Breaking the Silence on Lost Desire: Reactivating the Libido

Many women report that their sexual desire fluctuates from day to day —completely absent one day, suddenly resurfacing the next. This is because:

• Hormone levels do not decrease linearly, but often fluctuate during menopause, which affects libido.

• Psychological factors such as stress, self-image and relationship problems also play a role.

• External influences such as medications (e.g. antidepressants), sleep quality and physical fitness can have a decisive impact on libido.

Many women don't realize that certain medications can affect their libido. Often, a gradual loss of sexual desire isn't even associated with medication. However, there are a number of medications that can directly or indirectly negatively affect sexual desire, arousal, or orgasm.

Antidepressants (e.g. SSRIs)

• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline or paroxetine are among the most common antidepressants.

• They can dampen libido, delay orgasm or prevent it altogether.

• Some studies show that bupropion (Elontril) may be a helpful alternative because it has less negative effects on sexual function.

Antihypertensives

• Beta-blockers such as metoprolol or propranolol can lead to a decrease in libido and erection problems .

• Diuretics (water pills) can reduce blood flow to the genitals and thus reduce excitability.

• Alternatives? ACE inhibitors or calcium channel blockers have shown less impact on sexual function in studies.

Antihistamines (e.g. allergy medications)

• These medications, which are often used for hay fever or colds , have a depressant effect on the central nervous system.

• They can reduce excitability and impair natural lubrication .

• Diphenhydramine and cetirizine in particular are suspected of negatively affecting libido.

Hormonal contraceptives (pill, hormonal coil, implants)

• The pill in particular can lead to a reduced libido by lowering free testosterone .

• Preparations containing progestogen (mini-pill, hormonal IUD) can reduce libido more than combination preparations containing estrogen.

• Women who use hormonal contraceptives should observe whether their libido changes – switching to another method (e.g. copper IUD, NFP ) may be an alternative.

The brain is the most important sexual organ—so it's no surprise that psychological factors can significantly influence libido. Negative emotions, stress, or unresolved conflicts can cause sexual desire to disappear.

Chronic stress & overload – the number 1 sex killer

• A hectic daily routine, high professional or family demands, and constant availability lead to elevated cortisol levels. This stress hormone reduces the production of sex hormones , which can have a direct impact on libido.

• Women often report feeling “too tired” or “too exhausted” for sex in the evening – no wonder when the body is in constant stress mode.

Depression and anxiety disorders – emotional dampeners

• Depressive moods reduce levels of dopamine and serotonin , two neurotransmitters associated with pleasure and arousal.

• Anxiety disorders can lead to increased self-observation and pressure to perform , which further inhibits libido.

• Medications such as antidepressants (SSRIs) can also dampen libido, so it is worth discussing alternative options with your doctor.

Relationship problems – when closeness is lacking

• Emotional distance, unresolved conflicts or a stuck routine can lead to a decrease in desire for one's partner.

• It is known that sexual dissatisfaction is often due to relationship problems rather than physical causes .

• Communication plays a crucial role: studies show that women who talk openly about their needs and fantasies have higher levels of sexual satisfaction .

Past trauma or abuse – invisible barriers

• Women who have experienced sexual assault or abuse in the past may develop unconscious or conscious defenses against physical intimacy.

• The consequences range from difficulties with arousal to orgasm disorders to an aversion to sexuality.

• In such cases, sexual or trauma therapy can help to process negative experiences and rediscover one's libido.

Sexual desire isn't just a psychological or hormonal issue—general health also plays a major role. Certain illnesses can lower libido by affecting hormone levels, disrupting blood flow, or reducing energy levels.

Diabetes & hormonal disorders (e.g. hypothyroidism)

• Diabetes mellitus can impair libido through several mechanisms. Chronically elevated blood sugar levels damage nerves (diabetic neuropathy), which can lead to reduced sensitivity of the genitals .

• At the same time, diabetes can worsen blood circulation , resulting in insufficient lubrication and reduced excitability.

• Hypothyroidism leads to a slowed metabolism, fatigue, and lack of motivation. Studies show that low thyroid hormone levels are closely linked to loss of libido.

Tip: If you notice persistent loss of libido and exhaustion, a blood test of your thyroid levels (TSH, fT3, fT4) may be helpful.

Cardiovascular diseases – when blood circulation suffers

• Poor circulation to the genitals is a common but often overlooked cause of loss of libido. Conditions such as high blood pressure, atherosclerosis, or heart failure can lead to less blood flow to the pelvic area, reducing sexual arousal and orgasmic ability.

• After menopause, the risk of cardiovascular disease in women increases significantly. Estrogen deficiency contributes to blood vessels becoming stiffer and less elastic.

Tip: A heart-healthy diet (lots of vegetables, omega-3 fatty acids, little sugar), regular exercise and stress management not only help the heart but also the libido.

Obesity & lack of exercise – the underestimated factors

• Excess weight, especially abdominal fat , acts as an endocrine organ, producing pro-inflammatory substances and hormones. It can lower testosterone levels and thereby reduce sexual desire.

• Lack of exercise worsens blood circulation, which can also have negative effects on excitability.

• In addition, being overweight affects body image and self-confidence , which can indirectly inhibit libido.

Tip: Just 30 minutes of exercise per day (walking, dancing, yoga) can activate your metabolism and improve your sexual desire.

Hormone replacement therapy (HRT) is one of the most effective treatment options for women with severe menopausal symptoms such as hot flashes, night sweats, sleep disturbances, or vaginal dryness. It primarily involves administering estrogen, either alone or in combination with a progestin (in women with an intact uterus).

While HRT doesn't directly affect libido, it can help indirectly by alleviating symptoms such as sleep problems, fatigue, or vaginal dryness—all factors that can impair libido. Studies show that vaginal estrogens not only improve lubrication but also increase the sensitivity of the vaginal mucosa, which can have a positive effect on sexual desire.

Important to know: HRT should always be considered individually, as it can be associated with certain risks.

Although testosterone is often considered a "male hormone," it also plays a crucial role in women—particularly in energy, muscle development, mental clarity, and libido. Natural testosterone levels decline with age, which can lead to a loss of sexual desire and reduced arousal in some women.

Possible therapeutic approaches:

Studies show that transdermal testosterone (e.g., 300 µg per day) can increase sexual activity and desire in some women. However, there are challenges:

• In Germany, testosterone for women is only available as an “off-label” use, which means that it is not officially approved for this purpose.

• There are no commercial products specifically for women. Many doctors therefore prescribe low-dose testosterone gels or creams for men, but precise dosing is difficult.

• Long-term safety data are lacking. While testosterone therapies may be promising in the first few months, it is unclear whether they pose long-term risks for heart disease or breast cancer.

Important: Regular blood tests are essential to avoid side effects such as acne, increased body hair, or mood swings. Furthermore, therapy should be reviewed after six months at the latest. If no significant improvement is observed, it is recommended to discontinue treatment.

Dehydroepiandrosterone (DHEA) is a precursor to testosterone and estrogen and is produced by the adrenal cortex. DHEA levels decrease with age, which can lead to reduced production of these hormones.

Some studies suggest that vaginal application of DHEA may have positive effects on arousal and orgasmic ability in postmenopausal women. However, there are conflicting results:

• While some studies suggest an improvement in sexual function, others show no significant effects.

• Higher DHEA levels have been linked to an increased risk of depression in some studies. Therefore, routine supplementation is not generally recommended.

• The long-term effects have not yet been sufficiently researched, which is why DHEA is not considered a standard therapy for increasing libido.

Overall, DHEA remains an experimental option that may be worth trying for vaginal dryness and mild libido problems, but is not recommended as a general solution.

Many women prefer natural alternatives to boost libido, especially if they want to avoid hormonal or drug therapies. There are numerous herbal substances that have traditionally been considered aphrodisiacs, but the scientific evidence is mixed.

Maca (Lepidium meyenii) originates from the Peruvian Andes and is traditionally used there as a "superfood" to increase energy and sexual desire. Studies show that maca may potentially improve overall well-being and libido—although not in all women.

Some studies suggest that maca may help increase libido, especially in perimenopausal women. Maca acts as an adaptogen, meaning it can balance hormones and make the body more resilient to stress.

Both plants come from traditional Asian medicine and are known for their circulation-promoting properties.

• Ginseng (Panax ginseng) is a so-called adaptogen that can help reduce stress and increase libido. Studies in postmenopausal women have shown that ginseng extract can not only improve sexual arousal but also mental balance.

• Ginkgo biloba has traditionally been used to improve cognitive performance, but its circulation-boosting properties may also impact libido. Ginkgo leaf extracts are said to enhance sexual activity and mental well-being by promoting blood flow in the pelvic area.

• L-arginine is an amino acid required for the production of nitric oxide (NO), a molecule that dilates blood vessels and thus improves blood flow. Studies have shown that L-arginine may increase sexual arousal by increasing blood flow to the genitals.

• Niacin (vitamin B3) is involved in numerous metabolic processes, including the production of sex hormones. Some studies suggest that niacin may help improve blood flow, which could have a positive effect on libido.

However, large-scale, randomized studies that clearly confirm these effects are still lacking. The effectiveness of these substances can vary from person to person.

There are several medication options for women with persistent libido problems. However, scientific evidence is limited, and many of these medications are not approved in Europe.

Flibanserin is a drug approved in the United States under the trade name Addyi . Unlike Viagra, which improves blood flow, flibanserin acts on the brain, affecting the neurotransmitters dopamine, serotonin, and norepinephrine.

How does it work?

• Flibanserin must be taken daily (100 mg before bedtime).

• The effect only sets in after 4 to 8 weeks.

• According to studies, it leads to an average of 0.4 to 1 additional episode of sexual satisfaction per month .

Side effects & restrictions

• Common: Dizziness, fatigue, nausea (up to 18% of women discontinue treatment due to side effects).

• May lower blood pressure , therefore no alcohol should be consumed within 2 hours before and after taking this medicine.

• No approval in Europe because the effectiveness was considered too low and the side effects too high.

As a result, flibanserin has only a moderate effect on libido and is associated with frequent side effects. It remains an option for women diagnosed with hypoactive sexual desire disorder (HSDD), but should only be considered after medical evaluation.

Bremelanotide is available in the US under the trade name Vyleesi and is administered as a subcutaneous injection at least 45 minutes before sex .

How does it work?

• It targets the melanocortin receptor in the brain , which influences sexual arousal.

• The exact mode of action has not yet been fully researched.

• In studies, bremelanotide improved libido slightly more than a placebo .

Side effects & restrictions

• Nausea in 40% of users – 13% had to take an anti-nausea medication.

• Other side effects: headache, increased heart rate .

• Women with cardiovascular disease should not take it.

Conclusion: The effect is limited, and the side effects are significant. It remains an experimental option for women who have not had success with other approaches.

Bupropion (trade name Elontril ) is an antidepressant originally developed to treat depression and smoking cessation. It is also used off-label for the treatment of libido disorders.

How does it work?

• It affects dopamine and noradrenaline levels in the brain, which may potentially increase sexual desire.

• One study showed that a daily dose of 300 mg resulted in improved sexual desire and activity .

• Particularly interesting for women who have developed libido problems due to other antidepressants.

Side effects & restrictions

• May cause insomnia, nervousness and palpitations in sensitive individuals.

• Should not be combined with other stimulant medications.

• Not suitable for women with existing depression , as it has less of a mood-enhancing effect than classic antidepressants.

Conclusion: Bupropion is not a direct libido therapy, but it can help certain women – especially if their libido has been reduced by other medications (e.g. SSRI antidepressants).

In addition to hormonal, herbal, and medicinal approaches, there are other methods to increase libido – many of which target the psyche, relationships, or lifestyle. Often, it's the small changes in everyday life that can have a big impact.

One of the most important, but often overlooked, measures is open communication about sexuality and needs .

Why is this so important?

Studies show that women who talk openly with their partner about their desires, insecurities, or changes in their libido have higher sexual satisfaction .

What can help?

• Regular conversations about wishes and fantasies, but also about stress factors or emotional burdens.

• Shared rituals, dates and conscious touching, cuddling or slow approaches without the pressure that “sex has to happen”.

• Curiosity instead of criticism: Instead of saying, “I just don’t feel like it anymore,” a sentence like “I would like to find out what could reawaken my desire” could steer the conversation in a positive direction.

💡 Tip: If you find it difficult to talk about the topic, books, podcasts or couples therapy can help as a starting point.

Many women experience body insecurity during perimenopause or postmenopause, which can affect their libido. However, a positive body image is crucial for sexual desire.

What can help?

• Sensual movement such as yoga or dancing to strengthen the connection to one's own body.

• Self-love rituals : Consciously take time for a nice bath, a massage or lovingly look at yourself in the mirror.

• Exploring your own pleasure : Masturbation is an important way to understand what types of touch are pleasurable. Sensual literature or erotic fantasies can also help.

💡 Tip: Sexual desire often begins in the mind – if you feel desired, you can rediscover your own desire more easily.

Chronic stress is one of the biggest sex killers. Persistently high cortisol levels inhibit the production of sex hormones and block libido.

What helps?

• Mindfulness & Meditation: Studies show that mindfulness training can help regain sexual desire.

• Deep breathing & relaxation techniques: Autogenic training or breathing exercises can help you get out of stress mode.

• Consciously take time for yourself: A day without a to-do list, where you simply do what feels good, can work wonders.

Tip: Just 10 minutes of daily meditation can lower cortisol levels and help you feel more desire again.

Libido isn't a static state, but a delicate interplay of hormones, emotions, health, and relationship dynamics . It's completely normal for libido to change over the course of a lifetime—but that doesn't mean you have to accept it.

Whether through hormonal adjustments, herbal remedies, medication, or holistic methods such as mindfulness, touch, or communication , there are numerous ways to rediscover your own desire. The key is to understand your own body, avoid putting pressure on yourself, and be open to new approaches .

Lust begins in the mind – but it can be rekindled in the heart and body.