Loss of estrogen around peri-menopause and after the menopause or during the period of breast feeding, after giving birth, causes vaginal dryness, painful intercourse and lack of interest in having sex because no-one wants to do something that is painful. Further the lack of estrogen causes disturbed sleep and fatigue and slows down metabolism. No woman I know wants to have sex when they are exhausted or cranky or have a dry vagina.
For the menopausal woman estrogen does not ever return after the menopause (1 year of no periods) so either you replace it locally (vagina) in tiny doses or/and systemically with an estrogen patch or gel or cream, or both (see section below), and if you can’t take estrogen there are other non-hormonal options.
Hormones for the menopausal transition: I have been managing HRT for my women patients during the peri-menopausal and menopause for decades. I am a supporter of use of bio-identical estradiol (now either available as a patch, or gels by pharmaceutical companies or by compounding estradiol mixed with estriol with creams or gel at compounding pharmacies).
The administration of bio-identical hormones through the skin is safe and we can get benefit through very small doses. There is also seems to be a benefit to starting right at onset of the menopause for many health reasons including sexuality and libido. There has been a concern that the combination of estrogen and progestins (non-bioidentical progesterones) increase breast cancer risk (see below). This appears to be due to the standard use of non-bioidentical progestins (provera, augestin) which seem be toxic to the breast. Extensive European data supports the use of bio identical hormones estradiol and progesterone (not a progestin) together as safe. Further data shows that natural progesterone and testosterone in women do not seem to cause harm to the breast tissue, and that natural progesterone may be actually protective. More research is now happening with lower doses bio identical estrogen used transdermally and natural progesterone. I am definitely a proponent for hormone replacement if it is in your best interest and you understand what the goals at in using it. I also endorse use of testosterone for post-menopausal women to increase libido and enhance sexual experience with their partners decrease risk of breast cancer whether or not you are on HRT. (read my blog post on this subject or watch my YouTube video here: https://youtu.be/tmE9Y7e0mHA)
Unfortunately two decades of women did not receive HRT, doctors stopped prescribing it, and young doctors did not learn to help women with hormones. Most patients that come to my office have not been offered HRT as an option. They are told that it will pass. Just grin and bear it! American studies that have been used to focus on the “badness” of estrogen were based on the now found faulty Women’s health initiative study that utilized Premarin (a conjugated estrogen from pregnant mares not natural to our body that is metabolized into a more toxic product, and used at higher doses than we use now) with Provera ( a non-natural progesterone compound or progestin). Further, in the Women\’s Health Initiative study, these hormones were given orally to older women who had been in menopause for years, without any hormone replacement. Indeed under these condition more breast cancers were found in women receiving both Premarin and Provera, and a higher risk of stroke was found because estrogen replacement was given orally as pills, which makes the liver make clotting factors. In this study the risk of colon cancer was lower and these women had stronger bones so that they had a lower risk of osteoporosis-related fractures. Based on this old original study Estrogen was not recommended to prevent heart disease. But most conventional docs interpreted that women in general should not be given hormone replacement, even younger women, unless highly symptomatic. Sadly, two decades of women have experienced no HRT, and as a result more diabetes, weight gain, pericardiac fat deposition, and earlier heart disease. Heart disease causes more deaths for women than breast cancer.