex hormones, namely levels of oestrogen, progesterone and testosterone, are very important for a woman's physical and mental well-being during menopause. Even a slight lack of these hormones may have a negative impact on a woman's desire and sexual responsiveness.

Treatment of diminished libido must be individualised to the specific complaints of each woman. Since diminished libido can be a side-effect of changing hormonal balance, working to restore hormonal balance in a woman is typically a good place to start. Once a woman is back in balance, her desire often returns.

However ... there's more to sex then just your hormones!!!

Having the right attitude

"There is no more creative force in the world than the menopausal woman with zest!" - Margaret Mead^[5]

It's hard when you have no feelings of sexual desire but coupled with proper diet, exercise and hormonal treatment, a positive attitude towards sex can make an enormous difference. Deciding to have sex for the sake of your partner's needs or because hey!..it actually feels nice when you get started (and who knows where things may go from there!) may be the incentive for sex at the moment rather than having the desire that you used to.

Rediscover yourself and your body. Most importantly communicate your desires to your partner. You might like to:

v       Ask your partner to give you a sensual massage

v       Take a shower or a long bath scented with sensual aromatic oils alone or with your partner

v       Make a date with your partner to explore new ways or new places to have sex!

v       Buy some sexy underwear

v       Focus more on foreplay rather than intercourse

v       Book a hotel room for you and your partner. The Sydney Hilton Hotel offers a provocateur package for couples designed by experts and includes an aphrodisiac-inspired degustation platter, some wonderful naughty tips from the infamous Madame Lash, a bottle of wine, a profusion of rose petals, aromatic essences and a selection of your own music -- the scene is set for the night of your lives. To ‘provoke' passion, call the Hilton Sydney on (02) 9265 6045 or get creative and do something similar at home.

v       If you suffer from vaginal dryness always remember to use lubrication. Vitamin E and even coconut oil make nice natural lubricants. However read further our section on vaginal dryness.

v       Most importantly: let go of your inhibitions, laugh and have fun

Diet

Eating the right types of food and cutting down on other foods can help to increase libido and rebuild a woman's sex drive. As always, a diet based on organic, whole, fresh foods with an assortment of grains, fruits and vegetables will be the foundation of hormonal balance and support a harmonious transition. The avoidance of saturated fats and refined and processed foods is recommended, remembering always that ‘we are what we eat'.

Additionally:

Increase intake of phyto-oestrogen rich foods. Phyto-oestrogens have a weak estrogenic affect and may improve blood flow and provide natural lubrication to the genital tissues. Good sources of phyto-oestrogens include lignins, flavones and isoflavones, with isoflavones being the most potent^[6].

You can find lignins and flavones in a number of cereals as well as fruit, vegetables and seeds (especially flaxseed, which is also known as linseed). Flaxseed oil does not contain phytoestrogens therefore eating the ground-up seeds is better.

Isoflavones are found in legumes, including soya beans, tofu, lentils and chickpeas. Researchers have found that just adding 100g of tofu and 1 tbsp of freshly ground linseed to the diet each day can reduce symptoms of vaginal dryness^[7].

To stay lubricated on the inside and outside, ensure you are getting your daily requirement of essential fatty acids. Sources include oily fish like salmon and sardines, as well as nuts, sunflower and pumpkin seeds and avocadoes.

Drink at least 2L of water daily (preferably filtered). Try to avoid dehydrating substances such as coffee and alcohol -- these will dry up your tissues further.

While one glass of alcohol may help you get ‘in the mood', several alcoholic drinks will dampen your senses and affect your ability to reach orgasm. Be mindful of your alcohol intake.

Favour light foods rather then heavy foods This could be swapping your usual pasta dinner to cous cous, or choosing a soup for dinner rather then a potato bake. Remember, overeating is not conducive for comfortable lovemaking.

Though unsubstantiated by science these well-known aphrodisiacs have been used for centuries to enhance the libido. Why not give them a try?

v       Oysters are high in the nutrient zinc, which is required for production of testosterone. Testosterone is known to enhance libido and levels may be low in women approaching menopause.

v       Asparagus has long been considered an aphrodisiac in many different cultures and contains vitamin E, which is said to stimulate the sex hormones.

v       In traditional Ayurvedic medicine it is believed that consuming 3 figs and a handful of almonds daily will combat low libido and increase sexual drive.

v       And of course this list would not be complete without chocolate! Chocolate contains phenethylamine, a nutrient that enhances mood and the chemical we produce in our brains when we fall in love. The higher the cocoa content of the chocolate the better the effect, so stick to 70 per cent cocoa solid chocolate such as Lindt dark chocolate and limit yourself to one small square.

Supplements

v       Natural vitamin E (400 IU/d) is perfect for both internal and external use. Vitamin E is essential for the production of sex hormones and is a specific healing remedy for vaginal dryness. Because vitamin E is fat soluble, it must be taken with food to ensure absorption. Breaking open a capsule and applying the oil to the vagina is an excellent natural lubricant for the vagina, helping to prevent dryness.

v       A high-potency multivitamin specifically designed for women will help to support the body. This is important during the transitional period to ensure your body is getting all the nutrients it requires.

v       A Sustained Release B Complex is beneficial for supporting energy levels and nourishing the nervous system.

v       Stress is an enormous factor influencing diminished libido. Magnesium (300mg/d) works wonders in helping to restore libido if stress and fatigue are dampening your love life. Magnesium levels tend to drop in menopause.

Exercise

It is important to remember that many menopausal symptoms are transient. Ninety-eight per cent of women who experience symptoms before the age of 45 revert back to their premenopausal status after 6 months^[8]. Regular exercise is one way of improving sexual desire. Not only does it promote blood flow all around your body but it causes your body to release endorphins, which make you feel good. Any exercise that you enjoy doing will be beneficial; however, the most commonly recommended exercise for enhancing a woman's sex life are Kegel exercises. Developed more then 60 years ago, these exercises work by toning and tightening the vaginal muscles, subsequently ensuring many years of sexual pleasure.  Kegal exercises also help with incontinence issues.

How to do Kegel exercises

v       Firstly, to isolate your pelvic floor muscles try stopping and starting the flow of urine when you visit the bathroom. Once you have this down pat make sure your bladder is empty and find a private place to lie or sit down.

v       Begin by contracting your pelvic floor muscles.

v       Hold the contraction for four seconds then relax for four seconds. Repeat 10 times.

v       This may be hard at first but practice makes perfect.

v       Once you've perfected four-second muscle contractions, try it for six seconds at a time, alternating muscle contractions with a six-second rest period.

v       Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

v       For best results try and work up to doing 200 Kegels a day.

v       You can Kegel at anytime of the day anywhere...at the bus stop, at your desk, whilst cooking dinner...

Communication

It's essential to open the lines of communication with your partner during this sensitive time. Often, partners feel confused, rejected and unloved. You may know you love your partner but sometimes this may not be conveyed to them (particularly in amongst the menopausal mood swings!). Ask for their patience and try to show them you love them in other ways. Communicate what you have learned about your changing body and the feelings that seem beyond your control. Ask your partner for space without the pressure for sex. Communicating effectively with each other will cultivate a unity and understanding that only brings you closer together.

Lastly, if you still have any doubts, women live on average 30 years after menopause³ so it's really worth working on your libido! Menopause can be a time to rediscover your sexuality. Take action and make a change. After all, don't you want to be one of the women saying: "Sex after menopause? It's just gotten better and better!"

[1] Guthrie, J.R. et al (2004) The menopausal transition: a 9-year prospective population-based study. The Melbourne Women's Midlife health Project Climacteric 7:375-389

[2] Nappi, R.E. (2007) New attitudes to sexuality in the menopause: clinical evaluation and diagnosis, Climacteric 10 (Supp 2):105-108

[3] Howard, J.R. (2006) Factors affecting sexuality in older Australian women: sexual interest, sexual arousal, relationships and sexual distress in older Australian women. Climacteric 9:355-367

[4] Ojeda, L. (2003) Menopause without medicine, Hunter House Publishers, CA

[5] Gladstar, R. (1993) Herbal Healing for Women Fireside, USA

[6] Osiecki, H. (2004) The Physicians Handbook of Clinical Nutrition (7^th Ed.) Bio-concepts

[7] Trickey, R. Women, Hormones & The Menstrual Cycle

[8] Short, M. (2003) Menopause, mood and management Climacteric 6 (Suppl 2):33-36