perimenopause

How to be sexy (and know it) at any age

March 2, 2012 at 1:04 PM ET

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By Genevieve Field

Prevention

Your hormones have a tremendous effect on your libido. We've created this simple guide to understanding how these little chemical messengers can make you feel anywhere from ho-hum to hot, hot, hot.

A sparkling sex life is something we'd all like to have, regardless of age. When sex is less than satisfying, it's easy to point the finger at work, money, family, and a million other factors that combine to make it less important and, thus, less fulfilling. But as today's leading physicians and sex researchers are discovering, the link between female libido and the constantly fluctuating hormones produced by the ovaries is profound. Find out how controlling your body's unique balance can make the difference between a sex life that's so-so and one that soars.

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In Your 20s

The advantages

A dazzling time to do it: "At this age, estrogen, progesterone, and testosterone are at their highest levels," says Laura Berman, PhD, the author of Loving Sex: The Book of Joy and Passion. This biological bounce is an opportunity for lots of great loving--and babies too. Because hormones surge just before ovulation, women are more likely to fantasize about and initiate sex during this 2-to 4-day window, according to studies.

The challenges

A need for more roar-gasms: According to the 2010 National Survey of Sexual Health and Behavior, 20-somethings are less orgasmic than older women. "Despite the hormone swirl, women in their twenties may not yet have the confidence to ask for what they want in bed, so they're less satisfied," says Christiane Northrup, MD, the author of Women's Bodies, Women's Wisdom.

A sex-drive stopper: A recent study in the Journal of Sexual Medicine confirms that the Pill, a 20-something birth control favorite, actually causes a decrease in sex hormones, especially testosterone (p. 88).

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In Your 30s

The advantages

Prime time: "A woman in her thirties may well find herself at an emotional sexual peak," says Dr. Berman. "She's clear about what she wants, even though estrogen, progesterone, and testosterone begin to fluctuate and drop off during this decade."

More good news: Studies have shown that as women age, they become less anxious about their physical "flaws," which helps when one is baring all in the bedroom. "The key," says Dr. Northrup, "is to think of yourself as a sexy, attractive woman, regardless of hormone tempo."

The challenges

Mommy madness: After childbirth, testosterone falls to extremely low levels, and in nursing mothers, the hormone prolactin can suppress ovulation, as well as the production of estrogen and progesterone. All of that combines to make the thought of sex a big fat snore. One suggestion? Masturbation. Regardless of age, just using your equipment will turn on your equipment, which will in turn improve circulation and help balance your hormones.

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In Your 40s

The advantages

Call of the cougar: As a new study conducted at the University of Texas at Austin posits, female sex drive may actually increase as a woman's sex hormones and fertility decrease. "Women with declining fertility think more about sex, have more frequent and intense sexual fantasies, are more willing to engage in sexual intercourse, and report actually engaging in sexual intercourse more frequently than women of other age groups," say the study authors. It seemed surprising to many when the findings were announced, but the researchers have an explanation: They theorize that our female ancestors were so accustomed to losing children to disease, war, or starvation that they evolved to crave more sex--at a relatively advanced age--to produce more babies.

The challenges

The perils of perimenopause: "By forty," says Glenn D. Braunstein, MD, an endocrinologist and chair of the department of medicine at Cedars-SinaiMedicalCenter in Los Angeles, "a woman's testosterone levels will be about half the level they were at twenty-five." And yes, that drop certainly affects libido. For the average woman who enters perimenopause (defined as the 4 or so years leading up to her final period) in her late 40s, fluctuating estrogen, progesterone, and testosterone levels may put a damper on bedroom bliss. Irregular periods and even her first hot flashes may appear. To smooth things out, Steven R. Goldstein, MD, a professor of obstetrics and gynecology at NYU Langone Medical Center and immediate past president of the North American Menopause Society, prescribes low-dose birth control pills for many of his patients "to turn off the ovaries' erratic estrogen production and replace it with a small, consistent influx of estrogen every day." If dryness and discomfort develop, local estrogens--placed directly into the vagina in the form of a suppository, cream, or "ring"--can improve lubrication and pleasure for many women. (Estrogens that are applied locally to the vagina are widely believed to be safer than oral estrogens, which carry some cancer risks.)

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In Your 50s

The advantages

With maturity, expertise: As author Gail Sheehy wrote in her classic book on aging, Sex and the Seasoned Woman: "The middle years, between fifty and sixty-five, constitute the apex of adult life…For women, the passage to be made is from pleasing to mastery." Indeed, the National Survey of Sexual Health and Behavior found that 71% of 50-somethings surveyed--more than any other age group--said their last sexual experience resulted in an orgasm.

The challenges

Manipulating menopause: Because of dramatically reduced testosterone and virtually nonexistent estrogen, sex drive drops after menopause. But the options are plentiful if you want to rev things up:

Testosterone therapy using creams, gels, or patches has not been approved by the FDA and can only be prescribed off-label, but a growing number of women vexed by low sex drive swear by it. Physicians often prescribe very small off-label doses of testosterone along with menopausal hormonal therapy, or MHT.

Many women try MHT (formerly called hormone replacement therapy, or HRT), which involves taking estrogen and progestin to relieve vaginal dryness and hot flashes and reduce bone loss. MHT is controversial, not only because studies show it can increase women's risk of strokes, heart attacks, and breast cancer, but also because some forms can sap testosterone, causing libido to wane even more.

Pesky pounds: The more body fat you have, the less libido-boosting "free-floating" testosterone you have. If you're obese, losing 10% of your total weight can do wonders for your sex drive, found researchers at DukeUniversityMedicalCenter. Multiple studies have also shown that after just 20 minutes of exercise, blood flow to the genitals increases, resulting in more lubrication, better arousal, and better orgasms.

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