Perhaps perimenopause or menopause is just around the corner for you—or maybe you went around that corner, and you’re there already. Like many women, you have questions, and some of them may involve your sexual health, such as: What’s going to happen…or is happening…to my sex life? Is this hello menopause, goodbye libido? What can I do to revive that sexual spark? 

Goodbye libido: where it begins

At the root of sexual issues in menopause is declining levels of estrogen and testosterone. These hormonal changes are associated with menopause symptoms that can contribute to a lack of libido, such as vaginal dryness and tightness, mood swings, weight gain, depression, anxiety, and hot flashes.

Women with vaginal dryness, for example, can experience pain with intercourse, making them less interested in sex. The sudden appearance of extra pounds may make women feel less desirable or uncomfortable, while depression or anxiety can cause women not to want to think about sex at all. 

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Another hormone that affects libido is dehydroepiandrosterone (DHEA) and its sulfate DHEAS, both of which decline with age. These are the most abundant steroids in women, and when their levels go down, sexual function can decline as well. 

Testing for low libido

Your doctor can order a blood test to look for possible causes for low libido. One of those tests can reveal levels of estrogen, testosterone, thyroid hormones, iron, and prolactin (made in the pituitary gland). This test should be taken in the morning, as this is when hormone levels are their highest.

Another blood test that is sometimes overlooked is the DHEA-sulfate test. Levels of dehydroepiandrosterone (DHEA) and its sulfate DHEAS decline with age. These are the most abundant steroids in women, and when their levels go down, sexual function can decline as well. Levels considered to be normal in women are:

• Ages 40 to 49: 32 to 240 µg/dL 
• Ages 50 to 59: 26 to 200 µg/dL 
• Ages 60 to 69: 13 to 130 µg/dL 
• Ages 69 and older: 17 to 90 µg/dL 

These ranges are very wide and every woman is different. Your healthcare provider can help you determine whether DHEA supplementation is appropriate and the dose.

Treating low libido naturally

It’s important to treat the physical, emotional, and mental aspects of low libido for best results. Fortunately, there are various natural options for women to consider, including specific supplements, foods, lifestyle changes, and mental health support.  

DHEA and DHEAS: These hormones are produced in the adrenal glands and liver in women, and the body uses DHEA to produce estrogens and androgens, including testosterone. Levels of DHEA peak around age 25 and then decline steadily over time. By ages 70 to 80, DHEA levels are approximately 10 to 20 percent of those in young women.

According to Mount Sinai, “DHEA has been popular among perimenopausal women, seeking relief from menopausal symptoms, including decreased sex drive…and vaginal dryness. Studies have been mixed.”

Much more research needs to be done concerning the benefits and risks of using DHEA in menopause and postmenopause. However, in a recent report from the Polish Menopause and Andropause Society about the effectiveness and safety of using DHEA supplements in women, the experts concluded that this supplement is helpful for women with adrenal insufficiency (low DHEA), vaginal dryness and atrophy associated with menopause, hypoactive sexual disorders in postmenopause, and depression and anxiety. 

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The DHEA in supplements is a manmade hormone, so you should consult with your healthcare provider before using it. You also should have your DHEA levels tested prior to use. The supplement is available in tablets, capsule, drops, creams, chewing gum, and sublingual. 

Other ways to boost libido, ease vaginal dryness, and manage depression that can impact your sexual desire and health include the following:

Lubricants: To ease vaginal dryness, use a natural water-based lubricant free of fragrances and colors. Although some women use coconut oil and olive oil, they can damage condoms and are messy. 

Exercise: Physical activity boosts DHEA levels, releases feel-good endorphins, and can improve mood. It can also assist with weight loss and enhance self-esteem.

Emotional support: You are not the only woman who is facing this sexual dilemma. Reach out to support groups, either in person or virtual. You may be surprised by the amount of emotional support you get and the camaraderie you can develop with your peers. Many women don’t realize that emotional changes in their lives around the time of menopause, such as children leaving home, job stress, need to take care of elderly parents, and divorce, also impact sexuality and intimacy. 

Counseling/therapy: You may want to try individual or couples therapy with a sex therapist, relationship therapist, or other mental health professional. A third party can often help you (and your partner) appreciate the sexual changes and how to work through them together. They may also help with any communication issues between you and your partner. Unresolved conflicts and poor communication can impact a sexual relationship. 

Nonsexual touch: You and your partner can be intimate without sex. Cuddling, kissing, massaging, and other nonsexual acts involving touch cause your brain to release the bonding hormone called oxytocin. This, in turn, results in the release of dopamine and serotonin (“feel good” hormones) and reduces stress hormones. 

Kegel exercises: If you practice Kegel exercises daily, you will develop tighter pelvic muscles and better sexual satisfaction typically after about 4 to 6 weeks. They are easy to do, no one will even know you are doing them, and they work. Added bonus: they also are great for urinary control. 

Foods: Certain foods may help boost libido because of their nutritional content. Avocados, bananas, and figs have vitamins and minerals that boost blood flow, while dark chocolate promotes release of serotonin.  

Red ginseng: If your libido is lacking, red ginseng supplements may help. A study has shown that use of Korean red ginseng can improve blood circulation in the body, including the genital region, which in turn may boost arousal and sensation.

Maca: One study reported that maca supplementation helped postmenopausal women who had antidepressant-induced sexual dysfunction. 

Bottom line

Lack of libido is a common sexual health symptom of perimenopause and menopause, and several factors can contribute to this condition. An understanding of what is happening and adoption of some lifestyle changes can help resolve this sexual health challenge.