The three primary sex hormones for women are estrogen, progesterone, and testosterone. Testosterone naturally declines with age—at least in our modern Western experience. Estrogen, often considered the primary female hormone, drives sexual differentiation, regulates menstrual cycles, and plays a key role in fertility. Progesterone serves as a counterpart to estrogen and is linked to ovulation and pregnancy.
Most people focus on estrogen and progesterone. Estrogen, in particular, plays a crucial role in maintaining vaginal health. It helps sustain an acidic environment and the vaginal microbiome, which we are now learning more about. While we already understand a great deal about the gut microbiome, research on the vaginal microbiome is expanding, revealing its unique bacterial composition and functions.
As estrogen declines, we often see thinning of the vaginal tissue responsible for producing lubrication, maintaining pH balance, and preserving elasticity in the vaginal walls, vulva, clitoris, and perineum. Without exogenous hormone replacement therapy, this decline can lead to decreased lubrication, skin thickness, and elasticity, often resulting in dyspareunia (painful intercourse), which is a common concern for menopausal women.
For some women, testosterone plays a bigger role in libido, influencing sex drive and desire. While it’s not a universal solution, some women benefit from adding testosterone to their hormone replacement therapy. Female biology is complex, and sex drive is influenced by multiple factors beyond hormones, including emotional connection, psychological well-being, and relational dynamics.
Unlike men, who have pharmaceutical options for boosting libido, there is no single "magic pill" for women to enhance sexual desire or orgasm. Some women respond well to specific interventions, while others do not. In my experience, one of the most important factors in maintaining a healthy sex drive is ensuring comfort by optimizing hormone levels and vaginal health. Additionally, a woman’s connection with herself and her sexual partner plays a significant role.
For some couples, this transition is difficult to navigate and can signal the beginning of the end of the relationship. However, for others, it presents an opportunity to consciously redefine intimacy, explore new ways to connect, and create a shared vision for the future.
Ultimately, the key is helping women understand the tools available to them and finding what works best for each individual.
PART 2: Expanding the Menopause and Sexual Health Conversation
As we deepen the conversation about menopause and sexual health, it’s essential to broaden our understanding of available therapies and strategies that support women through this transformative stage of life. Hormonal changes are only part of the equation — the interplay of physical, emotional, and relational health demands a holistic, personalized approach.
One of the most widely discussed interventions for menopausal symptoms is hormone therapy (HT). While systemic hormone therapy — using estrogen alone or combined with progesterone — can alleviate hot flashes, night sweats, and mood fluctuations, it also plays a significant role in supporting vaginal health. Vaginal estrogen therapy, delivered via creams, tablets, or rings, is highly effective for treating genitourinary syndrome of menopause (GSM), a condition encompassing vaginal dryness, irritation, urinary urgency, and recurrent infections. Importantly, vaginal estrogen works locally with minimal systemic absorption, making it a safe and practical option for many women, including those who may not be candidates for systemic hormone therapy1.
Another often overlooked but essential aspect of sexual wellness is pelvic floor health. The pelvic floor muscles support the bladder, uterus, and rectum while also playing a key role in sexual function. With age, hormonal decline, and childbirth history, these muscles can weaken, contributing to symptoms such as urinary leakage, pelvic pressure, and decreased sexual sensation. Pelvic floor physical therapy is a specialized, non-surgical treatment that helps women regain strength, improve muscle coordination, and reduce pain during intercourse. Through targeted exercises, biofeedback, and manual therapy, pelvic floor specialists can restore function and improve quality of life for menopausal women2.
In recent years, the field of vaginal rejuvenation therapies has expanded, offering non-hormonal options to enhance vaginal health. These procedures — which include laser therapy, radiofrequency treatments, and platelet-rich plasma (PRP) injections — aim to stimulate collagen production, improve blood flow, and rejuvenate vaginal tissues. While some evidence supports their effectiveness in alleviating dryness, discomfort, and laxity, it’s important to approach these options with a well-informed perspective. Women should consult with a qualified healthcare provider to discuss potential benefits, risks, and realistic expectations, as the regulatory landscape for these therapies continues to evolve3.
Sexual wellness counseling is another vital resource that is too often underutilized. Menopause can trigger significant changes in body image, self-esteem, and intimate relationships. Women may find themselves navigating uncharted emotional territory, questioning long-held beliefs about sexuality and partnership. Trained sex therapists and counselors offer a supportive, nonjudgmental space to explore these changes, address concerns, and foster new pathways to intimacy. Counseling can be especially valuable for couples, helping to redefine intimacy and communication during this period of transition4.
In addition to medical and therapeutic interventions, lifestyle factors play a pivotal role in supporting sexual health during and after menopause. Regular physical activity, particularly exercises that engage the core and pelvic floor, can improve circulation and muscle tone. A balanced, nutrient-rich diet supports hormonal metabolism and tissue health, while stress-reduction practices like yoga, mindfulness, and meditation contribute to emotional well-being and sexual vitality.
It’s also important to acknowledge that cultural and social narratives around menopause and female sexuality deeply influence women’s experiences. Many women grow up internalizing messages that associate aging with decline, invisibility, or diminished desirability. Shifting this narrative toward one of empowerment, vitality, and self-discovery can have a profound impact. Menopause can serve not only as an end to fertility but also as the beginning of a new, self-directed chapter in a woman’s life — one in which sexual health and pleasure remain important, attainable, and worthy of attention.
Ultimately, there is no one-size-fits-all solution. The journey through menopause is as individual as the women experiencing it. By embracing a comprehensive, evidence-based, and compassionate approach that includes hormone therapy, pelvic floor health, regenerative treatments, counseling, and lifestyle strategies, we can better support women in reclaiming their sexual health and well-being in midlife and beyond.
References
North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794. doi:10.1097/GME.0000000000002028 ↩
Nygaard IE, Shaw JM. Physical activity and the pelvic floor. Am J Obstet Gynecol. 2016;214(2):164-171. doi:10.1016/j.ajog.2015.08.067 ↩
Salvatore S, Nappi RE, Zerbinati N, et al. Genitourinary syndrome of menopause: vaginal laser therapy vs vaginal estrogen therapy. Menopause. 2014;21(9):924-929. doi:10.1097/GME.0000000000000215 ↩
Brotto LA, Smith KB, Sadownik LA. Sexual health in menopause: a focus on intimacy. Women's Midlife Health. 2022;8(1):1-9. doi:10.1186/s40695-022-00079-6 ↩
FACING HAIR LOSS LATE IN LIFE: A REVELATION
Undisclosed contributor: Edited by Women's Health Digest
The realization hit her like a wave—an uncontrollable force of anxiety and grief. She felt sick to her stomach, overwhelmed by the thought that she might lose her hair entirely. She had always believed that something like this could never happen to her. Her hair was too thick, too strong. But now, standing in front of the mirror, she saw the signs staring back at her.
SOCIAL VALUE vs PERSONAL MOJO
It was in that moment that she truly understood the emotional weight of hair loss—not just for herself, but for others who had faced the same struggle. She thought of the men and women she had encountered throughout her life who had experienced hair loss. She had always been aware of it, of course, but it had never felt personal. Now, it was different. Now, she understood the depth of loss, the fear, the frustration. And she realized how little she had known about helping others who had gone through the same thing.
Hair, she came to understand, was not just an aesthetic feature. It was deeply tied to a person’s identity, their sense of self-worth, and even their place in society. The ideal of beauty, so often portrayed in magazines and movies, revolved around thick, healthy hair. It was a marker of youth, vitality, and even power. Losing it felt like losing a piece of herself. The stigma attached to hair loss weighed on her heavily. For some, like those undergoing chemotherapy, hair loss had been embraced with bravery, slowly reducing societal stigma. But for those experiencing unexplained or gradual thinning, the shame and emotional toll remained significant.
As she sought answers, Mary discovered the complexity of hair loss, particularly in women. She learned that there were multiple causes—immune disorders, inflammation, hormonal shifts, and genetic predispositions like androgenic alopecia. She read about how certain conditions, like eczema and psoriasis, could disrupt hair follicles through inflammation. She learned about how pregnancy, menopause, and hormonal imbalances could trigger shifts in hair growth cycles, sometimes leading to temporary loss, but other times causing permanent changes.
One of the most striking revelations was how little research had been dedicated to female hair loss compared to male hair loss. Most treatments had been developed based on studies conducted on men, largely because their hormonal stability made them easier test subjects. Finasteride, minoxidil—these treatments were designed with men in mind, with women’s unique biological differences often overlooked. What limited research existed showed that women’s hair loss did not always follow the same mechanisms as men’s, but there were still too many unanswered questions.
As she continued her research, Mary realized another significant challenge—the fragmentation of medical expertise in addressing hair loss. Dermatologists, gynecologists, endocrinologists, and hair restoration specialists each had their own body of knowledge, but there was little cross-collaboration between them. The lack of an integrated approach meant that many patients, like herself, were left navigating conflicting information and incomplete solutions.
GLOBAL VILLAGE
She discovered organizations and researchers dedicated to bridging these gaps, such as Learn Skin, which was pioneering integrative dermatology approaches. Their work incorporated functional medicine, aiming to identify root causes rather than just treating symptoms. It was a slow process to change conventional medicine, but Mary found hope in these emerging perspectives. If medical professionals could collaborate more effectively and approach hair loss from multiple angles—genetic, hormonal, and environmental—perhaps future generations would have better solutions.
Mary’s journey was one of transformation. What began as personal devastation evolved into a mission to understand and advocate for better awareness and treatments. She had once felt powerless, but through knowledge, she gained strength. She learned that early diagnosis and prevention could make a difference and that, like so many other health conditions, research and understanding had the potential to change lives.
Though she still faced the challenge of her own hair loss, Mary no longer felt alone. She was part of a broader conversation—one that was just beginning to acknowledge the true impact of hair loss on women. And with every new discovery, she grew more determined to ensure that no one else would have to face it without answers, without support, or without hope.
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