Written by Dr. Jordan Robertson, ND

Where did your libido go? Do you feel like you left it in your crush’s car in your 20s? Or in a stolen moment when your kids were asleep in your 30s? Many people in menopause feel a shift in their desire for intimacy and sexual pleasure or notice a steep change in how sexual function feels compared to their earlier years. From dryness to pain, loss of interest to a flat out numbness, sexual function in menopause has a significant influence on quality of life in women and people with ovaries over the age of 45¹. 

We often think of libido and “sex drive”, as a hormonal reflex or impulse that should be striking us through the day. When the drive or desire for sexual pleasure is absent, people can feel as though something hormonally is going amyss. By comparison, thirst is a real biological drive. For example, we’d drink from a puddle if we were thirsty enough! What is often surprising to people is that sexual pleasure doesn’t work the same way as other biological impulses. Libido is often thought of as a biological drive, (we even use the term “sex drive”) and when people lose their libido, they often feel like something is wrong with their body or hormones. The reality is that many things contribute to the changes in sexual function with age and can impact both desire and physical arousal ². Here are 4 common reasons why libido changes with age and menopause. 

Vaginal Health Changes 

The vagina has both estrogen-dependent tissues and an estrogen dependent microbiome. With the changes in hormone levels at menopause, both vaginal tissue and the microbiome change to influence the sexual experiences. Genitourinary Syndrome of Menopause (GSM) is a term that describes the vaginal tissue changes that occur in and around menopause due to the loss of estroge.³ With the loss of estrogen experienced in menopause, the walls of the vagina become thinner and may even contract¹. Vaginal secretions can become lower or absent during menopause, leading to both a dry and uncomfortable sensation both during sexual encounters and in day-to-day life⁴. The vaginal bacterial microbiome is also sensitive to estrogen levels. Estrogen influences the production of glycogen - the sugar-fuel that keeps vaginal bacteria healthy⁵. Changes to vaginal bacteria influence the pH of the vagina, leading to an increased risk of infection and inflammation.⁶Patients in menopause may require additional lubrication for intercourse or sexual activity to reduce symptoms of friction and discomfort. Lubricant can also improve the sensation of sexual activity in patients who have experienced vaginal changes. 

Mood Changes

Sexual health and libido are not just about “being in the mood”. Menopause causes changes to mood and mental health that can influence day to day life of the people in this hormone transition, which has a downstream effect on sexual function.⁷ Mood changes in menopause are more common in people with a previous episode of depression, but even in people who have never struggled with their mental health, the hormone changes in menopause can create significant challenges^.8 Estrogen fluctuations in perimenopause and the eventual decline in menopause can influence both mood and sleep, which reduce the likelihood that people are able to seek the pleasure of sexual activity alone or with their partner.⁹

Stress

Stress, libido and sexual function seem to go hand in hand. People in menopause with who report higher levels of stress report lower sexual desire¹⁰, and stress has been connected to lower sexual function in people as they age.⁷ Stressful life events such as divorce, job changes, ageing parents or career advancement have also been shown to be correlated to reduced sexual function.¹ Insomnia is an often overlooked aspect of nervous system regulation, and people with insomnia (menopause or otherwise) report lower sexual function likely due to the changes to their resiliency and ability to manage stressors 11. It has been suggested that the improvement in libido from the herb Ashwagandha is due to its impact on the stress response.¹²

Hormone Changes

Hormone changes are listed as last and maybe least. Given that hormone changes are the underpinning of most menopause symptoms, it’s natural to think that the hormone changes at menopause are the sole influence on sexual health. Interestingly, we can’t diagnose low sexual function based on testing hormone levels. What this means is that there is a more complex relationship between hormones, stress, mood and desire than it seems. Even though hormones are not the sole cause of changes to sexual function, the ripple effects from the loss of hormones do impact libido. As mentioned above, as patients transition through menopause, the loss of estrogen and progesterone influence sleep, mood, hot flashes, vaginal health and other body systems.¹⁴ These changes leave people feeling not like themselves and can contribute to low libido. 

One of the herbal solutions for low libido includes the botanical Tribulus. Tribulus has been shown to improve libido in people in menopause.^13,14 Tribulus increases androgenic hormones such as DHEA¹⁵ and testosterone¹⁶, which may be how this herb influences factors such as desire, sexual satisfaction and improves lubrication.¹³

There’s Hope

It’s important to note that not all changes to sexual function and desire are negative as people age. Many people report being more connected and communicative about what they need from a partner as they approach menopause and have more confidence in what they desire sexually.¹⁴ As the symptoms of the menopause transition begin to subside, many people report an improvement in sexual function,¹⁵ meaning that with both treatment and time people can expect to feel an improvement in this very important aspect of health and wellbeing. 

Support your mind and body during the menopause stage with Menosmart+ by Smart Solutions. This blend of herbs helps reduce hot flashes & night sweats and promotes calm mood as well.

Another way to support your sexual health and vitality is with Sexsmart – a comprehensive herbal blend including Tribulus that acts as an aphrodisiac.

References

1. Scavello I, Maseroli E, Stasi VD, Vignozzi L. Sexual Health in Menopause. Medicina. 2019;55:559.
2. Pfaus JG. REVIEWS: Pathways of Sexual Desire. J Sex Medicine. 2009;6:1506–33.
3. Angelou, K., Grigoriadis, T., Diakosavvas, M., Zacharakis, D., & Athanasiou, S. (2020). The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus, 12(4), e7586. https://doi.org/10.7759/cureus.7586
   
4. Graziottin A, Leiblum SR. Biological and Psychosocial Pathophysiology of Female Sexual Dysfunction During the Menopausal Transition. J Sex Medicine. 2005;2:133–45.
5. Amabebe E, Anumba DOC. The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Frontiers Medicine. 2018;5:181.
6. Lin, Y. P., Chen, W. C., Cheng, C. M., & Shen, C. J. (2021). Vaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis. Diagnostics (Basel, Switzerland), 11(11), 1996. https://doi.org/10.3390/diagnostics11111996
7. Heidari M, Ghodusi M, Rezaei P, Abyaneh SK, Sureshjani EH, Sheikhi RA. Sexual Function and Factors Affecting Menopause: A Systematic Review. J Menopausal Medicine. 2019;25:15–27.
8. Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal Symptoms and Their Management. Endocrinology and metabolism clinics of North America, 44(3), 497–515. https://doi.org/10.1016/j.ecl.2015.05.001
9. Dalal, P. K., & Agarwal, M. (2015). Postmenopausal syndrome. Indian journal of psychiatry, 57(Suppl 2), S222–S232. https://doi.org/10.4103/0019-5545.161483
10. Woods NF, Mitchell ES, Julio KS-D. Sexual Desire During the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study. J Women’s Heal. 2010;19:209–18.
11. Kalmbach DA, Kingsberg SA, Roth T, Cheng P, Fellman-Couture C, Drake CL. Sexual function and distress in postmenopausal women with chronic insomnia: exploring the role of stress dysregulation. Nat Sci Sleep. 2019;11:141–53.
12. Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154.
13. Vale FBC, Souza KZD de, Rezende CR, Geber S. Efficacy of Tribulus Terrestris for the treatment of premenopausal women with hypoactive sexual desire disorder: a randomized double-blinded, placebo-controlled trial. Gynecol Endocrinol. 2017;34:1–4.
14. Tadayon M, Shojaee M, Afshari P, Moghimipour E, Haghighizadeh MH. The effect of hydro-alcohol extract of Tribulus terrestris on sexual satisfaction in postmenopause women: A double-blind randomized placebo-controlled trial. J Fam Medicine Prim Care. 2018;7:888–92.
15. Kingsberg SA, Simon JA. Female Hypoactive Sexual Desire Disorder: A Practical Guide to Causes, Clinical Diagnosis, and Treatment. J Women’s Heal. 2020;29:1101
16. Souza KZD de, Vale FBC, Geber S. Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women. Menopause. 2016;23:1252–6.
17. Thomas HN, Hamm M, Hess R, Thurston RC. Changes in sexual function among midlife women. Menopause. 2018;25:286–92.
18. Blumel JE, Castelo-Branco C, Binfa L, Gramegna G, Tacla X, Aracena B, et al. Quality of life after the menopause: a population study. Maturitas. 2000;34:17–23.
19. Mashhadi ZN, Irani M, Mask MK, Methie C. A systematic review of clinical trials on Ginkgo (Ginkgo biloba) effectiveness on sexual function and its safety. Avicenna J Phytomedicine. 2021;11:324–31.
20. Triple-blind, placebo-controlled trial of Ginkgo biloba extract on sexual desire in postmenopausal women in Tehran - PubMed [Internet]. n.d. [cited 2022 Mar 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/24949064/