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Sexual difficulties in the menopause

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Key Points

  • Sexual difficulties can be life-long or recently acquired, but they are a common presentation at menopause.
  • Hormones are rarely the only factor involved in desire-arousal problems.
  • Declining sexual function correlates with falling oestradiol and not with testosterone.
  • Available testosterone does not decline over the menopausal transition.
  • Psychological and lifestyle issues always need to be addressed.
  • Start by optimising oestrogen therapy.
  • A trial of testosterone therapy may be appropriate for some women whose symptoms do not improve on MHT alone.
  • Formulations of androgens for the treatment of male hypogonadism should never be used in women.