Podcast Summary: "Is Your Libido Slowly Fading During Menopause?"

Rena Malik, MD Podcast
Host: Dr. Rena Malik
Guest: Tamsen Fadal
Released: March 28, 2025

Episode Overview

This episode offers a candid, evidence-based look at menopause—specifically, how hormone changes impact libido, sexual health, relationships, and day-to-day confidence. Dr. Rena Malik, a board-certified urologist, talks to Emmy-winning journalist, documentary filmmaker, and author Tamsen Fadal. Drawing from Tamsen's personal story and research for her new book "How to Menopause," the discussion demystifies common struggles, explores workplace and relationship dynamics, and delivers practical solutions for those navigating menopause or supporting someone through it.

Key Discussion Points & Insights

Demystifying Menopause: It's Not "Just for Older Women"

• Menopause begins earlier than people think: Symptoms can start in the late 30s or 40s, not just the 50s.
  • "We've made menopause seem like it's this old woman issue and it's not." (Tamsen Fadal, 00:00)
• It's a normal transition—a result of hormone fluctuations, not a disease or something shameful.

Tamsen’s Personal Journey: First Signs in the Newsroom

• Tamsen recounts her first intense symptom—a hot flash—while anchoring live TV, initially attributing her difficulties to stress or fatigue.
  • "I felt this tremendous heat, like, you know, from the core of my body up through my head and just kind of sweat break out everywhere. I really thought I was going to pass out." (Tamsen Fadal, 01:38)
• The diagnosis arrived via her patient portal: a single message "In menopause. Any questions?" with no prior education on what perimenopause was.
• This launched Tamsen's ongoing mission to educate and destigmatize menopause.

The Need for Support—Home and Workplace

• Education and empathy are critical in all spheres: Partners, friends, employers—all need to understand and normalize the transition.
  • "Support comes in a couple different ways. One, in education and two, in just not making fun of this transition because I think that's what we've seen for a long time." (Tamsen Fadal, 03:54)
• Organizational awareness: Women at the peak of their careers may face symptoms that affect performance, retention, and job satisfaction—supportive policies are a wise investment.
  • Simple workplace changes (fans, uniform adaptations) can make a significant difference at low cost. (Tamsen, 06:08)
• Menopause benefits: Emerging apps and counseling services offer support; organizations should actively make these resources visible to employees.

Communication Challenges: Libido, Intimacy, Relationship Strain

• Declining libido is common—and challenging to discuss: Many women feel disconnected from partners, sometimes describing the relationship as "living with a roommate."
  • "No woman wants to hear, like, 'Is it your hormones again?'" (Tamsen Fadal, 09:00)
• Open, nonjudgmental conversations are essential. Partners should approach discussions about intimacy changes with empathy, not blame.
  • "Intimacy is not just what happens in the bedroom…it's about the communication that has to take place." (Tamsen Fadal, 11:05)
• Male partners often feel helpless; education and being part of the solution—attending doctor appointments, exploring treatments—make a big impact.

Physical Changes Impacting Sex

• Genitourinary syndrome of menopause: Up to 80% of women face vaginal dryness, thinning of tissues, and pain with sex due to reduced estrogen.
  • "This can include symptoms like vaginal dryness, loss of lubrication...which can lead to pain with sex for a lot of women." (Dr. Rena Malik, 12:35)
• Providers should educate about safe, effective treatments like topical estrogen. Partners should show understanding and support.
  • "Education is important for all of us as women. I didn’t know I was in pain...how would my husband understand?" (Tamsen Fadal, 13:28)

Stigma, Self-Image, and Sexual Confidence

• The social stigma around menopause makes women feel undesired or "invisible," compounding body image challenges and avoidance of sex.
  • "People who have hot flashes, that's something old women go through...so when you start feeling like you’re older...this can lead to insecurity." (Dr. Rena Malik, 15:08)
• Verbal affirmations from partners can counteract the loss in confidence.

Menopause, Divorce, and Relationship Survival

• Statistics: About a third of divorces happen after age 55; 8 out of 10 women say menopausal symptoms strain relationships. Many women initiate divorce during this period.
  • "We don't know, maybe those marriages had to end for other reasons. But it could also be that women did not know exactly what was going on with them." (Tamsen Fadal, 16:23)
• Mood, mental clarity, and emotional volatility from hormonal changes are real—and directly affect partnerships.

Tips for Supportive Partners and Family

• Listening and education: Learning about menopause enables men to be true allies—not just at home, but in any community or workplace role.
  • "There’s certain ways to bring things up and address things that I think are the right way and that can be conversation openers versus closers." (Tamsen Fadal, 17:35)
• Even small acts to lower a partner's stress are invaluable—community and teamwork are more effective than telling someone to "just meditate."
  • "It doesn't have to be complicated...Community is not just like my three best friends—it’s people that can help support me to just alleviate that heaviness." (Tamsen Fadal, 19:42)

Insights from Matchmaking and Relationship Dynamics

• Biggest mistake: Rushing to meet arbitrary timelines, or staying in relationships that no longer serve well-being.
  • "If you feel like you’re doing all the work and you think you’re going to change somebody, that is never, ever, ever going to happen." (Tamsen Fadal, 22:40)
• Self-respect and authenticity: Don't change who you are or sacrifice your career or life path to fit someone else's standards.
• On men: They too face pressures and emotional struggles in relationships, though may not vocalize it.
  • "Men have the same stresses...they’re not immune to like questioning how the other partner feels...they might not vocalize it the way we do." (Tamsen Fadal, 23:10)

Notable Quotes & Memorable Moments

• On stigma and experience:
  "We’ve made menopause seem like it’s this old woman issue and it’s not." (Tamsen Fadal, 00:00)
• Workplace support:
  "There really is a cost of inaction with all this...these are valuable workers." (Tamsen Fadal, 05:34)
• On intimacy:
  "No woman wants to hear, like, 'Is it your hormones again?' But...there are ways to have these conversations." (Tamsen Fadal, 09:00)
• On treatments and shame:
  "There are very cost-effective ways to deal with this...There are options out there." (Tamsen Fadal, 13:28)
• On self-acceptance:
  "Things are going to work out the way they're supposed to...I wish I had known that when I was younger." (Tamsen Fadal, 26:31)
• On finding joy:
  "Every single day I have to get outside...I can feel my body pulling me outside." (Tamsen Fadal, 26:47)
• On relationship dealbreakers:
  "If you’re changing yourself to fit somebody else’s standards...that is going to be an exhausting part of life. That’s never going to be something you’re going to want." (Tamsen Fadal, 22:54)

Timestamps by Segment

• 00:00 — Opening (Dr. Malik & Tamsen on stigma, onset of menopause)
• 01:38 — Tamsen’s personal story: First symptoms as a news anchor
• 03:54 — Importance of support systems (home, workplace, relationships)
• 05:34 — Economic rationale for workplace menopause benefits
• 09:00 — Communicating about libido, relationship changes
• 11:05 — Tamsen’s remarriage and learning to talk about sexuality
• 12:35 — Dr. Malik on physical changes (genitourinary syndrome)
• 13:28 — Barriers to discussing sexual pain and available solutions
• 15:08 — Stigma, body image, and sexual confidence
• 16:23 — Relationship strain, divorce, and menopause
• 17:35 — Advice for men/supportive family
• 19:42 — The role of community and teamwork in reducing women’s stress
• 20:52 — Lessons from matchmaking and modern relationships
• 23:10 — Men’s perspective: relationship difficulties and silent struggles
• 24:54 — Respect, boundaries, and the foundation of a healthy relationship
• 25:30 — What’s next for Tamsen: New podcast and goals
• 26:31 — Final Four: Life lessons, daily must-dos, life hacks, and dreams

Actionable Takeaways

• For Women Going Through Menopause:

  • Understand menopause can start earlier than expected; don't suffer symptoms in silence.
  • Seek evidence-based medical support—there are safe treatments for physical symptoms.
  • Communicate openly with partners about your experience.

• For Partners and Family:

  • Learn about menopause and approach discussions with empathy.
  • Support isn't about fixing—offer understanding, affirmation, and practical help.
  • Address intimacy issues together; join healthcare conversations if welcome.

• For Employers:

  • Create an environment where women feel safe to disclose health concerns.
  • Small, inexpensive changes (e.g., uniforms, amenities) can help retain talent.
  • Implement or promote menopause-related benefits.

Tone:
Candid, supportive, evidence-informed, and hopeful. The conversation balances practical advice, compassionate storytelling, and an empowering message that menopause is a stage of life to be met with information, empathy, and new connection—not shame or isolation.