Increase Libido During Menopause & Perimenopause Naturally

Perimenopause and menopause bring significant hormonal changes that can affect energy, mood, vaginal comfort, and sexual desire. For many women, declining estrogen and shifting androgen levels may lead to lower libido, vaginal dryness, and reduced sexual satisfaction. While these changes are common, they are not something women simply have to “accept.” There are evidence-based, natural strategies to help increase libido during menopause.

In this post, we’ll explore the science behind menopause and lifestyle modifications and specific ingredients that may help increase libido during menopause. For some background on female libido more generally (i.e., not specific to menopause and perimenopause), read our prior post here.

Why Libido Changes During Perimenopause and Menopause

Libido during midlife and beyond is influenced by several biological shifts, which are outlined below.

Declining Estrogen

Estrogen supports:

• Vaginal tissue elasticity

• Blood flow

• Vaginal lubrication

As estrogen levels drop, vaginal dryness and discomfort may increase, which can indirectly reduce desire.

Testosterone Decline

Testosterone is the main hormone of sexual motivation and arousal, and women produce testosterone in even less amounts starting in perimenopause. Although testosterone is less important for libido in women than men, research suggests that declining androgens during midlife is among the more significant contributors to low libido in women.

Increased Stress & Sleep Disruption

Hot flashes, night sweats, and mood shifts may disrupt sleep. Poor sleep and chronic stress elevate cortisol, which can suppress sexual desire. Stress and cortisol are two of the main contributors to low libido pre-menopause, and they are also significant contributors during perimenopause and menopause.

Vaginal Microbiome Changes

Hormonal shifts can alter the vaginal microbiome (the ecosystem of bacteria, fungi, and viruses inhabiting the vaginal tract), increasing susceptibility to dryness, irritation, and recurrent urinary tract infections (UTIs). Dryness, irritation, and UTIs all negatively affect intimacy. Proper maintenance and care for the vaginal microbiome is an example of a change that can be done independent of changes to hormones and stress.

Natural Ways to Increase Libido During Menopause

Support libido during menopause using lifestyle modifications in addition to targeted, research-backed supplementation.

Improved Quality of Life, Stress Resilience & Increased Sexual Satisfaction with Ashwagandha

Ashwagandha (Withania somnifera) is an adaptogenic herb studied for its stress-modulating effects. It has been studied in both perimenopause and women of all ages at a dose of 600mg per day. In our view, Ashwagandha is the single most effective ingredient to increase libido during menopause, which is why we cover each of the trials in detail below.

Gopal S, Ajgaonkar A, Kanchi P, Kaundinya A, Thakare V, Chauhan S, Langade D. Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study. J Obstet Gynaecol Res. 2021 Dec;47(12):4414-4425. doi: 10.1111/jog.15030. Epub 2021 Sep 22. PMID: 34553463.

In this study of 100 women in perimenopause, Ashwagandha supplementation at 600mg per day resulted in statistically significant reductions in:

• Menopause Rating Scale (MRS) (p < 0.0001)
  • The MRS is a validated metric used to assess the severity of menopausal symptoms and their impact on quality of life
  • This study result means that the study participants given Ashwagandha 600mg/day had a significant reduction in menopausal symptoms and increased quality of life
• Menopause-specific Quality of Life (MENQoL) scores (p < 0.0001)
  • MENQoL is another validated metric used to measure the impact of menopausal symptoms on a woman's quality of life
  • This study result means that the study participants given Ashwagandha 600mg/day had a significant improvement in quality of life

Additionally, the study participants given Ashwagandha 600mg/day had statistically significant changes in several key hormones that are affected by menopause:

• Increase in serum estradiol (p < 0.0001)
• Decrease in serum follicle-stimulating hormone (p < 0.0001)
• Decrease in serum luteinizing hormone (p < 0.05)

Ajgaonkar A, Jain M, Debnath K. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract for Improvement of Sexual Health in Healthy Women: A Prospective, Randomized, Placebo-Controlled Study. Cureus. 2022 Oct 28;14(10):e30787. doi: 10.7759/cureus.30787. PMID: 36447681; PMCID: PMC9701317.

80 women between 18 and 50 were studied using Ashwagandha 600mg/day, and the investigators found the following differences statistically significant results were found versus placebo:

• Improvement in Female Sexual Function Index (FSFI) scores (p < 0.0001), which also included improvement in all sub-scales of the FSFI
  • increased desire
  • increased arousal
  • increased vaginal lubrication
  • increased orgasm
  • increased overall sexual satisfaction
  • decreased pain during intercourse
• Improvement in the Female Sexual Distress Scale (FSDS) (p < 0.0001), which is a different metric used to assess sexual function in women

Although a statistically significant change in all domains of the general health questionnaire (GHQ-28) scale were not achieved, there was a positive trend toward significance in overall (global), physical, psychological, and social function outcomes in the Ashwagandha-treated arm of the study. There was also a statistically significant improvement in Satisfying Sexual Encounters (SSEs) in the treatment arm (p = 0.017 at 4 weeks and p = 0.002 at 8 weeks), which is consistent with the overwhelming evidence supporting Ashwagandha as an effective agent to increase libido during menopause and all women more generally.

Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154. doi: 10.1155/2015/284154. Epub 2015 Oct 4. PMID: 26504795; PMCID: PMC4609357.

The 2015 Dongre study is one of the first and most-cited studies investigating Ashwagandha to improve sexual function in women. It also used a dose of 600mg/day. Similar to the studies that were reviewed above, this study found statistically significant improvements in:

• FSFI total score (p < 0.001), as well as FSFI domains scores for:
  • arousal (p < 0.001)
  • lubrication (p < 0.001)
  • orgasm (p = 0.004) and
  • satisfaction (p < 0.001)
• FSDS score (p < 0.001) and 
• Number of SSEs (p < 0.001)

In conclusion, Ashwagandha 600mg/day is one of the most-studied and research-backed ingredients for female libido. If you are looking to increase libido during menopause, a supplement containing this dose of Ashwagandha is a no-brainer.

Consider Saffron Extract for Sexual Function Support

Saffron (Crocus sativus) is another adaptogenic herb that has been researched for its potential to improve sexual function in women. Several studies in the last decade have all reported overwhelmingly-positive results, which are detailed below. 

Ranjbar H, Ashrafizaveh A. Effects of saffron (Crocus sativus) on sexual dysfunction among men and women: A systematic review and meta-analysis. Avicenna J Phytomed. 2019 Sep-Oct;9(5):419-427. PMID: 31516855; PMCID: PMC6727438.

This meta-analysis published in 2019 reviewed 5 studies investigating the effect of Saffron on sexual function. There were a combined 173 study participants, each receiving 15mg of Saffron, and statistically significant improvements in the Female Sexual Function Index (FSFI) were observed, including statistically significant improvements in each of the subscales (increased desire, increased arousal, increased lubrication, increased orgasm, increased overall sexual satisfaction, and decreased pain).

Kashani L, Aslzadeh S, Shokraee K, Shamabadi A, Tadayon Najafabadi B, Jafarinia M, Esalatmanesh S, Akhondzadeh S. Crocus sativus (saffron) in the treatment of female sexual dysfunction: a three-center, double-blind, randomized, and placebo-controlled clinical trial. Avicenna J Phytomed. 2022 May-Jun;12(3):257-268. doi: 10.22038/AJP.2022.19714. PMID: 36186931; PMCID: PMC9482709.

Another major study on Saffron was conducted after the Ranjbar 2019 review, and this study looked at a higher dose of Saffron: 30mg/day. Similar to the prior studies, this trial resulted in a statistically significant increase in FSFI scores, an impressive 62% increase in just 6 weeks!

The bottom line is that Saffron, like Ashwagandha, is an essential supplement to increase libido during menopause.

Support Vaginal Health with Probiotics

The vaginal microbiome becomes more susceptible to imbalance during menopause due to declining estrogen. Estrogen supports glycogen production in vaginal tissue, which feeds beneficial Lactobacillus bacteria. When estrogen declines, microbiome stability may decrease.

There are probiotics in everything nowadays, but if you are taking probiotics for purposes of the vaginal microbiome, two strains are particularly important: Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14. These strains have been studied in postmenopausal women specifically and have found:

• Significant improvement in the Nugent score (an assessment of vaginal microbiome)
• Increase Lactobacillus colonization
• Reduction in Gram-negative anaerobes ("bad" bacteria)
• Improved vaginal ecosystem balance

References: (1) Petricevic L et al. (2008); and (2) Bisanz JR et al. (2014).

Although probiotics do not directly increase libido during menopause, they contribute indirectly by improving vaginal comfort, reducing pain-related avoidance, and restoring confidence.

Cranberry PACs and Urinary Tract Support

Recurrent urinary tract infections are more common during and after menopause. Use of cranberry products to prevent UTIs is very well understood and accepted in society, but not all cranberry products are created equal. Cranberry proanthocyanidins (PACs) are the active part of the cranberry, and they are what has been studied in the clinical literature to prevent bacterial adhesion to the urinary tract lining.

Indeed, a review published in Cochrane Database of Systematic Reviews evaluated cranberry products for UTI prevention. Cochrane Reviews are considered one of the most trusted forms of evidence in healthcare because they are high-quality, independent, and systematic reviews of medical research. The Cochrane Review on cranberry products found a 26% relative risk reduction in UTIs for properly-dosed cranberry products.

When buying a cranberry product, make sure that the product lists the Cranberry PACs content, and look for 36mg-72mg because those are the doses studied in clinical trials.

Similar to probiotics, Cranberry PACs do not directly increase libido during menopause, but they support confidence and comfort with intimacy, which can have a positive effect on libido.

Optimize Sleep and Hormonal Rhythm

Sleep disruption during menopause is common and can significantly impact libido.

Research shows sleep deprivation may:

• Lower testosterone

• Increase cortisol

• Reduce mood stability

Supporting sleep hygiene may improve overall vitality and sexual interest.

Hormone Therapy

Hormone replacement therapy (HRT) can be effective for some women, but it is not appropriate or desired in all cases.

In most cases, it is better to first explore:

• Dietary changes such as avoiding processed foods and eating a whole foods diet

• Lifestyle interventions

• Targeted supplementation with natural supplements

• Stress reduction

Even if HRT is initiated, natural methods to improve libido during menopause should be implemented.

Final Thoughts

Libido changes during perimenopause and menopause are common, but they are NOT inevitable and NOT irreversible.

Improve your diet and lifestyle (better sleep + regular exercise), and look for a supplement to improve libido for women during menopause with research-backed ingredients at the doses actually studied:

• Ashwagandha 600mg/day
• Saffron Extract 15mg-30mg/day
• Vaginal-specific probiotics like Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14
• Cranberry PACs 36mg-72mg/day

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