Help For An Overactive Bladder (OAB)

Nothing is more distressing than losing urine and unable to reach a toilet in a timely fashion. It is a source of embarrassment, anxiety, and even depression.

Your bladder can start to present problems at menopause as sneezing, laughing, increased urgency and frequent night calls can disturb your sleep and your peace of mind.

This is particularly true at menopause when up to 40% of women are affected by OAB. Unfairly perhaps, but women do suffer urinary incontinence four to five times as often as men.
Some of that has to do with pregnancy and childbirth, which can weaken the vagina, the pelvic floor muscles, and the ligaments that support the bladder. This can cause the bladder to be pushed out of place, making it harder for the muscles to perform. That’s why you may leak a little urine when you sneeze, cough, or laugh.

Symptoms of OAB:
* increased urinary frequency
* a sudden urge to urinate
* the need to urinate during the night
* difficulty getting to the bathroom without leaking

Types of Incontinence
There are two separate types of incontinence:
Type 1: Stress incontinence leads to leakage of urine when the pressure in the abdomen is higher than the sphincter pressure. Normally, contraction of the pelvic floor muscles compresses the urethra [bladder outlet] and prevents loss of urine and stress incontinence. Loss can happen with sneezing, coughing and during exercise such as lifting, jumping and walking.
Type 2: Urge incontinence is when an uncontrollable need to pass urine occurs due to over activity of the bladder wall muscle. Typically this occurs as you put the key in the front door or when water is running. There is generally no weakness in the pelvic floor muscles or muscles controlling the bladder outlet. This is also known as overactive bladder syndrome.

Mixed incontinence occurs when there is muscle weakness and and uncontrollable urge to go to the toilet together.

The hormone factor
For women, the bladder and urethra have hormone receptors and it is estrogen that affects the health of the pelvic muscles and the urinary tract. It is estrogen that helps to preserve the strength and flexibility of supportive pelvic and bladder tissues so low levels may be part of the reason these supportive tissues sometimes weaken as a woman ages and may also contribute to muscular pressure around the urethra.
Estrogen can improve the flow of blood and strengthen the tissue around the urethra so women who are low in body weight at menopause may not be producing sufficient for this purpose. Often prescribed are low-dose topical estrogen creams or patches but according to the Mayo Clinic, scientific evidence to support this treatment is lacking.
Low estrogen generally indicates even lower progesterone levels so a combination cream of both hormones can be effective.

When to get help
Bladder weakness can affect many areas of your life from disturbed sleep, to your sex life and embarrassment in public over urinary accidents. This can make it hard to enjoy everyday activities and so many women don’t seek help but these signs indicate you have a problem:
• urinate more than eight times in a 24-hour period
• get up in the night to urinate
• experience frequent leaking
• have changed your activities to accommodate your symptoms

How to help yourself
There are many types of surgery for stress incontinence and although this can be helpful, as time goes by a number of women will get a return of their urine leakage between 5 to 10 years after surgery. It is better to try and manage the condition by first trying pelvic floor muscle exercises which are an inexpensive and effective method of treating mild stress incontinence.

Often referred to as Kegel exercises you could follow the plan below. First you need to be able to identify your pelvic floor muscles and learn how to contract and relax them. To do this, stop urination in midstream. If you succeed, you’ve got the right muscles. Then practice this as below:
* Once you’ve identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
* Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.
* Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day.
More information:
Unfortunately at menopause women tend to put on weight, and being overweight can make bladder problems more common. Sleep at menopause is also often disturbed for this reason and for this progesterone does help aid sleep and rebalance hormones to help with any weight loss.
However for women who do need additional estrogen as well as progesterone and are not overweight a combination cream is usually more effective for the bladder.

Bottom Line: Incontinence and OAB are common maladies affecting millions of American women. You don’t have to depend on Depends! Help is available. Speak to your doctor.

Using Hormone Therapy To Reduce Recurrent UTIs in Women

Women often experience recurrent UTIs after menopause. The cause is often a result of reduced estrogen levels that is so common after menopause. This blog will discuss the use of topical estrogens to reduce the frequency to recurrent urinary tract infections.

Topical hormone replacement therapy (HRT) was associated with a lower incidence of urinary tract infections (UTIs) compared with both oral HRT or even no HRT.

UTIs are a frequent problem among postmenopausal women necessitating antimicrobial use, and resistance is increasing. Every year, 8–10% of postmenopausal women have 1 episode of a urinary tract infection; of these, 5% will have a recurrence in the next year.

Studies have demonstrated use of oral estrogens does not reduce the incidence of UTIs, but topical HRT reduced the number of UTIs in two small studies.

To determine whether a difference existed in incidence of UTIs in women 60–75 years of age, a study compared the number of UTIs per patient per year over 1 year in 3 groups of postmenopausal women: topical HRT, systemic HRT, and control (n=75 per group).
Women aged 60–75 years with a history of UTI (n=448) were identified from retrospective charts (2011–2013). Patients were excluded if they were taking antibiotics for UTI prophylaxis, treated with antibiotics for reasons other than UTI for 2 or more weeks, were on both topical and systemic HRT, or on chronic methenamine hippurate.
The number of UTIs per patient per year was significantly different among the 3 groups. There was a significant difference between topical HRT and systemic HRT, and topical HRT and control, but not systemic HRT and control. The control group had an average of 1.24 UTIs per patient per year, compared with 1.01 in the systemic group and 0.65 in the women who used topical estrogen replacement.

Bottom Line: Topical estrogens may be beneficial when other preferred agents cannot be utilized.

Restoring The Fountain of Youth-DHEA Just May Be The Youth Hormone For Women

American women (men too) are always looking to find a way to turn back the biologic clock. We all would like to look like the women in Cosmopolitan and Vogue Magazines. If your goal is to look younger, feel better, and improve energy level, then you might consider the benefits of DHEA.

DHEA, dehydroepiandrosterone, is a hormone produced in the adrenal gland, the small triangular structure that sits on top of the kidneys. DHEA is made by the adrenal glands and is then converted to androgens, estrogens and other hormones. These are the hormones that regulate fat and mineral metabolism, sexual and reproductive function, and energy levels. DHEA levels increase until our mid to late 20′s then gradually decline. DHEA is a very powerful precursor to all of your major sex hormones: estrogen, progesterone, and testosterone. (Its molecular structure is closely related to testosterone). DHEA is called the “mother hormone” — the source that fuels the body’s metabolic pathway.

When DHEA levels are low, your body does not have enough working material for proper endocrine function. This throws off your hormone production and you feel a general sense of malaise, along with other symptoms of hormonal imbalance — how severe depends on how many other demands are being made on your body at the same time.
There is a growing body of evidence that healthy levels of DHEA may help stave off Alzheimer’s disease, cancer, osteoporosis, depression, heart disease and obesity, but there is still no clear-cut consensus. There may be some increased risks associated with DHEA for women with a history of breast cancer — all the more reason to take DHEA under medical supervision.

Symptoms of low DHEA include extreme fatigue, decrease in muscle mass, decrease in bone density, depression, aching joints, loss of libido, and lowered immunity.
DHEA is stated to be possibly effective for these conditions:
1. Aging Skin – Taking DHEA orally seems to increase epidermal thickness, sebum production, skin hydration, and decrease facial skin pigmentation in elderly men and women
2. Osteoporosis – Taking DHEA orally 50-100 mg per day seems to improve bone mineral density (BMD) in older women and men with osteoporosis or osteopenia.
3. DHEA is also thought to contribute to a sense of well-being when used by those with adrenal and/or androgen insufficiency.
4. It may also support lean body mass in postmenopausal women.

DHEA has many potential benefits but does also have some side effects, which include hair loss, hair growth on the face (in women), aggressiveness, irritability and increased levels of estrogen. Calcium channel blockers may increase DHEA levels and those using calcium channel blockers should avoid supplementation. Anyone with a history of hormone-related cancer such as estrogen sensitive breast cancer should definitely avoid DHEA due to the probability of increased estrogen levels.

If you don’t feel DHEA is appropriate for you, it may be possible to increase the body’s natural production of DHEA with regular exercise and restricting the number of calories you consume. Calorie restriction is associated with a longer life span and the increase in DHEA production may be partially responsible. In fact, there are many studies that show you can improve your DHEA levels naturally by maintaining a body mass index of 19-25, getting adequate rest and exposure to sunlight, exercising regularly (including sexual activity), and fostering more “downtime” in your life — but more on that in a moment.

Without a medical test it’s impossible to know what your DHEA levels are. Using blood tests, your doctor can check for estradiol in the follicular phase (usually days 3–9 of a menstrual cycle); progesterone in the luteal phase (days 14–28); DHEA-S; and both free and total testosterone levels.
Treatment With DHEA Supplements

If tests indicate the need for DHEA supplementation, you may start off with as little as 1-5 mg, twice a day. The dosage can be slowly increased to 10–12 mg per day. Most doctors do not suggest any woman exceed 25 mg per day if capsule forms are used. Once balance has been restored and symptoms even out, most women produce enough DHEA on their own.

Bottom Line: Many women are suffering from hormone imbalance. Decreased DHEA can be a cause of many problems affecting middle age women and can even impact her libido and her energy levels. DHEA should never be taken casually or unsupervised, but its benefits are real for the women who need it.

Sex Drive In the Tank? Then Filler Up With DHEA

Nearly every doctor and every patient believes that their sex drive or libido comes from their testosterone level and that restoring testosterone with injections, gels, or pellets will restore a man’s virility. The answer is yes and no. Yes, testosterone is responsible for a man’s sex drive but so is the ratio of testosterone to estrogen. A testosterone/estrogen imbalance can severely inhibit sexual desire and sexual performance.

In a man’s youth, low amounts of estrogen are used to shut down the powerful cell stimulating effects of testosterone. As estrogen levels increase with age, testosterone cell stimulation may be locked in the “off” position, thus turning off sexual arousal and sensation and resulting in a loss of libido in aging men.

Another concern is that aging men sometimes convert testosterone to estrogen. The increase in estrogen is taken up by testosterone receptor sites in the cells and prevents circulating testosterone from gaining access to the cells where it can do its greatest function.

Testosterone is responsible for the sex drive in both men and women. In order for testosterone to do its job, it must be in the free form and not bound to other circulating proteins like sex hormone binding globulin (SHBG). SHBG increases with age and grabs the free testosterone making it unavailable to the cells where it is needed to initiate sex-stimulating centers in the brain. Also excess estrogen increases the production of SHBG and blocks the testosterone-receptor sites. These are the two mechanisms that impact a man’s libido associated with aging.
Therefore, it is necessary to suppress excess levels of SHBG and estrogen while increasing free testosterone to the level of a younger more youthful man. By restoring the normal ratio of testosterone to estrogen ratio a man’s libido and sexual performance often improves.

One of the easiest ways to accomplish this restoration of the normal T\E ratio is to prevent testosterone from being converted into excess estrogen. Too much estrogen plays havoc with a man’s sex life by binding to testosterone receptor sites and also the associated increase in SHBG, which decreases the freely available testosterone.
Certainly estrogen is a necessary hormone for men just as testosterone is necessary hormone for women.

The problem of an abnormal ratio of T\E can easily be diagnosed with a simple blood test for estradiol. Levels that are greater than 30pg/ml are abnormal and would benefit from treatment that lowers the estrogen level and the SHBG levels.

Treatment of elevated estradiol in men can be accomplished with a prescription medication, Armidex, which is aromatase inhibitor and blocks the conversion of testosterone to estrogen. The dosage is 50mg\day. Studies have demonstrated that this dosage decreases the estrogen level in approximately one month.

Bottom Line: Testosterone deficiency is a common problem affecting many middle age and older men. Often this is due to an imbalance of testosterone\estrogen ratio. This can be easily treated with oral aromatase inhibitors. So if you are middle age and your doctor prescribed testosterone and it isn’t working, I suggest you speak to him or her about getting an estradiol level and if it is elevated, then treatment with an aromatase inhibitor.

Dr. Neil Baum is a physician practicing at Touro Infirmary and can be reached at his office, 504 891-8454, or via his website, http://www.neilbaum.com

Saying Goodbye To Jumping Jack “Hot” Flash

Not all women will experience hot flashes, but three out of four will, with one of 10 experiencing them through their seventies. The cause of hot flashes are the dilation of the blood vessels in the face and upper chest result in increased blood flow to these areas. Some women also sweat during hot flashes. For some women, the hot flashes are not very common and are an inconvenience. For other women, they impact the woman’s quality of life and are incapacitating. The time-honored treatment for hot flashes has been estrogen replacement therapy or hormonal therapy. While hot flashes are not dangerous, they cause discomfort, embarrassment and sleep loss. During menopause some women may have more than 10 a day.

Women with uncomfortable hot flashes now have a medication option that doesn’t involve hormones. The U.S. Food and Drug Administration approved the first nonhormonal drug to treat moderate to severe hot flashes and night sweats associated with menopause. The drug, Brisdelle, contains peroxetine, a selective serotonin reuptake inhibitor (SSRI) that is also the active ingredient in the antidepressant Paxil.

Many women are reluctant to treat menopausal symptoms with hormones including estrogen and progesterone, as a 2002 study conducted by the Women’s Health Initiative implied that a combination of hormones, estrogen and progesterone, with increased cancer risk.

Side effects of the drug included headache, fatigue, nausea and vomiting. Brisdelle will be available starting in November.

Bottom Line: Every woman would like to have her hot flashes disappear like magic. Although estrogen replacement therapy has been effective in reducing hot flashes, many women do not want to take hormones. Brisdelle may just be the solution that many women have been waiting for.

Read more: http://www.nydailynews.com/life-style/health/nonhormonal-hot-flash-treatment-approved-fda-article-1.1388094#ixzz2XvmVGY89

Hormone Headaches-You Don’t Need To Suffer Every Month

Menstrual Migraine

So Many Of Our Patients Are Plagued By Headaches during their menstrual periods. These headaches can be debilitating and are usually related to changing levels of estrogens that occur each month. Let us give you some suggestions that can relieve these hormonal headaches.

Entice the endorphins
If you exercise you can reduce the risk of menstrual migraines. This can be as easy as walking, jogging, biking, or swimming. These exercises increase the release of endorphins, which are nature’s most powerful pain relievers even more powerful than morphine.

Eliminate food triggers
The most common triggers are aged cheeses, processed meats with nitrites, chocolate, excessive caffeine, alcohol (especially red wine), citrus fruits, bananas, onions, and foods containing MSG.

Have a routine
Don’t skip meals, sleeping late on weekends, or any changes in your usual schedule can lead to menstrual headaches.

Rest and relax leads to relief
Yoga, meditation, or biofeedback teaches you how to control the muscle contractions and swelling of the blood vessels around your brain.

Put a little magnesium in your diet
We suggest 400-600 mg of chelated magnesium a day.

Pain pills.
At the first sing of a headache take a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen. Also over the counter aspirin and acetaminophen may be helpful. If you know the day you are going to experience a headache, take a pain reliever two days before your anticipate your headache.

Estrogen
It may be helpful to increase your estrogen levels by taking 1mg of estrogen (17 beta-estradiol) twice a day7 2-3 days prior to your period and continue for 2-3 days during your period.

Triptans
This is the latest and best medication according to headache experts. Triptans, such as Imitrex, Maxalt, Zomig, stop the pain within hours after the pain starts and you can start the medication at the first sign of a migraine.

Bottom Line: Menstrual migraines are very common and can be debilitating for women who have these monthly headaches. Most of these headaches can be controlled by without medications but if the headaches are severe, speak to your doctor and he\she can help with medication.

for more information on pelvic pain, triggers of hormonal headaches, and menopause, please see our book, What’s Going On Down There-Improve Your Pelvic Health, available from Amazon.com

Book on Pelvic Health By Drs. Siddighi and Baum

Pelvic Pain-May Be Caused By Birth Control Pills

Birth Control Pills With Estrogen

Low-dose oral contraceptives might increase the incidence of chronic pelvic pain in young women, especially during sexual climax, a new study suggests. This is a side effect that is not discussed and is not in the package insert.
Current oral contraceptives contain very low-dose estrogen, which causes changes in serum estradiol, free testosterone levels, hormonal receptors, and vulvar mucosa. The researchers hypothesized that this could result in pelvic pain.

Low-dose estrogen users were significantly more likely to meet the criteria for a diagnosis of chronic pelvic pain than nonusers.

Bottom Line: If you have chronic pelvic pain and are using low dose estrogen birth control pills, you may want to speak to your doctor about changing your medication to a birth control pill that does not contain low estrogen.

Hot Flashes? Exercise Your Way To Cool The Fire

Hot flashes are one of the most disturbing aspects of menopause. It makes women uncomfortable and can wreck havoc on their lives. This blog will describe how exercise can cool the hot flash.

Increased energy and a fit body are just a few of the benefits of exercising. There is another advantage of working out for women. For menopausal women who exercise, they experience fewer hot flashes in the 24 hours after physical activity.

Women who are inactive or obese are more likely to have a higher risk for hot Women in a study at Penn State had fewer hot flash symptoms following exercise. As well, women who were identified as overweight, had a lower level of fitness, or experienced more frequent or more intense hot flashes, sensed the smallest reduction in symptoms.

Bottom Line: Becoming and staying active on a regular basis as part of your lifestyle is the best way to ensure healthy aging and well being, regardless of whether you experience hot flashes or not.

The findings are published in the current issue of Menopause.

Brain Health and Your Blood Pressure-One More Reason To Check For and Treat Hypertension

Researchers at University of California, Davis found that high blood pressure could damage the brain’s structure and function in people as young as 40.

They found accelerated brain aging among hypertensive and prehypertensive individuals in their 40s, including damage to the structural integrity of the brain’s white matter and the volume of its gray matter.

This suggests that vascular brain injury develops insidiously over the lifetime with discernible effects. The study is the first to demonstrate that there is structural damage to the brains of adults in young middle age as a result of high blood pressure.

Structural damage to the brain’s white matter caused by high blood pressure has been associated with cognitive decline in older individuals.

The research emphasizes the need for lifelong attention to vascular risk factors for brain aging.

Normal blood pressure has a systolic blood pressure below 120, and a diastolic pressure below 80. Prehypertension blood pressure range is a top number between 120 and 139, and a bottom number between 80 and 89.

Elevated blood pressure affects about 50 million Americans and is associated with a 62 percent risk of cerebrovascular disease, and a 49 percent risk of cardiovascular disease.

The study says there is evidence that lowering blood pressure among people in middle age and in the young elderly can help prevent late-life cognitive decline and dementia.

Bottom Line: People can influence their late-life brain health by knowing and treating their blood pressure at a young age, when you wouldn’t necessarily be thinking about it.

For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com

New book on women’s health

Sex Life In the Tank? Suggestions For Getting Back on Track

Sex Life In the Tank? Six Suggestions For Getting Back on Track

The movie, Hope Springs, with Meryl Streep and Tommy Lee Jones, which describes a couple that, have fallen out of love and had their sex life in the tank. With the help of a therapist, staring Steve Carrell, they were able to rekindle the sexual fire that they once had. What can you do if the same thing is happening to you?

Try Something New-It Is The Spice of Line
There’s biological evidence that novel experiences, both sexual and non-sexual, cause the release of dopamine in the brain. Dopamine is a chemical messenger that’s connected to the pleasure center in your brain. Remember how exciting your romance was when you first met and first had sexual intimacy? That’s because the romance was novel and everything is novel and your brain responds accordingly.

Be creative. Try a different place, a different time, a different position, a new sex toy. Sex every Saturday night in bed with papa on top for 4 minutes is not going to cut it. Try having a morning quickie. Attempt sex in the shower, or on the kitchen island. Do it on the floor or in the changing room at Victoria’s Secret. It isn’t a secret that you won’t be the first couple that tried that venue! Try it at 25,000 feet on your next flight.

Got a headache or are too tired? Take a Romantic Break
All couples are tired at the end of a long day with many demands. By the time you get everyone to bed and deal with unavoidable chores, you just don’t have the energy for a romantic evening.
Instead of waiting until just before you put out the lights, take a break from the computer the newspaper or a TV show (unless it is Modern Family) for a romantic encounter before going night-night.

Take Your Sex Life Off of the Back Burner
Make a date with your partner. Set aside one day a week to have time together. Hire a baby sitter and leave the home for something special. I don’t suggest that you go for the humdrum such as dinner and a movie thing, which seems like it’s supposed to be a lead-in to sex. Instead tray a shared experience such as biking, bowling, or something silly. Return from your night out with new sexual vigor and you can be sure you will be singing, “Come on baby light my fire!” Now don’t make date-night a once upon a time event. Make it a priority and stick to it like you stick to the other obligations on your schedule. Let it become a habit, and you’ll feel reconnected, and the desire will just grow from there.

If It Hurts, Get Help-NOW
Sometimes it’s not that you’re not feeling in the mood, it’s that your body isn’t cooperating because sex is actually painful. This can be a big issue for women approaching menopause, and you might be too embarrassed to tell your partner. It is entirely normal for women to have vaginal dryness after menopause. When the vaginal lining becomes thin and dry this can result in painful intercourse. This pain is due to an estrogen deficiency and can be corrected with oral or topical estrogen creams or vaginal tablets.

For women who have had breast cancer and should not use any estrogen supplements, there are lubricating jellies like K-Y jelly Vaseline, or Replens that do not contain any estrogens but do decrease the friction and pain associated with sexual intimacy.
Some men have a condition called Peyroine’s disease, which results in a significant bend of the penis resulting in pain for both the man and the women. There are treatments for this condition and men should see their urologist. (For more information on Peyroine’s disease see my YouTube video at http://www.youtube.com/watch?v=qkZZPBdWztY)

Your Libido or Sex Drive Has Mysteriously Disappeared
A dwindling libido may not just be a sign of aging. It may be the sign of another health problem or behavioral issue. For example: Depression, anxiety, and hormonal imbalances can all contribute to sexual dysfunction. In men, the inability to get an erection can be an early warning sign of diabetes or heart disease, or testosterone deficiency. Some medications, including antidepressants and blood pressure drugs, can lower your sex drive. Smoking and excessive alcohol consumption can put a damper on sexual response. Even too much time on the bike can lead to problems in bed. Both men and women who are always on their spin bike or the small seat on a road bike can have problems with orgasm and arousal, because of the pressure put on the nerves and blood vessels that supply the penis or the vagina. Sleep apnea can also be a culprit and can lead to lack of oxygenation of the genital tissues. See blog (https://neilbaum.wordpress.com/2012/08/17/not-enough-sleep-can-lead-to-not-enough-sex/) for more information on sleep apnea and its treatment.

Bottom Line: Sex at age 20 is easy and fun and occurs without any effort. Sex in mid life can take some work, effort, and time. Invest in your relationship; you will be happier, healthier, and will have more love and affection from your partner. If that isn’t reason enough to get your sex life back on track, tell your partner that Dr. Baum prescribed it!

If you have any ideas for putting the fire and passion back into your relationships, let me hear from you. I’m always looking for new ideas. Don’t hold back. No idea is too wild or far out.

This blog was modified from a recent post on WebMD by Gina Shaw (https://mail.google.com/mail/u/0/?hl=en&shva=1#inbox/13939af485fb6048)

When Sex Is No Longer Fun For Women

Women have sex drive and libido just like men. Although the sex drive of women is hormonally based and when the hormones are not aligned properly, havoc takes place. There are also a dozen other physical causes that can affect a women’s interest in sex. However, help is available and most women with decrease or loss of libido can be helped.
A woman’s desire for sex is based on a complex interaction of many components affecting intimacy, including physical well-being, emotional well-being, experiences, beliefs, lifestyle and current relationship. If you’re experiencing problems in any of these areas, it can affect your sexual desire.
Physical causes
Numerous nonsexual diseases can also affect desire for sex, including arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. Infertility also can contribute to low sex drive, even after infertility treatments are over.
Many prescription medications — including antidepressants, blood pressure medications and chemotherapy drugs — are notorious libido killers. Antihistamines also can diminish your sex drive.
A glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive; the same is true of street drugs.
Any surgery related to your breasts or your genital tract can affect your body image, function and desire for sex. Also, surgery in the pelvis on the uterus or ovaries can affect a woman’s sex desire and interest.
Finally, changes in your hormone levels may change your desire for sex: Estrogen helps maintain the health of your vaginal tissues and your interest in sex. But estrogen levels drop during the transition to menopause, which can cause a double whammy — decreased interest in sex and dryer vaginal tissues, resulting in painful or uncomfortable sex. At the same time, women may also experience a decrease in the hormone testosterone, which boosts sex drive in men and women alike. Although many women continue to have satisfying sex during menopause and beyond, some women experience a lagging libido during this hormonal change.
Treatments for low sex desire
Unfortunately, there is no simple pill or potion to increase sex drive in women. In fact, most women benefit from a multifaceted treatment approach aimed at the many causes behind this condition. This may include sex education, counseling, lifestyle changes and sometimes medication.
Healthy lifestyle changes can make a big difference in your desire for sex: Regular aerobic exercise and strength training can increase your stamina, improve your body image, elevate your mood and enhance your libido. Finding a better way to cope with work stress, financial stress and daily hassles can enhance your sex drive. Pelvic floor exercises (Kegel exercises) can improve your awareness of the muscles involved in pleasurable sexual sensations and increase your libido. To perform these exercises, tighten your pelvic muscles as if you’re stopping a stream of urine. Hold for a count of five, relax and repeat. Do these exercises several times a day. Remember a Kegel a day keeps the sex drive up so you can have a great time in the hay!
Systemic estrogen therapy — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in women. However, replacing testosterone in women is controversial and it’s not approved by the Food and Drug Administration (FDA) for sexual dysfunction in women. Plus, it can cause negative side effects, including acne, excess body hair (hirsutism), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgery to remove the ovaries (oophorectomy). If you choose to use this therapy, your doctor will closely monitor your symptoms to make sure you’re not experiencing negative side effects. I have had several dozen patients who have used testosterone replacement therapy for decreased libido with amazing results.

Bottom Line: Sex is not over when a women enters middle age. There are many treatment options that can help her get back in the saddle. Contact your doctor for more information.

This article has been excerpted from the May Clinic Newsletter: http://www.mayoclinic.com/health/low-sex-drive-in-women/DS01043/DSECTION=causes