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Drop in romantic interest can have many causes

SHARE Drop in romantic interest can have many causes

Question: I am a 47-year-old married woman with four children. Over the past few years I've noticed that my interest in romance has dropped off dramatically. I've also had a lot of hot flashes and irritability, but I'm not in menopause yet. Can you help me?

Answer: Yours is a common complaint and one that has several possible causes. Although you are not yet menopausal, you are undoubtedly in the perimenopause — the period of a woman's life just before menopause. Your ovaries are beginning to falter, and this has resulted in a drop in your serum estrogen level.

A decrease in estrogen leads to hot flashes and emotional irritability. It can also account for a loss of interest in sex. Another major cause of loss of libido in women your age is a drop in the serum testosterone level. Women manufacture the "male" hormone right along with estrogen and progesterone, but when the ovaries begin to fail in the perimenopause, testosterone levels also decrease.

Testosterone has a direct effect on the brain's sex centers and is the major biologic determinant of a person's sex drive. Menopausal women make about half the testosterone they did in their reproductive years, thus accounting for a loss of libido in some women at this stage of life. (Men also have decreasing testosterone levels with advancing age, but the drop is more gradual. A decrease in circulating testosterone levels can cause a loss of interest in sex and erectile dysfunction in men.)

Most gynecologists don't bother with measuring testosterone levels in women since a single measurement does not necessarily provide an accurate picture of testosterone production and metabolism. Rather, they rely on a description of your symptoms in order to determine whether a trial of testosterone might be of value.

Some women notice substantial improvement in libido by taking testosterone, although there are occasionally unwanted side effects, such as acne and facial hair growth. (Testosterone comes in pill form but some pharmacies can also make up lozenges at the direction of your physician; there are no FDA-approved over-the-counter testosterone products available.)

Although testosterone is clearly the strongest biological determinant of libido, there are a host of other factors, both biologic and nonbiologic, that contribute to a woman's interest in sex. The two most important nonbiologic influences are the quality of the marriage relationship and the amount of stress in a woman's life. Indeed, these factors are often the most important determinants of libido.

It's been said that the best aphrodisiac is a great relationship. Women who are in loving and satisfying relationships are more likely to want and enjoy fulfilling physical intimacy. Conversely, the biggest damper on libido is a troubled relationship. Who wants to be intimate with someone with whom you're not getting along?

You and your husband would benefit by spending some time evaluating where things stand between you. Changes in how you communicate, express affection and spend time together may be needed in order to get things back on track. Proper nourishing of the relationship is critical to romantic success.

A major challenge of married life lies in figuring out how to keep the romance flame alive despite the presence of significant stressors. For women between 35 and 50 in particular, juggling the demands of being a wife, mother, homemaker, wage-earner and church or community member is a daunting task and can exact a significant emotional toll. When it does, a woman"s interest in sex will usually dwindle.

Stress reduction may help you regain sexual feelings. This may require you to reevaluate your responsibilities, alter expectations or change your current life situation in some way. Talking this through with your husband or a trusted friend may help you figure out what to do.

Finally, a variety of other factors must be considered as causes for decreased libido. These include problems in your general health, fatigue, depression, the effects of medications you might be taking and other unresolved emotional problems. A visit to a physician experienced in these matters will help you discover the source of your current difficulties and determine the best course of action.

Keep in mind that a loss of libido in younger women is usually due to psychological or emotional stressors, while physiologic or medical problems are more often to blame in older women.

Stephen Lamb practices OB/GYN at the Millcreek Women's Center in Salt Lake City. He is also the co-author of "Between Husband and Wife."

E-MAIL: slamb@desnews.com