Chapter 11 – Menopause

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Other issues to consider

Decrease in libido 

This issue is complex and multifactorial. Factors that lead to a decrease in libido may include relationship to partner, expectations of sexual activity, competing work and family agendas, general health, and the presence of other menopausal symptoms such as vulvovaginal atrophy causing dyspareunia. A discussion about sexual health should be a routine part of the menopause consultation. A biopsychosocial approach to management should be taken.(32) Management options: local vaginal therapy, in particular vaginal estrogen, helps reduce discomfort during intercourse tibolone may help to improve libido in some women although data is limited if on MHT changing to transdermal estradiol rather than oral estradiol may be helpful due to a lower effect on testosterone levels than oral preparations a transdermal 1% iopsychosoc preparation ( Androfeme®) was approved by the TGA in November 2020 for the treatment of hypoactive sexual desire dysfunction in post menopausal women. It may be useful after exclusion of other causes for low libido using a iopsychosocial model. Blood levels of testosterone should be obtained as a baseline and then levels should be monitored to ensure that testosterone levels do not exceed a normal premenopausal range. A practice guideline for the use of systemic testosterone for women with HSDD was ... Buy now