Low Libido
One of the most confusing and perhaps unexpected symptoms of peri- and post-menopause can be fluctuations in your libido. Up to 53% of women report symptoms of lowered sexual desire as they move through menopausal phases, and it's actually the most common women’s sexual health complaint.
42 - 88% of women reported at least one sexual dysfunction symptom during the menopause transition
A decrease in libido means that the natural interest in sex is diminished and a woman may have no (or low) interest in part of sexual activity including self pleasure. Low libido can stem from physical or mental physiological changes, but often is a result of both. Undiagnosed changes in sexual desire can lead to confusion, discouragement, embarrassment, or self-doubt. If left untreated, low libido can become a chronic condition affecting physical, relational, and mental wellness. Fortunately, hormonal, non-hormonal, localized, and systemic treatment options are available.
Why is this happening?
Libido refers to the desire for sexual activity. Libido is affected by arousal, attraction, stimulation, mental wellbeing, and physical health. When estrogen and androgen hormone levels drop during perimenopause, interest in sex may also drop. Hormones act as trigger controls for sexual functions. Lowered levels can mean decreases in sexual interest. A recent study of sexual health in menopause found 40 – 55% of respondents had lowered sexual desire.
Hormones act as trigger controls for sexual functions.
Genitourinary syndrome of menopause (GSM) is diagnosed when low libido, poor vaginal lubrication, and/or pain during intercourse (dyspareunia) are reported during the peri- or post-menopausal phases. Hormones related to sex (estrogens and androgen steroids) can complicate the sexual triggers during menopause. In addition, aging, metabolic and cardiovascular changes also affect libido in ways ranging through physiological and psychological symptoms. Concurrent to menopausal hormone changes, your body’s androgen hormones (testosterone and its dopamine effects, for example) are also changing, with potential negative effects on your libido.
The medical diagnosis for a prolonged, lowered libido without a medical cause is Hypoactive Sexual Desire Disorder (HSDD). Up to 10% of pre-menopausal women suffer from HSDD and 32% of peri-menopausal women. A recent study of sexual health in menopause found 40 – 55% of respondents had lowered sexual desire. Post-menopausal women aged 50 - 60 years old were surveyed and 34% reported a reduction of previous levels of libido. Up to 10% of pre-menopausal women suffer from HSDD and 32% of peri-menopausal women.
Other impacted areas
Lowered levels of libido can have far-ranging negative effects for a woman, if left undiagnosed. Some of the menopausal symptoms often associated with low libido are:
- Menopausal fatigue
- Heightened anxiety
- Vaginal dryness
- Incontinence
- Depression
Although some of the negative consequences have psychological or relationship roots, they are avoidable with effective treatment. It’s important to remember that low libidio is a symptom of biological factors, not a reflection on intimate relationships or feelings. Talking about your menopause symptoms with your doctor and those closest to you can help to relieve some of the associated stress.
Diagnosis
A woman’s libido level can’t be medically tested, so your physician will rely on self-observation for a diagnosis.
Possible triggers or risk factors
Comorbidity with several other common menopausal symptoms means that hormonal reductions can be exacerbated by additional physiological and psychological factors. Weight gain, body shape changes, feelings of excessive fatigue, depression, and other menopausal symptoms can cause or worsen low libido.
Want to speak with a Menopause doctor?
Treatments & remedies
There are many treatment options available both prescription based and effective over the counter products.
Click below to scroll to a specific section
Nutrition
For optimal feelings of energy and engagement when participating in all of your normal activities, it is important to be well-hydrated and to maintain a healthy diet throughout menopause.
Exercise
Positive exercise choices include:
· Maintaining healthy weight
· Participating in sexual activity to promote blood flow
· Practicing Kegel pelvic floor exercises
Mindset
If you are worried that a decrease in libido is or might impact the relationship you have with your partner, it is important to talk to them about it. Explain that low libido is a symptom of biological factors, not a reflection on intimate relationships or feelings. Talking about your menopause symptoms with your doctor and those closest to you can help to relieve some of the associated stress.
Supplements
There are no supplements available that have strong clinical research proving efficacy when it comes to treating low(er) libido.
- DHEA. In one small study women were given a daily low dose (10 mg a day) of DHEA (dehydroepiandrosterone) for one year. Women in aged 50 - 60 years reported significantly improved sexual function and frequency. Even though there seem to be some promising results, DHEA is not a recommended treatment for low libido at this time.
OTC Products
There is a range of effective over-the-counter products to help with libido concerns.
- Ristela from Bonafide is a plant-based, non-hormonal arousal and orgasmic stimulant
- Light erotic books and podcasts have helped many women: e.g. from classic stories written by Anaïs Nin, to 50 Shades of Grey and Dirty Diana podcast, or here is an overview of 10 of the Best (Brilliant) Dirty Books
- Self-pleasure websites - omgyes.com is an incredible resource for many women to learn more about self-pleasure (or for men on how to please a woman better!)
- Masturbation/self-pleasure activities using sex tools - classy vibrators can be ordered online, delivered in discreed packaging, and are socially common, no longer taboo or salacious.
Prescription
- Ospemifene- An estrogen receptor agonist/antagonist (selective estrogen receptor modulator, SERM) used in the treatment of vulvar and vaginal atrophy. It has a unique non-hormonal composition and may be effective for women suffering from low libido symptoms concurrent with other vaginal conditions related to menopause.
- Flibanserin and Bremelanotide - are relatively new pharmaceutical options for women suffering from HSDD and studies show (very) limited positive changes and some concerning side-effects. Flibanserin, which corrects neurotransmitters, has been noted to cause sleepiness and fainting and requires abstinence from alcohol. Bremelanotide, which has to be injected shortly before sexual activity, can cause nausea that is counter-productive to the goal of increasing libido. Both drugs were heavily lobbied for FDA approval in the US, and aggressively marketed on the names Addyi and Vyleesi respectively. Given the weak clinical support for their efficacy and common side effects, neither of these drugs should be considered first line treatment for HSDD.
Hormone Treatment
- Vaginal Estrogen Therapy (cream/rings/pills) and Systemic Estrogen Therapy (used with progestin) or Hormonal Replacement Therapy (HRT) Vaginal Estrogen Therapy is a common prescription and studies have shown equal levels of efficacy regardless of the method of application (estrogen cream, estrogenic ring, vaginal tablets).
- Testosterone Replacement Therapy (for HSDD) Testosterone Replacement Therapy is not approved in all areas, however randomized controlled trials indicated sexual function improvement after treatment with a low-dose testosterone therapy in post-menopausal women with HDSS. Long-term safety risks are not yet understood for women receiving testosterone therapy.
- Tibolone (for HSDD) is a synthetic steroid molecule which is essentially a progestogen and a form of HRT. Although it has not been studied as extensively as other forms of HRT, there is some evidence that shows improved sexual function when taking this medicine.
Holistic Treatment
Want to speak with a Menopause doctor?
Want to speak with a Menopause doctor?
Take Action
FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
References
Davis, S. R., Baber, R., Panay, N., Bitzer, J., Perez, S. C., Islam, R. M., Kaunitz, A. M., Kingsberg, S. A., Lambrinoudaki, I., Liu, J., Parish, S. J., Pinkerton, J. A., Rymer, J., Simon, J. A., Vignozzi, L., & Wierman, M. E. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism, 104(10), 4660–4666.
Genazzani, A. R., Stomati, M., Valentino, V., Pluchino, N., Potì, E., Casarosa, E., Merlini, S., Giannini, A., & Luisi, M. (2011). Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality. Climacteric, 14(6), 661–668.
Ito, T. Y., Trant, A. S., & Polan, M. L. (2001). A Double-Blind Placebo-Controlled Study of ArginMax, a Nutritional Supplement for Enhancement of Female Sexual Function. Journal of Sex & Marital Therapy, 27(5), 541–549.
Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016 Apr;176(4):453-62. doi: 10.1001/jamainternmed.2015.8565. PMID: 26927498.
Scavello I, Maseroli E, Di Stasi V, Vignozzi L. Sexual Health in Menopause. Medicina. 2019; 55(9):559. https://doi.org/10.3390/medicina55090559
Soe LH, Wurz GT, Kao CJ, Degregorio MW. Ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy: potential benefits in bone and breast. Int J Womens Health. 2013;5:605-611. Published 2013 Sep 25. doi:10.2147/IJWH.S39146
Vegunta S, Kling JM, Kapoor E. Androgen Therapy in Women. J Womens Health (Larchmt). 2020 Jan;29(1):57-64. doi: 10.1089/jwh.2018.7494. Epub 2019 Nov 5. Erratum in: J Womens Health (Larchmt). 2020 Nov;29(11):1487. PMID: 31687883.
West SL, D’Aloisio AA, Agans RP, Kalsbeek WD, Borisov NN, Thorp JM. Prevalence of Low Sexual Desire and Hypoactive Sexual Desire Disorder in a Nationally Representative Sample of US Women. Arch Intern Med. 2008;168(13):1441–1449. doi:10.1001/archinte.168.13.1441
https://www.ndtv.com/food/ayurveda-for-menopause-4-foods-to-include-in-your-diet-1836597
https://www.healthywomen.org/content/article/global-guidance-testosterone-hsdd
https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/symptoms-causes/syc-20374554
Low Libido
One of the most confusing and perhaps unexpected symptoms of peri- and post-menopause can be fluctuations in your libido. Up to 53% of women report symptoms of lowered sexual desire as they move through menopausal phases, and it's actually the most common women’s sexual health complaint.
42 - 88% of women reported at least one sexual dysfunction symptom during the menopause transition
A decrease in libido means that the natural interest in sex is diminished and a woman may have no (or low) interest in part of sexual activity including self pleasure. Low libido can stem from physical or mental physiological changes, but often is a result of both. Undiagnosed changes in sexual desire can lead to confusion, discouragement, embarrassment, or self-doubt. If left untreated, low libido can become a chronic condition affecting physical, relational, and mental wellness. Fortunately, hormonal, non-hormonal, localized, and systemic treatment options are available.
Dr. June Tan Sheren
Why this is happening
Libido refers to the desire for sexual activity. Libido is affected by arousal, attraction, stimulation, mental wellbeing, and physical health. When estrogen and androgen hormone levels drop during perimenopause, interest in sex may also drop. Hormones act as trigger controls for sexual functions. Lowered levels can mean decreases in sexual interest. A recent study of sexual health in menopause found 40 – 55% of respondents had lowered sexual desire.
Hormones act as trigger controls for sexual functions.
Genitourinary syndrome of menopause (GSM) is diagnosed when low libido, poor vaginal lubrication, and/or pain during intercourse (dyspareunia) are reported during the peri- or post-menopausal phases. Hormones related to sex (estrogens and androgen steroids) can complicate the sexual triggers during menopause. In addition, aging, metabolic and cardiovascular changes also affect libido in ways ranging through physiological and psychological symptoms. Concurrent to menopausal hormone changes, your body’s androgen hormones (testosterone and its dopamine effects, for example) are also changing, with potential negative effects on your libido.
The medical diagnosis for a prolonged, lowered libido without a medical cause is Hypoactive Sexual Desire Disorder (HSDD). Up to 10% of pre-menopausal women suffer from HSDD and 32% of peri-menopausal women. A recent study of sexual health in menopause found 40 – 55% of respondents had lowered sexual desire. Post-menopausal women aged 50 - 60 years old were surveyed and 34% reported a reduction of previous levels of libido. Up to 10% of pre-menopausal women suffer from HSDD and 32% of peri-menopausal women.
Other impacted areas
Lowered levels of libido can have far-ranging negative effects for a woman, if left undiagnosed. Some of the menopausal symptoms often associated with low libido are:
- Menopausal fatigue
- Heightened anxiety
- Vaginal dryness
- Incontinence
- Depression
Although some of the negative consequences have psychological or relationship roots, they are avoidable with effective treatment. It’s important to remember that low libidio is a symptom of biological factors, not a reflection on intimate relationships or feelings. Talking about your menopause symptoms with your doctor and those closest to you can help to relieve some of the associated stress.
Diagnosis
A woman’s libido level can’t be medically tested, so your physician will rely on self-observation for a diagnosis.
Possible triggers or risk factors
Comorbidity with several other common menopausal symptoms means that hormonal reductions can be exacerbated by additional physiological and psychological factors. Weight gain, body shape changes, feelings of excessive fatigue, depression, and other menopausal symptoms can cause or worsen low libido.
Treatments & Remedies
There are many treatment options available both prescription based and effective over the counter products.
Products
There are no supplements available that have strong clinical research proving efficacy when it comes to treating low(er) libido.
- DHEA. In one small study women were given a daily low dose (10 mg a day) of DHEA (dehydroepiandrosterone) for one year. Women in aged 50 - 60 years reported significantly improved sexual function and frequency. Even though there seem to be some promising results, DHEA is not a recommended treatment for low libido at this time.
There is a range of effective over-the-counter products to help with libido concerns.
- Ristela from Bonafide is a plant-based, non-hormonal arousal and orgasmic stimulant
- Light erotic books and podcasts have helped many women: e.g. from classic stories written by Anaïs Nin, to 50 Shades of Grey and Dirty Diana podcast, or here is an overview of 10 of the Best (Brilliant) Dirty Books
- Self-pleasure websites - omgyes.com is an incredible resource for many women to learn more about self-pleasure (or for men on how to please a woman better!)
- Masturbation/self-pleasure activities using sex tools - classy vibrators can be ordered online, delivered in discreed packaging, and are socially common, no longer taboo or salacious.
- Ospemifene- An estrogen receptor agonist/antagonist (selective estrogen receptor modulator, SERM) used in the treatment of vulvar and vaginal atrophy. It has a unique non-hormonal composition and may be effective for women suffering from low libido symptoms concurrent with other vaginal conditions related to menopause.
- Flibanserin and Bremelanotide - are relatively new pharmaceutical options for women suffering from HSDD and studies show (very) limited positive changes and some concerning side-effects. Flibanserin, which corrects neurotransmitters, has been noted to cause sleepiness and fainting and requires abstinence from alcohol. Bremelanotide, which has to be injected shortly before sexual activity, can cause nausea that is counter-productive to the goal of increasing libido. Both drugs were heavily lobbied for FDA approval in the US, and aggressively marketed on the names Addyi and Vyleesi respectively. Given the weak clinical support for their efficacy and common side effects, neither of these drugs should be considered first line treatment for HSDD.
Lifestyle
For optimal feelings of energy and engagement when participating in all of your normal activities, it is important to be well-hydrated and to maintain a healthy diet throughout menopause.
Positive exercise choices include:
· Maintaining healthy weight
· Participating in sexual activity to promote blood flow
· Practicing Kegel pelvic floor exercises
If you are worried that a decrease in libido is or might impact the relationship you have with your partner, it is important to talk to them about it. Explain that low libido is a symptom of biological factors, not a reflection on intimate relationships or feelings. Talking about your menopause symptoms with your doctor and those closest to you can help to relieve some of the associated stress.
Holistic
TCM
Focus on herbs/ foods for Kidney Yin Deficiency
Ayurveda
Focus on saunf/elaichi/jeera water/coconut water, plus aloe vera gel, shatavari, fenugreek seeds, and Ashoka powder; massage, meditation, yoga, etc.
Acupuncture
Restoring the body’s balances, particularly for HDSS
Mindfulness
Meditation, yoga, breathing, guided imagery
.svg)