Understanding Libido During Menopause: Navigating Changes in Sexual Health and GSM

By: Dr. Karlee Tario ND

Let’s talk about something that doesn’t get nearly enough airtime: libido during menopause. Yep, that little spark of desire can feel more like a flicker—or even like it’s gone out entirely—when menopause rolls in. And guess what? You’re not imagining it, and you’re definitely not alone.

As your hormones shift, you might notice changes in everything from sleep and mood to energy and sexual desire. Along with those hormonal changes, many women experience Genitourinary Syndrome of Menopause (GSM)—which can add an extra layer of discomfort to your sex life.

But here’s the good news: just because libido changes are common doesn’t mean they’re permanent or that you have to just "deal with it." Let’s break down what’s happening and how you can feel good (and yes—desire!) again.

So... What’s Actually Going On with Libido?

When you reach menopause (defined as 12 months without a period), two major hormones take a nosedive: estrogen and testosterone.

• Estrogen helps keep vaginal tissues thick, elastic, and well-lubricated. When it drops, you might experience dryness, irritation, and discomfort during sex.

• Testosterone—yep, women have it too!—plays a big role in your sex drive. Lower levels can make your libido feel like it’s left the building.

These hormonal shifts are completely natural—but they can affect how you feel about intimacy, both physically and emotionally.

Enter GSM: Genitourinary Syndrome of Menopause

GSM is a term that covers a group of symptoms caused by declining estrogen, and it can have a big impact on your sexual health. These include:

• Vaginal dryness or irritation

• Painful sex (dyspareunia)

• Frequent urinary tract infections

• Increased urgency or frequency of urination

It’s no surprise that when sex starts to feel uncomfortable (or downright painful), desire takes a dip. Add in some stress or fatigue, and you might start wondering where your libido went.

Why Libido Changes During Menopause

Let’s connect the dots. Here are a few of the biggest libido disruptors in midlife:

1. Hormonal Changes

• Less estrogen = more dryness and discomfort.

• Less testosterone = less drive.

2. GSM Symptoms

• Physical discomfort = less interest in intimacy.

3. Emotional Rollercoaster

• Mood swings, body image shifts, and anxiety can all put a damper on desire.

4. Stress & Exhaustion

• When you’re juggling a million things (hello, life!), it’s hard to feel sexy.

5. Testosterone Decline

• Less testosterone as we age is a natural part of the picture—but it can still be frustrating.

Reclaiming Your Libido: What Can You Do?

You don’t have to “just live with it.” There are many supportive, natural, and medical strategies to help you feel like yourself again.

Vaginal Estrogen Therapy

These low-dose treatments (creams, rings, or tablets) help restore moisture, thickness, and comfort to vaginal tissues. Game changer.

Non-Hormonal Relief

• Lubricants for immediate comfort during intimacy

• Vaginal moisturizers for everyday hydration

• Ospemifene: A non-estrogen prescription option for painful sex

Naturopathic Approaches to Supporting Libido

As naturopathic doctors, we love combining conventional wisdom with natural, holistic options. Here’s how we support libido and GSM from a root-cause and whole-body perspective:

Botanical Medicine

• Adaptogens like ashwagandha and rhodiola help your body respond to stress (which is a major libido killer).

• Libido-supportive herbs like maca root, tribulus terrestris, and damiana may help promote hormonal balance and increase desire.

Vaginal Botanical Blends

• Certain vaginal suppositories or natural lubricants (like vitamin E and coconut oil) can soothe irritated tissues and support natural lubrication.

Nutritional Support

• Zinc, vitamin B6, magnesium, and omega-3 fatty acids all support hormone production and mood balance.

• Phytoestrogens (found in foods like flaxseeds, soy, and lentils) can gently support estrogen balance in the body.

Acupuncture

• Regular sessions can help regulate hormones, reduce stress, and boost energy—indirectly supporting libido and overall vitality.

Hormone Balancing Plans

• Depending on your lab results and personal health picture, we may support gentle hormonal balance using nutrition, herbs, and targeted supplements (including support for adrenal and thyroid function, which play into sex drive too).  We can also help you navigate hormonal treatment options with your prescriber.

Mind-Body & Lifestyle Strategies

Pelvic Floor Exercises

Kegels strengthen the pelvic floor, support urinary function, and can enhance sexual sensation.

Stress Reduction

Daily practices like breathwork, mindfulness, or restorative yoga can lower cortisol and bring you back into your body.

Open Communication

A loving and honest convo with your partner can reduce anxiety, build connection, and make intimacy feel emotionally safe.

Movement & Sleep

Exercise boosts circulation and endorphins, while good sleep supports hormone production and mood—win-win for libido!

When to Reach Out for Support

If these changes are affecting your well-being or your relationships, you don’t have to figure it out alone. Talk to a practitioner who understands hormonal transitions and sexual health (like us!). Whether it’s pelvic floor therapy, botanical support, bioidentical hormone therapy, or simply creating a safe space to talk—we’ve got options.