Menopause
The menopause transition typically begins between 40 and 50 years of age (average 47.5). The duration of perimenopause may be for up to eight years. Women will often, but not always, start these transitions (perimenopause and menopause) about the same time as their mother did.
Hormone replacement therapy
The maintenance and improvement of quality of life during the menopausal period is at the core of estrogen and progestogen-based HRT. Both HRT and estrogen replacement therapy (ERT) have been shown to enhance sexual desire in a significant percent of women; however, as with all pharmacological treatments, not all women have been responsive, especially those with preexisting sexual difficulties. ERT restores vaginal cells, pH levels, and blood flow to the vagina, all of which deterioration are associated with the onset of menopause. Dyspareunia (due to vaginal dryness) appears to be the most responsive component of menopausal women’s sexuality to ERT. It also has been shown to have positive effects on the urinary tract and atrophy and may initially improve libido or sexual sensitivity. Other improvements in areas such as sexual desire, arousal, fantasies, and frequency of coitus and orgasm have also been noted. However, the effectiveness of ERT has been shown to decline in some women after long-term use. A number of studies have found that the combined effects of estrogen/androgen replacement therapy can increase a woman’s motivational aspects of sexual behaviour over and above what can be achieved with estrogen therapy alone. Findings on a relatively new form of HRT called tibolone — a synthetic steroid with estrogenic, androgenic, and progestogenic properties — suggest that it has the ability to improve mood, libido, and somatic symptoms of surgically menopausal women to a greater degree than ERT. In various placebo-controlled studies, improvements in vasomotor symptoms, emotional reactions, sleep disturbances, somatic symptoms, and sexual desire have been observed. However, while this is and has been available in Europe for almost two decades, this has not been approved for use in North America at this point.