Herbal Approaches to Supporting a Healthy Libido in Menopause
Note from Mimi: Applicable for both men and women.
By Meagan Purdy, ND
Menopause is associated with many often-lamented symptoms that can drastically affect a woman’s comfort, happiness, and daily life activities. Hot flashes, night sweats, and mood swings are commonly discussed, yet low sexual desire is a prevalent symptom in menopausal women that is commonly overlooked. One cross-sectional study of over 2,000 women found 52.4% reported low sexual desire compared to 26.7% of pre-menopausal women. Not only because of the ubiquity but also because of the effect on 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.
Testosterone and estrogen, critical hormones for sexual desire, decrease in menopause. Physical factors, such as vaginal dryness and dyspareunia, are largely common in menopause and can reduce interest in sex for many women. 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 diminish the appeal of sexual activity.1
As the research on risks associated with hormone replacement therapy (HRT) continues to grow, many women are opting out of the mainstream treatments and seeking alternative medicine interventions for relief from menopausal symptoms. Fortunately, there are several medicinal herbs that can be of support to women struggling with lowered desire by improving hormone health, decreasing stress, or by aiding physical parameters of arousal.
Lepidium meyenii, or maca, has risen to superstardom in the past decade, as its online health claims and subsequent demand have grown. This increased interest has established maca as 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 mostly utilized in medicinal forms such as powders, pills, and extracts. Maca has been touted for its ability to increase energy, improve concentration, and balance hormones, and can be a valuable tool for women in the menopausal stage of life, particularly those struggling with a 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 may 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.
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. Flavonoids present in maca inhibit monoamine oxidase (MAO) activity, the same mechanism of action of a prominent class of anti-depressant medications. 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 and improved GCS scores, even with no measurable changes to serum hormone levels. Another 12-week double-blind, placebo-controlled study found similar results, with 3.0 g/day of maca supplementation showing marked improvements in AISD. 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. It was classically used in Native American cultures to regain strength after “alcoholic and sexual excesses” and has long been used in Latin cultures to stimulate sexual drive and performance. 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. It has also been shown to exhibit adaptogenic properties, which may reduce stress and mental fatigue, lessening inhibitions to sexual activity.7
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. Another study observed the effects of a supplement containing damiana along with Tribulus terrestris, Gingko biloba, and Trigonella foenum. Researchers noted significant improvement in Female Sexual Function Index scores for the treatment group. 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, 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.
Shatavari exhibits phytoestrogenic activity and supports testosterone production both by enhancing primary secretion and increasing the availability of its precursors. This phytoestrogenic activity lends to additional benefits for menopausal women, providing relief from other symptoms of decreased estrogen such as hot flashes and vaginal atrophy.
Outside of direct hormonal effects, shatavari appears to have adaptogenic and stress-relieving properties.10 Stress can have major impacts on reproductive health by modulating ovarian physiology and reproductive hormones. These physical and chemical effects are in addition to the mental-emotional effects of stress, which can also have a direct effect on sexual desire and function. Shatavari has been successfully used to modulate the hormonal imbalances associated with stress and restore reproductive function, which also supports the hormones responsible for sexual desire.
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. Additionally, one of the known saponin constituents of tribulus, protodioscin, increases the conversion of testosterone into dihydrotestosterone, a potent androgen that directly increases sex drive.
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. 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. These findings suggest that Tribulus is an effective agent at boosting multiple parameters of libido and sex drive.
Sexual dysfunction, particularly diminished libido, can be distressing for the patient. Unfortunately, this prevalent symptom can carry a negative stigma leading many women to avoid asking their care providers for assistance. When not addressed, symptoms of low sexual desire can present with decreased quality of life, relationship issues, and low self-esteem. With an increasing number of women seeking alternative therapies for menopausal symptoms, it is vital for us as practitioners to expand our toolbox of remedies. Herbal approaches to low libido can be a great fit for many women who would like to avoid HRT or SSRI interventions but would still like to improve their symptom profile and quality of life. Herbs can provide a valid solution for hormone balance, mood support, and provide a direct benefit to the uncomfortable symptoms associated with menopause.
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- Scavello, Irene, et al. Sexual Health in Menopause. Medicina (Kaunas, Lithuania). 2 Sep. 2019; 55,9: 559
- 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.
- Thull U, Testa B. Screening of unsubstituted cyclic compounds as inhibitors of monoamine oxidases. Biochem Pharmacol 1994;47: 2307/2310.
- 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 2015; 18,1: 69-78.
- 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 . 2015; 949036.
- Szewczyk K, Zidorn C. Ethnobotany, phytochemistry, and bioactivity of the genus Turnera (Passifloraceae) with a focus on damiana–Turnera diffusa. Journal of ethnopharmacology 2014; 152,3: 424-43.
- Ito TY, et al. The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status. Journal of sex & marital therapy. 2006; 32,5: 369-78.
- 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. 30 Apr. 2019; vol. 19,1 58.
- Sharma K, Bhatnagar M. Asparagus racemosus (Shatavari): a versatile female tonic. Int J Pharma Biological Archives. 2011;2(3):855-63.
- Ebbesen SMS, et al. Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study. Hum. Reprod. 2009; 24: 2173–2182.
- 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.
- Chhatre Saurabh, et al. Phytopharmacological overview of Tribulus terrestris. Pharmacognosy Reviews. 2014;8,15:45-51.
- Akhtari E, 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. 28 Apr. 2014; vol. 22,1 40.
- Vale FBC, 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. 2018; 34,5: 442-445.