Hi, I’m Dr. Connie Jeon.

I routinely have patients complain about low libido.  While many men patients have the same issue, today, we’ll focus on women.

The menopausal transition can be a very difficult time for many women.  Often, I find that there is much more happening under the surface in my patients’s lives than meets the eye.

Busy lifestyles, everyday stress, lack of “quality” sleep, and many other variables can place sex at the bottom of the to-do list.

Most roll their eyes at me and share that sex is a “chore”.

They complain that they just don’t like it and try their best to avoid the situation, but we all know it’s a significant part of a relationship.

Low libido is a multidimensional issue; it’s like a mosaic with different, smaller problems creating an overall, bigger issue.

Typically, it’s accompanied by fatigue, sleep deprivation, mood swings, and even mild depression.

It’s possible to get proper help, but the solution requires that you pay attention to the right issues.

In my experience, there are three broad categories that cause the most problems: endocrine, physical, and lifestyle.

1.  Endocrine Factors

An example of this is when hormones fall out of balance.

As women approach perimenopause and transition into menopause, low libido can result from declining levels of estrogen, progesterone, DHEA, and testosterone.

Sometimes, adrenal, thyroid, and growth hormones can also contribute to sexual dysfunction as well.

Estrogen Dominance

During perimenopause, the delicate balance between estrogen and progesterone is disrupted by fewer ovulatory cycles.  Typically, progesterone levels plummet as estrogen levels fluctuate.

This can cause estrogen dominance, causing symptoms such as water retention, breast tenderness, bloating, and irritability.  Other common symptoms can include hot flashes, night sweats, and vaginal dryness.

Such imbalances between progesterone and estrogen can cause low libido.

Remember though, menopause is not a disease.  However, despite the controversy, carefully administered bioidentical hormones can help patients to not only fend off the symptoms, but provide a better “quality” of life.

There’s much more we can discuss regarding hormone replacement therapy. However, that is a discussion in itself, so we’ll save that for another day.

Adrenal Dysfunction

As we age, DHEA levels decrease.  The problem is that cortisol levels remain the same or increase, skewing the DHEA:cortisol ratio.

This imbalance can cause fatigue, foggy thinking, decreased energy, and low libido. Sound familiar?

On the flip side, when the body doesn’t make enough cortisol, this can result in extreme fatigue, low blood pressure, and low blood sugar, all which makes you feel perpetually drained.

If this is the scenario, DHEA replacement therapy can be an effective strategy to balance the DHEA to cortisol ratio.

This can also address low libido as well as other accompanying symptoms.

Because adrenals synthesize progesterone, adrenal health becomes an important focus in controlling estrogen dominance during your transitional hormone stage.  The typical age for this is between 35- 55.

Hypothyroidism

Your provider will typically measure TSH.  However, if you seek out a functional medicine practitioner, they will likely measure a full spectrum of labs when it comes to thyroid (T4, Tgbn, TSH, fT3, TPOab).

It’s common for patients to have an under active thyroid and thus, decreased sexual interest. [3]

It is also important to note, selenium and iodine can help support the conversion of the thyroid hormone (T4) into its active form (T3).

Many patients generally regain their sense of well being once the thyroid is in balance again.

Metabolic Syndrome

Endocrine imbalance can result in metabolic disturbances during the transitional menopause years.

Women with metabolic syndrome have a lower sexual drive.

2.  Physical Factors

Dyspareunia

Dyspareunia is another term for painful sex.

As estrogen production declines, vaginal dryness and atrophy is a common complaint.  Even if your desire remains, pain during intercourse is common and very uncomfortable.

It’s your right to enjoy intercourse, and I’m letting you know there are some effective solutions.

Estrogen Therapy

“Estrase” cream can be prescribed by your OB/GYN to effectively help you plump up your vaginal region, which will help with dryness and atrophy.

Testosterone

This is not just for men. Testosterone plays a huge role for women in the transitional menopausal phase in helping them have a positive experience, and specifically, help them have orgasms.

Low testosterone is a particular concern if you’ve undergone surgical menopause, because replacement therapy is often necessary.

Non Hormonal Approach

This approach can work for those of you who can’t take hormones or only present with vaginal dryness.  Hyaluronic acid suppositories with cocoa butter or vaginal application of vitamin E can work wonders.

For some of you who have pelvic organ prolapse, a pelvic floor physical therapy intervention has proven to have amazing results.

Strengthening of the pelvic floor muscles is key in this approach, in which I utilize a vaginal probe to provide you with necessary stimulation to strengthen your pelvic floor muscles.  This will allow for a better experience both for you and your partner.

3.  Lifestyle Factors

Focus on Supporting a Healthy Brain

The female brain is one of the most powerful erogenous zones, meaning it is very sensitive to sexual stimulation.  Addressing brain health is an essential part of improving your libido, especially for those of you who are at a transitional phase in your life.

At the core, you need to be thinking about ways to increase blood flow to your brain.

  1. Avoid smoking, nicotine, and excessive alcohol as they constrict blood flow and reduce overall health of your vascular system.
  2. Exercise. Exercise will strengthen the heart, improve overall neurotransmitters that make you feel good in the moment, like endorphins and serotonin, and also tone your body. This is particularly important as you lose muscle drastically during this phase.  I’ve found that if you look good, you are more likely to be in the mood.
  3. Consume good fats. Omega 3 fatty acids play an essential role in the function of the cells.  Also, cholesterol, yes, I said cholesterol, is needed to make adequate levels of sex hormones. [7]
  4. Stay hydrated. Drinking water throughout the day not only keeps you hydrated but is particularly important for brain function, since your brain is 80% water!
  5. Have good nutrition. Healthy foods provide your body with the vitamins and minerals it needs, which are necessary for a sexy appetite.  Our bodies need B vitamins, magnesium, zinc, and iron for our brain to synthesize neurotransmitters.  For example, dopamine, which is a neurotransmitter responsible for “pleasure”, requires both iron and vitamin B6 for its production.
  6. Get good sleep. Quality sleep is essential for a sexy libido [8].
  7. Take supplements. Asian ginseng (Panax ginseng), the Peruvian herb Maca (Lepidium myelin), and Ginko (Ginko biloba) are examples of herbals used in Chinese medicine to improve blood flow and sexual function.  [9]

If your partner’s libido is also declining, take action. Typically my patients feel that the waning desire is what’s acceptable and is part of a natural aging process.  I’m here telling you don’t take a back seat when it comes to your aging.

A healthy sex life can have a positive impact in your life, so always seek to take on behaviors that will add to the quality of your life.

Thanks again for reading and I’ll see you next time.

References

[1] Lee JR: What Your Doctor May Not Tell You About Menopause. ed revised edition, New York, Hachette Book Group, 2004.

[2] Head KA, Kelly GS: Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev 2009;14:114-140.

[3] Pamela Wartian Smith: What You Must Know About Vitamins, Minerals, Herbs & More. Choosing The Nutrients That Are Right For You. Square One Publishers, 2008.

[4] Kelly Brogan M: A Mind of Your Own. HarperCollins Publishers, 2016.

[5] Trompeter SE, Bettencourt R, Barrett-Connor E: Metabolic Syndrome and Sexual Function in Postmenopausal Women. Am J Med 2016;129:1270-1277.

[6] Amen DG: Magnificent Mind at Any Age. New York, Harmony Books, 2008.

[7] Schmidt MA: Brain-Building Nutrition. ed 3rd, Berkeley, Frog Books, 2007.

[8] Kling JM, Manson JE, Naughton MJ, Temkit M, Sullivan SD, Gower EW, Hale L, Weitlauf JC, Nowakowski S, Crandall CJ: Association of sleep disturbance and sexual function in postmenopausal women. Menopause 2017.

[9] Muskin PR: Complementary and Alternative Medicine and Psychiatry. Washington, DC, American Psychiatric Press, Inc., 2005.