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.