Women entering menopause face mental, emotional, and physical changes. While many symptoms arise in this stage of life, the decline in libido is one that many women will experience. A population-based study followed women through menopause. It found that from the early stage to late menopausal transition, the percentage of women who suffered from sexual dysfunction increased from 42% to 88%.
While there are multiple reasons for decreased libido throughout a woman's life, the primary reason for the decline during menopause is a shift in sex hormones. Understanding how your hormones fluctuate with aging can help you get a grasp on how to manage and adequately support yourself throughout menopause.
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How Does Menopause Affect Libido?
During menopause, significant hormonal changes occur. Your body decreases its production of estrogen and testosterone. Estrogen is the key hormone in regulating your menstrual cycle and supports the urinary tract, brain, breast, skin, hair, circulatory system, and mucus membranes. The decline of estrogen production during menopause can cause issues in those organs and body systems. The estrogen drop can also lead to vaginal dryness and vaginal atrophy.
Testosterone in women supports sexual desire, arousal, and the ability to orgasm. As this hormone declines, it often leads to discomfort, making engaging in sexual activity less desirable.
Menopause causes symptoms such as hot flashes, night sweats, difficulty sleeping, emotional changes (irritability, mood swings, depression), weight gain, and headaches, all of which can significantly affect someone's mental capacity to want to engage in sexual activity. Much like the life transition in puberty, menopause can be a phase of getting to know your body again while processing the occurring changes.
Does Menopause Lower Libido in All Women?
Many women experience a decrease in their libido while becoming menopausal, but not all. Multiple factors influence this other than hormonal changes. Emotional, physical, and life stressors can also affect sexual desire and thoughts about it. On the other hand, some women experience an upswing in their libido because there is less worry and anxiety over becoming pregnant. These women find joy in intimacy with the relinquishing of responsibility that can be attached to their younger fertile years.
Low Libido Signs & Symptoms
Each woman's sex drive differs, making it essential to know and understand your range of sexual desire, interest, and activity. If your desire and activity change drastically during menopause, here are some common indicators that you have a low libido:
- Low to no interest in sexual activity
- Never, or rarely having sexual thoughts
- Concern for your lack of sexual activity or thoughts regarding it
- Decreased sense of arousal
- Difficulty achieving an orgasm
- Reduced vaginal lubrication
- Discomfort during intercourse
Functional Medicine Tests for Low Libido in Women During Menopause
Testing your sex hormones can give insight into the decline of the hormones that shift during menopause. If you experience significant menopause symptoms, a few tests can help your provider determine the appropriate action plan to make you feel like yourself again.
DUTCH Sex Hormone Metabolites test looks at 19 biomarkers, including estrogen and its three versions- Estrone (E1), Estradiol (E2), and Estriol (E3). This test measures these, in addition to metabolites of Estrone which occur after metabolization in the liver. Measuring these can help determine if the phase 1 metabolism of these hormones is out of balance. Also measured in this test are androgens, with testosterone being of primary importance. Progesterone, while not the main hormone of concern with low libido, is also measured and can provide some clinical insight.
If fatigue, stress, or other menopausal symptoms are involved in your case, completing a comprehensive test such as the DUTCH Complete may be beneficial. This test assesses both sex hormone and adrenal hormone metabolites.
Since these hormones are metabolized in the liver, getting a Hepatic Function Panel is a good screening tool for liver function health.
How to Increase Female Libido During Menopause
Nutrition
While there is not a libido-specific diet, there are ways to support your body during this process to ensure you get appropriate nutrients that support overall health. If you are in the perimenopausal stage (transitional time before menopause), healthy food can assist in creating a suitable internal landscape for thriving in menopause. A perimenopausal diet focusing on adequate protein, Omega-3 fatty acids, fiber, and calcium can be helpful.
Phytoestrogens, which are naturally occurring plant compounds, have estrogen-like properties. A systemic review and meta-analysis looked at the benefits of phytoestrogens for the improvement of vaginal dryness in menopause. It found a modest reduction in vaginal dryness with dietary or supplementary phytoestrogen compounds. Foods high in phytoestrogens are soy, flaxseed, garlic, sesame seed, blueberries, strawberries, broccoli, brussels sprouts, and kale.
Herbs & Supplements
Panax Ginseng: is a great botanical that can assist in sexual function by improving stamina and impotence. In a study on Ginseng in postmenopausal women, 500mg of this botanical resulted in significant improvement in the quality of sexual function compared to the placebo group. This study shows promising results for use in women before reaching the postmenopausal state.
Trigonella foenum-graecum: commonly known as Fenugreek, can improve menopausal symptoms and increase serum estradiol. In a study using a novel extract of Fenugreek Husk, participants were given 500mg twice daily for 90 days. Results showed that many symptoms of menopause improved, including a 56% decrease in vaginal dryness and a 120% increase in serum estradiol levels. This botanical is commonly used in women's health and shows promising results for use in cases of low libido.
Ginkgo biloba: is a herb used to stimulate blood flow and relax smooth muscles, making it a great candidate to improve vaginal blood flow leading to arousal and increased lubrication. One research study found that using Gingko in combination with sex therapy significantly increased sexual desire and pleasure.
Lifestyle changes
Movement
Exercise is a therapeutic way to manage emotional changes, which may impact your libido. While there is no set exercise routine to increase libido, it is advised to incorporate physical activity throughout menopause to maintain a healthy weight and support your overall well-being. A standard recommendation is to engage in 150 minutes of moderate aerobic activity per week- such as walking, swimming, or biking and at least two days a week of strength training exercises, such as light weights or bodyweight movements.
A review examined the direct and indirect effects of acute and chronic exercise and sexual function in women. Data shows that acute exercise can improve sexual arousal by increasing your sympathetic nervous system. Although there is less data on regular, more consistent exercise and sexual function, there is some speculation that it likely enhances sexual satisfaction by improving cardiovascular function, creating a body-positive mindset, and improving your mood.
Communication and Couples therapy
Maintaining clear communication with your partner during this time will help you both be on the same page about what you are dealing with. Having realistic expectations can help diminish sexual aggravation and increase compassion toward your situation. Increasing intimacy in other ways, such as kissing, cuddling, and meaningful interactions, can help improve your mood and desire for sexual activity.
If this area becomes a challenge for you and your partner, seeking couples therapy with a specialized sex therapist can help you both navigate this new phase. Sex therapy could allow you both to explore your sexual relationship with one another and provide insight into ways in which you can improve your intimacy and desire for one another.
Hormone Replacement Therapy
While hormone replacement therapy (HRT) is not always the first line of therapy to increase libido in menopause, it can definitely be helpful in certain situations. As functional medicine practitioners, our goal is to help patients thrive sustainably and synergistically. Therefore, using bio-identical hormones is often our first recommendation when HRT is being considered.
The North American Menopause Society has named three FDA-approved bio-identical hormones- Estradiol, Estrone, and Micronized Progesterone. Vaginal estradiol preparations effectively treat diminished lubrication, pain associated with intercourse, and other genitourinary symptoms of menopause. Progesterone therapy, although not used as often for menopause, may be an option depending on your individual case. Testosterone, while often decreased in menopause, is not FDA-approved for use in female sexual dysfunction. Some physicians trained in HRT have used testosterone off-label to increase libido. Still, it is worthwhile knowing that it can come with unwanted side effects such as acne, hirsutism, and personality changes.
What Can I Do to Treat Vaginal Dryness During Menopause?
Lubricants can be a first-line support for vaginal dryness. Over-the-counter products such as K-Y jelly can help increase libido by improving sensation and decreasing discomfort. As a natural-minded doctor, I highly recommend finding a non-toxic brand of lubricant since these products are directly absorbed in the mucous membrane of the vaginal tissue. Here is a comprehensive list of natural options available, including toxic ingredients to avoid.
In addition to lubrication, hormone replacement therapy can support an increase in vaginal fluid. Botanicals such as Ginkgo and Fenugreek can also be supportive in this area. While avoidance may be your initial instinct, engaging in sexual activity or masturbation can help stimulate the vaginal walls and encourage elasticity which all help maintain tissue lubrication and integrity.
Summary
Loss of sexual interest due to menopausal side effects can be managed and supported with the right tools. The first step is understanding your baseline libido and being aware of when that drastically changes. It's normal to have an ebb and flow in sexual activity. But, if you notice that you rarely engage in sex, that may indicate seeking medical guidance.
Working with a functional medicine practitioner who can look at the overall picture, appropriately test your hormones, and create an individualized treatment plan can help you regain your libido. Aging can come with many challenges, but lack of sexual desire or activity does not have to be one of those.
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