Herbal Approaches to Low Libido in Menopause
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Menopause is associated with many often-lamented symptoms that can have drastic effects on a woman’s comfort, happiness, and daily life activities. Hot flashes, night sweats, and mood swings are commonly discussed because of their prevalence (up to 80% of women experience hot flashes during menopause[i]). Though less often discussed, low sexual desire is another prevalent symptom in menopausal women. One cross-sectional study of over 2,000 women found 52.4% reported depressed sexual desire compared to 26.7% of pre-menopausal women.[ii] Not only because of the ubiquity but also because of the effect on the quality of life, symptoms of sexual dysfunction in menopausal women deserve more attention and more treatment options, as the current choices leave much to be desired.
What Causes Low Libido in Menopause?
There are many factors associated with libido changes in menopause. Decreases in estrogen can cause hot flashes, vaginal dryness, vulvovaginal atrophy and directly contribute to lowered sexual desire.[iii] In addition to estrogen levels, testosterone, which also decreases in menopause, has been implicated as a critical hormone for female sexual desire.[iv] Physical factors, such as vaginal dryness and pain during sex, are largely common in menopause and can reduce interest in sex for many women.[v] Many women also report increased levels of depression, cognitive symptoms, and mood swings during menopausal transitions. While these may not have a direct effect on sexual desire, they can surely diminish the appeal of sexual activity.1
Fortunately for us, there are several herbs showing fantastic results for boosting libido in women of menopausal age. Here are a few of my favorites:
One cross-sectional study of over 2,000 women found 52.4% reported depressed sexual desire compared to 26.7% of pre-menopausal women.
Lepidium meyenii, or maca, is one of the premium exports of Peru. Traditionally consumed as a health food addition to soups or juices with a unique flavor and caramel notes, Peruvian maca is now primarily utilized in medicinal forms such as powders, pills, and extracts. It is rich in fiber, vitamin C, copper, and iron, yet its nutritional properties are not at the forefront of its medicinal magic.[vi] Maca has been touted for its ability to increase energy, improve concentration, and balance hormones.[vii] Because of these properties and more, maca can be a valuable tool for women in the menopausal stage of life, particularly those struggling with diminished libido.
The precise mechanisms of maca are still relatively unknown, though its results have been promising both clinically and in studies. Maca appears to significantly reduce parameters of sexual dysfunction as well as scores on the Greene Climacteric Scale (GCS), a measurement of menopausal symptoms. One group of researchers hypothesized that this might be due to a hormone modulating effect of maca. Yet, in their study, they found no significant changes in estrogen levels of postmenopausal women. However, the women in their study did experience a decline in menopausal symptoms and reported significant improvements in libido and sexual function.[viii]
It is feasible that maca’s profound effect on sexual function is related to its effect on psychological symptoms. Maca has been shown to have beneficial effects on anxiety and depression, which may increase parameters of sexual desire.11 Flavonoids in maca inhibit monoamine oxidase (MAO) activity, the same mechanism of action of a prominent class of antidepressant medications.[ix],[x] Interestingly, many of the present studies on maca revolve around its use as a treatment for antidepressant-induced sexual dysfunction (AISD). In a double-blind, placebo-controlled study of menopausal Chinese women suffering from AISD, maca reduced symptoms of depression. It improved GCS scores, even with no measurable changes to serum hormone levels.[xi] Another 12-week double-blind, placebo-controlled study found similar results, with 3.0g/day of maca supplementation showing marked improvements in AISD.[xii] These results suggest that maca can be a powerful tool for women who have opted to treat their menopausal symptoms with SSRIs, only to succumb to the side effects of low libido.
Turnera diffusa, or damiana as it is commonly known, is one of the most appreciated plant aphrodisiacs for both males and females. Native American cultures historically used damiana to regain strength after “alcoholic and sexual excesses.” Latin cultures have long turned to damiana to stimulate sexual drive and performance[xiii]. Damiana enhances nitric oxide synthesis, a mediator that plays a role in genital arousal in women as it does in men by relaxing smooth muscle tissue in the genitals and increasing blood flow to the region.[xiv] It has also been shown to exhibit adaptogenic properties, which may reduce stress and mental fatigue, lessening inhibitions to sexual activity.[xv]
One randomized, double-blind, placebo-controlled study evaluated the effects of damiana coupled with L-arginine, ginseng, ginkgo, and vitamins. After four weeks, women from both the perimenopausal and postmenopausal groups reported significant improvements in sexual desire compared to those in the placebo group.[xvi] Another study by the same research group used the same nutritional interventions and observed notable improvements in not only sexual desire but also saw a reduction in vaginal dryness, increased frequency of orgasm, and improved clitoral sensation.[xvii] Another study observed the effects of a supplement containing damiana and Tribulus terrestris, Gingko biloba, and Trigonella foenum. Researchers noted significant improvement in Female Sexual Function Index scores for the treatment group.[xviii] The results of these trials suggest that damiana can be a valuable constituent of any herbal regimen aimed at improving libido and sexual function, particularly for menopausal women.
Shatavari is an herb with a longstanding tradition of use for female sexual dysfunction, and modern research is beginning to add validity to this history.
Shatavari, the common name for Asparagus racemosus, means “she who possesses a hundred husbands,” referring to its historical use as a female reproductive tonic to increase fertility and vitality. In Ayurveda, it is known as the “Queen of Herbs” for similar reasons. Shatavari is an herb with a longstanding tradition of use for female sexual dysfunction, and modern research is beginning to add validity to this history.
Studies have shown favorable variations in sexual behavior in mice studies when using shatavari.[xix] These effects could be attributed to the steroidal saponin constituents that give rise to direct hormonal effects. Shatavari exhibits phytoestrogenic activity and supports testosterone production by enhancing primary secretion and increasing the availability of its precursors.19,[xx] Its phytoestrogenic activity offers additional benefits for menopausal women, providing relief from other symptoms of decreased estrogen such as hot flashes and vaginal atrophy.[xxi]
Outside of direct hormonal effects, shatavari appears to have adaptogenic and stress-relieving properties.[xxii] Stress can have major impacts on reproductive health by modulating ovarian physiology and reproductive hormones.[xxiii] These physical and chemical effects are in addition to the mental-emotional impact of stress, which can also directly affect sexual desire and function. [xxiv]Shatavari has been successfully used to modulate the hormonal imbalances associated with stress and restore reproductive function, supporting the hormones responsible for sexual desire.[xxv]
Tribulus terrestris is primarily known for its actions with male hormonal dysfunction in historical circles. The same qualities that it’s touted for in males lend to it being an incredible tool for menopausal women with low libido. Tribulus increases the release of nitric oxide, supporting more blood flow to the sexual organs for enhanced sexual function.[xxvi] Additionally, one of the known saponin constituents of Tribulus increases the conversion of testosterone into dihydrotestosterone, a potent androgen that directly increases sex drive.[xxvii]
7.5 mg/day of Tribulus significantly improved desire, arousal, lubrication, and sexual satisfaction compared to placebo
In one double-blind, placebo-controlled study, researchers observed the effect of Tribulus extract on women with hypoactive sexual desire disorder. They found that 7.5 mg/day of Tribulus significantly improved desire, arousal, lubrication, and sexual satisfaction compared to placebo.[xxviii] Another prospective, randomized, double-blind, placebo-controlled trial observed improvements in sexual arousal, lubrication, orgasm, pain, and satisfaction for the Tribulus group. The treatment group also exhibited increased levels of free and bioavailable testosterone.[xxix] These findings suggest that Tribulus is an effective agent at boosting multiple parameters of libido and sex drive.
Another randomized, double-blind, placebo-controlled study looked at the effects of Tribulus on desire and sexual function in 36 menopausal women. After 120 days of Tribulus supplementation, participants in the treatment group noticed a significant improvement in desire, arousal, lubrication, and anorgasmia, compared to no improvements in the placebo group. Women in the treatment group also saw a significant increase in testosterone levels.[xxx] Another group of researchers observed a significant improvement in reported sexual satisfaction for 30 menopausal women compared to their placebo counterparts.[xxxi]
Sexual dysfunction, particularly diminished libido, can be distressing for many women. When not addressed, symptoms of low sexual desire can present with decreased quality of life, relationship issues, and low self-esteem. Herbal approaches to low libido can be an excellent fit for many women who would like to improve their symptom profile and quality of life. Herbs can provide a valid solution for hormone balance, mood support, and directly benefit the uncomfortable symptoms associated with menopause like lowered libido.
[i] Minkin, Mary Jane. “Menopause: Hormones, Lifestyle, and Optimizing Aging.” Obstetrics and gynecology clinics of North America vol. 46,3 (2019): 501-514. doi:10.1016/j.ogc.2019.04.008
[ii] West, Suzanne L et al. “Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women.” Archives of internal medicine vol. 168,13 (2008): 1441-9. doi:10.1001/archinte.168.13.1441
[iii] Allam SA et al. Menopause practice: a clinician’s guide. 5th edition. Mayfield Heights (OH): The North American Menopause Society; 2014.
[iv] Cappelletti, Maurand, and Kim Wallen. “Increasing women’s sexual desire: The comparative effectiveness of estrogens and androgens.” Hormones and behavior vol. 78 (2016): 178-93. doi:10.1016/j.yhbeh.2015.11.003
[v] Scavello, Irene et al. “Sexual Health in Menopause.” Medicina (Kaunas, Lithuania) vol. 55,9 559. 2 Sep. 2019, doi:10.3390/medicina55090559
[vi] Gonzales, Gustavo F et al. “Lepidium meyenii (Maca): a plant from the highlands of Peru–from tradition to science.” Forschende Komplementarmedizin (2006) vol. 16,6 (2009): 373-80. doi:10.1159/000264618
[vii] da Silva Leitão Peres, Natália et al. “Medicinal effects of Peruvian maca (Lepidium meyenii): a review.” Food & function vol. 11,1 (2020): 83-92. doi:10.1039/c9fo02732g
[viii] Brooks NA et al. Beneficial effects of Lepidium meyenii (maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content. Menopause. 2008 Nov-Dec;15(6):1157-62.
[ix] Thull U, Testa B. Screening of unsubstituted cyclic compounds as inhibitors of monoamine oxidases. Biochem Pharmacol 1994;47: 2307/2310.
[x] Sloley BD et al. Identification of kaempferol as a monoamine oxidase inhibitor and potential neuroprotectant in extracts of Ginkgo biloba leaves. J Pharm Pharmacol 2000;52:451/459.
[xi] Stojanovska, L et al. “Maca reduces blood pressure and depression, in a pilot study in postmenopausal women.” Climacteric : the journal of the International Menopause Society vol. 18,1 (2015): 69-78. doi:10.3109/13697137.2014.929649
[xii] Dording, Christina M et al. “A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women.” Evidence-based complementary and alternative medicine : eCAM vol. 2015 (2015): 949036. doi:10.1155/2015/949036
[xiii] DK Patel, et.al. Pharmacologically screened aphrodisiac plant-A review of current scientific literature. Asian Pacific Journal of Tropical Biomedicine. Volume 1, Issue 1, 2011,Pages S131-S138
[xiv] Szewczyk, Katarzyna, and Christian Zidorn. “Ethnobotany, phytochemistry, and bioactivity of the genus Turnera (Passifloraceae) with a focus on damiana–Turnera diffusa.” Journal of ethnopharmacology vol. 152,3 (2014): 424-43. doi:10.1016/j.jep.2014.01.019
[xv] María DB, et al. Neurobehavioral and toxicological effects of an aqueous extract of Turnera diffusa Willd (Turneraceae) in mice. J Ethnopharmacol. 2019 May 23;236:50-62.
[xvi] Ito, Thomas Y et al. “The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status.” Journal of sex & marital therapy vol. 32,5 (2006): 369-78. doi:10.1080/00926230600834901
[xvii] Ito, T Y et al. “A double-blind placebo-controlled study of ArginMax, a nutritional supplement for enhancement of female sexual function.” Journal of sex & marital therapy vol. 27,5 (2001): 541-9. doi:10.1080/713846828
[xviii] Palacios, S et al. “Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire.” BMC women’s health vol. 19,1 58. 30 Apr. 2019, doi:10.1186/s12905-019-0755-9
[xix] Thakur M, et al. A comparative study on aphrodisiac activity of some ayurvedic herbs in male albino rats. Arch Sex Behav. 2009;38(6):1009–1015.
[xx] Haren, M. T., et al. (2002). Defining relative androgen deficiency in aging men: How should testosterone be measured and what are the relationships between androgen levels and physical, sexual and emotional health. Climacteric, 5, 15–25.
[xxi] Sharma K, Bhatnagar M. Asparagus racemosus (Shatavari): a versatile female tonic. Int J Pharma Biological Archives. 2011;2(3):855-63.
[xxiii] S.M.S. Ebbesen, et. Al. Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study, Hum. Reprod. 24 (2009) 2173–2182.
[xxv] Pandey AK, et al. Impact of stress on female reproductive health disorders: possible beneficial effects of shatavari (Asparagus racemosus). Biomed Pharmacother. 2018 Jul;103:46-9.
[xxvi] Adaikan PG, et al. Proerectile pharmacological effects of Tribulus terrestris extract on the rabbit corpus cavernosum. Ann Acad Med. 2000;29:22–6.
[xxvii] Chhatre, Saurabh et al. “Phytopharmacological overview of Tribulus terrestris.” Pharmacognosy reviews vol. 8,15 (2014): 45-51. doi:10.4103/0973-7847.125530
[xxviii] Akhtari, Elham et al. “Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo – controlled study.” Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences vol. 22,1 40. 28 Apr. 2014, doi:10.1186/2008-2231-22-40
[xxix] Vale, Fabiene Bernardes Castro et al. “Efficacy of Tribulus Terrestris for the treatment of premenopausal women with hypoactive sexual desire disorder: a randomized double-blinded, placebo-controlled trial.” Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology vol. 34,5 (2018): 442-445. doi:10.1080/09513590.2017.1409711
[xxx] de Souza, Karla Zanolla Dias et al. “Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial.” Menopause (New York, N.Y.) vol. 23,11 (2016): 1252-1256. doi:10.1097/GME.0000000000000766
[xxxi] Tadayon, Mitra et al. “The effect of hydro-alcohol extract of Tribulus terrestris on sexual satisfaction in postmenopause women: A double-blind randomized placebo-controlled trial.” Journal of family medicine and primary care vol. 7,5 (2018): 888-892. doi:10.4103/jfmpc.jfmpc_355_17
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