I was sitting with a group of my closest female friends, a much needed evening away from all of our responsibilities, and my good friend Laura whispered: “Ladies – when was the last time you… you know…?”
Yes, she was talking about sex. And once that conversation got started, there was no stopping us. It turned out that the reason Laura had brought it up was that she just hadn’t felt the desire to have sex in months.
As someone who was used to having a higher sex drive, this was unsettling for her.
And then, our friend Deanna said: “Welcome to menopause.”
Let me tell you, I was so happy to be there for this conversation. And I told my friends next what I’m about to tell you now. Yes, changes in your hormones – including perimenopause and menopause – can affect your sex drive.
But we are not powerless here! By understanding how your hormones influence your sex drive, you can actually take control of the situation and fire yourself back up again.
Let me show you how.
Low Sex Drive Doesn’t Have to Be Your New Normal
It’s not just the women I know personally – so many of my patients are also going through the same thing right now: low sex drive.
I think that part of the problem is we tend to think that just because something is common, it’s “normal”, or it’s fine, or there’s nothing we can do about it. I see the same thing happen when it comes to fatigue and stress. It’s become so “normal” to be overwhelmed, overworked, and worn out that half of the women I talk to seem to think that’s just the way they will always feel– and having a lack of interest in sex is the same way.
Low sex drive may be common, but that doesn’t mean it’s unavoidable!
I’ve talked about some of the possible factors behind this low sex drive before, and I’ve mentioned hormonal imbalance. Today, I want to zoom in more on that, because it’s such a common root cause of decreased libido– but it can be complicated to pinpoint and untangle.
It is normal for our hormones and our bodies to change as we get older. But that doesn’t mean that we have to go through the rest of our lives living with hormonal imbalances that affect our health and our quality of life in so many different ways.
I want to empower you to understand more about your hormones so that you can take some of the pressure off yourself and work in harmony with your body to balance your hormones, heal your body, and get your mojo back!
The Connection Between Emotional & Physical Health
Before we get into the actual hormonal causes of low sex drive, I want to take a look at the emotional piece of the puzzle.
I notice this pattern all the time in which women notice their low sex drive, and at least partly, they blame themselves. You might feel like you’re not trying hard enough or not putting enough effort into your relationship. Of course, there may be emotional factors or relationship challenges that are playing a role, but so often, hormones are the real culprit.
A hormonal imbalance is also likely to cause other issues that contribute to and exacerbate the problem– like fatigue and mood swings.
So, there is often more than one thing going on– it might not be all hormonal or all physiological, but it likely is not all emotional or mental, either. A well-rounded approach to getting your sex drive back involves considering all of the possible contributing factors.
The connection between emotional and physical health goes both ways here, too. An imbalance in hormones may contribute to fatigue, moodiness, and low libido. But if your hormones are out of balance, stress is likely to be a primary root cause.
Why Having a Healthy Sex Drive Matters
When I hear my patients (and a lot of my friends!) talk about sex drive, they sort of feel like they could take it or leave it. It’s not necessarily a complete lack of interest or desire, but they have no “oomph” about it.
If you can remember a time when you did have a healthy appetite for sexual pleasure, hold onto that memory for a second! For those of us who have a million things going on at work, at home, and in general, sex might seem like a frivolous concern, or just an afterthought. I would like to put a halt to this idea right away!
You can certainly have a fulfilling, happy, and healthy life in which sex does not play much of a role, if that is your choice. But I think that for most of us it is important to be able to experience that desire and pleasure, and you do not have to let it go just because you’re about to go through menopause, have gone through it, or because you simply have bigger priorities.
Brushing aside our own sexual pleasure is another way in which we, as women who wear so many hats, put our happiness and fulfillment on the backburner– and it doesn’t need to be that way.
And all of that aside, low libido is often a warning sign of a hormonal imbalance that may be behind all kinds of other symptoms, from fatigue to depression to weight gain.
Hormonal Imbalances and Sex Drive
Hormonal imbalance can be tricky. A lot of women I work with do have a hunch that their low sex drive is related to a change or imbalance in their hormones, but that doesn’t necessarily tell them what to do about it or where to look!
There are so many different hormones at play. The main ones we want to look at when we’re exploring low sex drive are testosterone, estrogen, cortisol, progesterone, and DHEA.
Correcting a hormonal imbalance is not necessarily going to be quick or easy, but it is achievable, and it comes with so many benefits. It involves a whole lifestyle approach in order to address the root cause, and rebalance our hormones from within.
I definitely see decreased sex drive most often in women who are going through perimenopause, but it can start earlier– levels of crucial sex hormones like DHEA and testosterone start to go down when we’re in our 20s, and although this is natural to some extent, this is often where a problematic imbalance begins.
Besides decreased libido, perimenopause often brings about mood swings, weight gain, difficulty sleeping, fatigue, and any number of other symptoms. And of course, these symptoms are likely to contribute. If you’re exhausted, unhappy with your weight, or battling incessant hot flashes, sex is not likely to be very appealing. But if we can balance our hormones, we can tackle all of those things together.
Let’s take a look at the key hormones we want to explore when it comes to sex drive.
Cortisol: Stress– and therefore, the stress hormone cortisol– is behind a lot of hormonal problems. Most women I see in my practice are suffering from adrenal fatigue to some degree.
Adrenal fatigue occurs when we’re burned out in every way. Low sex drive is a symptom of both adrenal fatigue and a hormonal imbalance involving cortisol. Other symptoms of cortisol levels that are too high or low can include extreme fatigue, a feeling of being “tired but wired”, cravings for sugar or carbs, weight gain, and insomnia.
Estrogen: Estrogen is our primary female sex hormone, and it is a common culprit when it comes to hormonal imbalance and low sex drive. It’s estrogen’s job, among other things, to regulate our menstrual cycles and prepare us for pregnancy.
Levels of estrogen do naturally decrease during perimenopause, but levels often drop too low, or fall out of balance with levels of other important sex hormones like testosterone and progesterone. In addition to decreased libido, this can lead to mood swings, weight gain, vaginal dryness, and bloating. Prior to the menopausal stage, an imbalance in estrogen levels can cause irregular periods and symptoms of PMS.
Testosterone: We often think of testosterone as being the male sex hormone, but it’s essential for women too. Testosterone, like DHEA, starts to go down when we’re in our 20s. It decreases more dramatically during perimenopause
Too-low testosterone levels are very common among women as they get older. There are also other factors that often contribute to low levels, like being on or having been on the pill or other hormonal birth control. There is a major link between testosterone and sex drive, and low levels should definitely be a key suspect when investigating low libido.
Other symptoms of low testosterone can include excess hair growth or hair loss, skin issues, depression, fatigue, and anxiety.
DHEA: Testosterone is produced by the ovaries, and it can also be made through the conversion of DHEA. However, if DHEA production is low, or if stress is high and DHEA needs to be converted into the stress hormone cortisol, testosterone production will be reduced.
Progesterone: Progesterone is another essential female hormone that works to control the menstrual cycle, among other important female functions. Progesterone itself hasn’t been as closely linked to issues with sex drive, but if progesterone levels are off, this typically points to a general hormonal imbalance.
You might notice that many different hormonal imbalances are linked to similar symptoms like fatigue, weight gain, and moodiness. There are certain identifying features of specific hormonal issues, but as a general rule, if one thing is out of whack, everything is going to be a little off. Hormones work together, and everything is connected.
How to Correct a Hormonal Imbalance & Low Sex Drive
There are a lot of “miracle” solutions that I see advertised. Let’s just be clear, no amount of eating oysters is going to resolve a hormonal libido issue! But there are lots of great, natural methods for getting your mojo back.
Hormone replacement therapy may be recommended in some cases, but I would much rather start with natural methods for healing from within. My goal with my patients is to get to the root cause, and figure out which hormones are imbalanced, why, and what we can do to stabilize production of these hormones from within, rather than just replacing them from an outside source without really getting to the issue.
Make sure you’re eating enough healthy fats. One of the most important things to consider when working on correcting a hormonal imbalance is whether your diet contains enough healthy fats. We need cholesterol (the good kind) to produce hormones, and cholesterol requires fat (again, the good kind). We don’t want to leave our bodies in a situation where resources are limited and they have to decide whether the available cholesterol goes to our sex hormones or to the brain or other types of cells.
Address stress and adrenal function. The cause of many hormonal issues is stress and adrenal dysfunction. It is important to look at all kinds of stressors: working too hard, a lack of good quality sleep, an inflammatory diet, the use of certain medications like hormonal birth control or antidepressants, a lack of activities that make you feel joy… these can all contribute. Any successful treatment plan will involve making time to take care of yourself, eating a healthy, nourishing, whole foods diet, and getting enough sleep and gentle exercise.
Consider adaptogens. This goes hand in hand with the previous step. Adaptogens are certain types of herbs that help to regulate the body’s natural stress response. Some of the most effective adaptogens include eleuthero, astragalus, rhodiola, and ashwagandha.
Find a functional medicine practitioner. I would recommend trying to find a functional medicine practitioner to work with, who can help you to untangle your hormonal web and find a plan that’s right for you.
Address the emotional piece. Because emotional and physiological factors tend to intermingle when it comes to sex, it is also important while addressing hormonal issues to foster healthy communication with your partner and explore any underlying emotional concerns that may be playing a role.
Hormonal Imbalances Can (And Should) Be Resolved
There are SO many things going on for most of us during perimenopause. A rapidly declining sex drive might seem like the tip of the iceberg or it might just seem incidental– you’re moody and exhausted all the time, you’re gaining weight, hot flashes make few things less desirable than sex.
I hear a lot of women explaining away so many symptoms that affect their quality of life by saying “it’s just hormonal”. I think a lot of people confuse “hormonal” with “inevitable”! Yes, it is natural for our hormones and our bodies to change in different stages of our lives, but that doesn’t mean that we have to suffer. It doesn’t help that many practitioners dismiss women who are going through perimenopause with the same “laissez-faire” attitude. But I believe that we can learn to understand, work with, and support our hormones and our bodies, and feel better.
The older we get, the more we should feel connected to and in control of our bodies. This should include being able to achieve sexual pleasure– at any age.
Reviewed by Dr. Mark Menolascino, MD