June 5, 2007

Low libido in menopause linked to trouble sleeping

Depression and night sweats also involved, say Group Health researchers

Seattle—Women whose sexual desire diminishes during menopause are more likely to report disturbed sleep, depression symptoms, and night sweats, according to Group Health research in the June American Journal of Obstetrics and Gynecology.

To the best of the research team’s knowledge, this marks the first time that sleep disturbance has been independently associated with diminished sexual desire during or after menopause.

The paper is based on data from Group Health's Herbal Alternatives for Treatment of Menopause Symptoms (HALT) study. Other results from this study, showing that the herbal supplement black cohosh did not relieve menopausal hot flashes or night sweats (hot flashes during sleep), were reported in the Annals of Internal Medicine in 2006.

All 341 of the women were chosen to be in the study because they were age 45 to 55 and had hot flashes, night sweats, or both. Of them, 64 percent reported diminished sexual desire, 43 percent slept poorly, and 18 percent had major depression.

"It seems reasonable that night sweats can disturb sleep," said Susan D. Reed, MD, MPH, the paper’s lead author. Dr. Reed is an associate professor of obstetrics and gynecology and epidemiology at the University of Washington and an affiliate investigator at Group Health Center for Health Studies. "And poor sleep can reduce energy for everything, including sex."

However, Dr. Reed cautioned against inferring cause and effect between depression and low libido. "They are each so complex that the interactions can be difficult to tease apart."

Dr. Reed noted a well-established "catch 22": Like depression itself, treating depression with a selective serotonin reuptake inhibitor (SSRI), the most common type of antidepressant medication, can interfere with interest in sex. Likewise, she added, although systemic hormone therapy with estrogen can reduce vaginal dryness, it can also lower women’s natural testosterone, which affects some women’s libido.

"Before starting any drug treatment for changes that happen in menopause, women need to weigh their individual risks and benefits with their doctors," said Dr. Reed. She advocates beginning with self-care to lessen depression and sleep problems (see below). Previous studies have established that, for women, the most important factor for maintaining sexual desire is the quality of their intimate relationships. "Diminished desire can be a red flag that the relationship needs some work," she said. "Middle age is a great time for couples to check in with each other and work toward improving communication and nurturing their partnership."

With age, sexual desire may be diminished for both women and men, said Dr. Reed, whose clinical practice is at the Women's Clinic at Harborview Medical Center in Seattle. But gender differences may complicate matters. "For women, greater intimacy tends to open the door to more sexual desire," she said. "That’s not always true for men."

"Our work reinforces the difficult time some women have during the menopause transition, and the importance of other symptoms happening at the same time," said Katherine M. Newton, PhD, associate director of Group Health Center for Health Studies and principal investigator of the HALT study. "We are planning future studies to explore further the associations between depression, night sweats, sleep, and libido, including genetic determinants."

The National Institute on Aging and the National Center for Complementary and Alternative Medicine funded the study. The other authors are Andrea LaCroix, PhD, Louis Grothaus, MA, and Kelly Ehrlich, MS, of Group Health Center for Health Studies.

Self-care tips for menopause

Changes that happen with menopause can disturb women’s sense of well-being. But experts recommend a variety of steps that women can take on their own to feel better through the transition. Jane Ann Dimer, MD, a 44-year-old Group Health Women’s Health Service line chief, provided these self-care suggestions for the following menopause-linked symptoms:


  • Support ongoing regular physical exercise—whatever works for you (be it yoga or karate)—to promote fitness, balance, social networking, and an energetic approach to life.
  • Eat small, balanced meals, including snacks, at regular intervals. Avoid getting too hungry or overeating, because a full stomach can make you feel glum.
  • Try new activities.
  • Spend some time every day outside in the daylight.

Low libido:

  • Address the changes that menopause and age—including changes in male sexual response—can bring to relationships.
  • Be aware that both women and men may need more time for arousal.
  • Try learning to massage each other.
  • Talk to your doctor about solutions for vaginal dryness, e.g., lubricants and topical estrogen.

Vaginal dryness:

  • Talk to your doctor about applying small amounts of vaginal estrogen, e.g., through an estradiol vaginal ring (which is discrete and not messy and can have the secondary effect of raising interest in sex through novelty).
  • Avoid unhealthy practices, e.g., douching and over-the-counter vaginal creams.

Night sweats:

  • Sleep in a cool room. Near your bed, place ice water and a fan—or a spray bottle with plain or scented water.
  • Avoid possible triggers such as very hot liquids and alcohol.

Disturbed sleep:

  • Try taking a warm shower just before going to bed: The effect of cooling off may help you drift to sleep.
  • Try wearing a sleep mask.
  • Especially if you snore, are overweight, or have lung problems, talk to your doctor about the possibility that you might have undiagnosed sleep apnea.
  • Some sleep disturbance results from tooth grinding. So ask your dentist whether you grind your teeth; if so, wearing a night guard might decrease your tooth grinding and help you sleep more soundly.


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