Navigating Changes in Libido During Perimenopause and Menopause: Natural and Hormonal Support Options

by Dr. Zoë Kelly Linkletter

For many women, perimenopause and menopause bring a range of changes—some expected, others more surprising. Among the less openly discussed but deeply impactful shifts are changes in libido and sexual function. If you’re noticing differences in your desire, arousal, or comfort during intimacy, know that you’re not alone—and that there are supportive, holistic options available to help you feel more like yourself again.

Understanding Libido Changes in Perimenopause and Menopause

As estrogen, progesterone, and testosterone levels decline with age, many women experience:

  • Decreased sexual desire

  • Vaginal dryness or discomfort during intimacy

  • Decreased sensation or difficulty with orgasm

  • Changes in body image or emotional connection with self or partners

These changes are multifactorial. Hormonal shifts play a major role, but so do stress, sleep disruption, pelvic floor health, and relationship dynamics. The good news is that with a personalized, naturopathic approach, these challenges can be addressed.

1. Hormone Replacement Therapy (HRT)

Hormone replacement therapy can be an effective option for restoring hormonal balance and supporting sexual wellness.

  • Estrogen therapy can improve vaginal tissue health, increase blood flow, and enhance lubrication—helping reduce pain with intimacy.

  • Progesterone may be added for balance and to support sleep, mood, and uterine protection in women with a uterus.

  • HRT is available in multiple forms—topical, oral, vaginal—and your provider will help determine the safest, most effective option for your specific needs.

Recent studies have affirmed the safety of bioidentical hormones for many women when appropriately prescribed and monitored. HRT may not only help with libido, but also with hot flashes, mood changes, and sleep disruptions.

2. Testosterone Therapy

Though often associated with male sexual health and function, testosterone is an important hormone for female sexual desire, arousal, and orgasmic function.

Low testosterone in women can contribute to:

  • Low libido

  • Reduced sensation and pleasure

  • Fatigue or low motivation

A low-dose, testosterone replacement treatment plan can help restore natural sexual desire and energy. At our clinic, we use comprehensive hormone testing to assess levels and determine whether testosterone therapy may be beneficial.

3. Herbal Medicine and Nutritional Support

We often incorporate botanical medicine to support hormonal balance, restore nervous system health, and improve sexual vitality.

Some herbs that may be used include:

  • Maca root – traditionally used to support libido and energy

  • Tribulus terrestris – shown in studies to support arousal and desire

  • Shatavari and ashwagandha – adaptogenic herbs that nourish the endocrine system and help reduce the impact of stress

  • Damiana – historically used as an aphrodisiac and nervine tonic to manage stress and support a sense of emotional openness and connection

These are typically prescribed in customized formulations and combined with nutritional counseling to address any deficiencies (such as zinc or vitamin D) that may impact hormone production or energy levels.

4. Pelvic Floor Therapy

Physical therapy for the pelvic floor can be a transformative part of a sexual wellness plan.

During and after menopause, estrogen loss can weaken pelvic tissues and affect muscle tone, vaginal dryness and sensations during intimacy. Pelvic floor therapy can help with:

  • Improving muscle tone and sensation

  • Reducing pain with intercourse

  • Supporting bladder function and confidence

Incorporating Pelvic Care sessions in the holistic  treatment approach supports the health of the physical structures of the pelvis as well as providing a somatic modality to explore emotional and energetic patterns related to sexual desire and function. 

5. Craniosacral Therapy for Nervous System Support

Stress is a major contributor to low libido and diminished sexual function—and chronic stress can exacerbate hormonal imbalances, muscle tension, and emotional disconnection. Craniosacral therapy is a gentle, hands-on modality that works with the body’s craniosacral rhythm to support the central nervous system and promote deep relaxation.

Benefits of craniosacral therapy include:

  • Calming the stress response

  • Enhancing mind-body awareness

  • Improving sleep and mood

  • Supporting hormonal balance indirectly through parasympathetic activation

By helping the body shift out of a constant “fight-or-flight” state, craniosacral therapy may help individuals reconnect with their bodies and restore the sense of safety, pleasure, and ease that supports a healthy libido.

A Holistic and Individualized Approach

At our clinic, we understand that changes in libido are complex and deeply personal. Our naturopathic approach looks at the whole picture—hormones, physical health, emotional well-being, and relationship dynamics.

Whether you’re just starting to notice changes or have been navigating them for a while, know that you’re not alone—and that support is available.

We welcome you to schedule a consultation to explore what options may be right for you. Together, we can help you reclaim your sense of vitality, connection, and pleasure in this new chapter of life.

Ready to feel like yourself again?
Book a consultation with one of our naturopathic doctors today and discover how hormone therapy, herbal medicine, and pelvic floor support can help restore your sexual wellness.

See you in clinc,

Dr. Zoë

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