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Low Libido

One of the most confusing and perhaps unexpected symptoms that women experience in midlife and (peri) 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 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 there is a range of very effective treatment options available from systemic hormonal, to localized OTC treatment.

The Lowdown on Low Libido

Why does this happen, how does it impact you, how is it diagnoses and common triggers/ risk profiles.

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. 

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.

A woman’s libido level can’t be medically tested, so your physician will rely on self-observation for a diagnosis. If you are struggling with a low(ered) libido and you want to do something about it - you have every right to speak to a health professional about this and get treatment. Do not let anyone tell you different.

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. 

Mental and Physical health

How common is low(ered) Libido?

Quick answer: very common.

Roughly speaking up to 10% of pre-menopausal women suffer from Hypoactive Sexual Desire Disorder (HSDD) aka a prolonged, lowered libido without a medical cause.

When it comes to women going through the Menopause transition - a recent study of sexual health in menopause found 40 – 55% of respondents had lowered sexual desire during this time. Post-menopausal women aged 50 - 60 years old were also surveyed and 34% reported a reduction of previous (pre-menopause) levels of libido. That doesn't mean their libido is zero, it just means that it is less and/or fluctuates more.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of low(ered) libido. This is not an exhaustive list of the treatment options available, but a good start.

There are many treatment options available both prescription based and effective over the counter products.  

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.

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 - 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. 
  • 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. 


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