Low Libido in Women: Common Causes and How to Feel Like Yourself Again

In short: Low sexual desire in women has physical causes, such as anaemia, lack of oestrogen, vaginal dryness and some medicines (for blood pressure or depression), and psychological ones, such as depression, exhaustion and marital problems. Treatment depends on the cause: treating the physical cause or changing the medicine, counselling for the couple, moisturisers and local oestrogen for dryness, and hormone treatment after the menopause. Ask the doctor to find the cause before any treatment.

If sex is at the heart of many marital relationships, then it is sexual desire — or libido — that shapes how fulfilling that intimacy feels. A drop in libido is very common in women after a certain age, and it can lead to a further loss of sexual interest over time. This is rarely discussed in men, though they can face their own concerns, such as erectile dysfunction. There is no single accepted explanation for why female libido declines, but several physical and emotional circumstances are commonly linked to it.

During periods of hormonal change — including after childbirth, perimenopause, and menopause — many women notice a lower sex drive along with insomnia, digestive issues, mood swings, hot flashes, fatigue, and weight gain. These symptoms can understandably make a woman feel unwell, which in turn affects her interest in intimacy. That’s why, for most women, feeling better physically is often the first and most important step toward improving libido.

Causes of lack of libido in women:

These causes can be physical or psychological in origin.

Physical causes for loss of female libido:

• Anemia — most commonly iron-deficiency anemia caused by iron loss during menstrual periods.

• Alcoholism: excess alcohol intake can reduce sex drive. Current advice is that both men and women should drink no more than 14 units a week (spread over three or more days), and less is better.

• Drug abuse.

• Certain medications can lower libido, including some antihypertensive drugs, medicines that raise prolactin levels (such as some antipsychotics), anti-androgenic drugs such as cimetidine, finasteride, and cyproterone, hormonal contraceptives in some women, as well as SSRI antidepressants. This can affect both men and women.

• Post-baby coolness — the loss of libido that can occur after childbirth, caused by hormonal shifts during that period, as well as the general physical and emotional demands of delivery.

• Hormonal changes such as hyperprolactinaemia, abnormal luteinizing hormone (LH) levels, low androgen hormone levels, and an underactive thyroid.

• Physical changes in the vagina that affect libido:

As women approach menopause, falling estrogen levels can cause dryness and thinning of the vaginal and vulval tissues (genitourinary syndrome of menopause). This can lead to irritation, itching, and pain during sex, which naturally reduces desire.

Psychological Causes for loss of female libido:

• Depression: a serious condition involving persistent sadness that can interfere with daily life, including sexual wellbeing. Treating depression, often with medication prescribed by your doctor, may help — though one class of antidepressants, SSRIs, can itself lower sex drive. If this applies to you, your doctor may consider switching you to a different medication.

• Stress and exhaustion: chronic stress and tiredness affect mood, energy and the brain’s hormonal signals, all of which can reduce sexual desire and response. Lifestyle changes, rest and support can help manage stress levels.

• Relationship problems (problems with your sexual partner):

Relationship difficulties are among the most common causes of low libido. Feeling unhappy, uncertain, or worried in a relationship can reduce sexual desire. Sometimes the issue is a specific performance concern that makes sex difficult — for example, impotence or premature ejaculation in men, or painful sex and vaginismus (involuntary tightening of the vaginal muscles before penetration) in women.

• Past sexual abuse or trauma.

• Difficult living conditions.

Solutions for low libido - Treatment for loss of female libido:

• Treatment of the underlying causes of vaginal dryness and thinning:

• Vaginal moisturisers used two to three times a week, and water- or silicone-based lubricants during intercourse, can help when symptoms are mild (vitamin E suppositories are sometimes used, but evidence for them is limited).
• Adding dietary soy, which contains phytoestrogens that may support vaginal lubrication.
• Restoring adequate estrogen levels with hormone replacement therapy when appropriate: your doctor will adjust treatment according to your symptoms, as regular blood tests are usually not needed.
• When ovarian estrogen production declines, the body still produces small amounts of estrogen from body fat and the adrenal glands, but this is usually not enough to prevent vaginal dryness; a healthy diet supports general wellbeing, but effective relief usually comes from moisturisers or estrogen treatment.
• Some women have lower estrogen levels than others and may benefit from topical estrogen placed directly in the vagina. This can soothe vaginal tissue and support natural lubrication for more comfortable intimacy. It is available as suppositories, creams, or rings.

• Testosterone:

Testosterone plays an important role in sexual interest, arousal, response, orgasm, and lubrication. After menopause, estrogen levels fall relatively quickly, while testosterone levels decline more gradually. Some women naturally have lower testosterone, and levels also fall after removal of the ovaries; however, blood testosterone levels do not reliably predict libido in women.

After menopause, the ovaries and adrenal glands continue to produce some testosterone, and levels decline gradually with age. Good nutrition and a lower-stress lifestyle support overall wellbeing and sexual health, although they have not been shown to raise testosterone levels.

Testosterone therapy is sometimes considered for postmenopausal women with hypoactive sexual desire disorder. Clinical trials show that testosterone in doses suited to women can modestly improve desire, arousal and satisfaction in postmenopausal women with distressing low desire, particularly when HRT alone has not helped. At these doses side effects are uncommon and mainly mild acne or extra hair growth; voice changes and clitoral enlargement occur with excessive doses, so blood levels are checked during treatment. Any such treatment should be guided by your doctor.

A testosterone patch designed for women (Intrinsa) was available in the UK from 2007 but was withdrawn in 2012; today testosterone is usually prescribed as a small daily dose of a gel or cream (in Australia a licensed female cream is available), under medical supervision.

Some compounding pharmacies (which prepare medications from base ingredients) offer testosterone creams or gels, but their strength and purity are not regulated, so international guidelines recommend using approved products at doses suited to women instead.

• Suction vibrators:

These devices may help increase arousal by applying gentle suction to the clitoris. Traditional non-suction vibrators have also been used with good results over the past decade.

• Desire cream:

This cream, made with wintergreen, creates a tingling sensation on the clitoris and was introduced in the early part of this century.

• Erection drugs (like Viagra):

These medications may increase blood flow to the vagina and clitoris and support lubrication, but they have not been proven effective for treating low libido in women, and they are not licensed for use in women.

• Zestra:

A genital massage oil containing borage seed oil, evening primrose oil, angelica root extract, and vitamins C and E. A few small studies, mostly funded by the manufacturer, suggest it may modestly increase arousal, genital sensation, and the ability to reach orgasm in some women, including those using SSRI antidepressants; larger independent studies are lacking.

• ArginMax:

This nutritional supplement (ArginMax, containing L-arginine, ginseng and ginkgo) showed some benefit for sexual desire and satisfaction in a small study published in 2001 in the Journal of Sex and Marital Therapy, but the evidence remains limited, and it can interact with blood pressure and heart medicines.

Note: Please speak with your doctor before starting any supplement, to understand possible side effects or interactions with other medications.

If you’re experiencing changes in libido and would like a compassionate, confidential discussion about your options, the team at Dr. Najeeb Layyous’s clinic is here to listen and help guide you toward the right next steps for your body and wellbeing.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist