Alongside headaches, insomnia and anxiety, "loss of libido" was just another symptom I invited clients to tick, or not, on the standard health questionnaire I use as a practising nutritional therapist and hypnotherapist. It's important that I get as full a picture as possible of someone's health before I decide how to help them, so I always get them to provide this information before they walk through my clinic door.
But I had no idea of the impact that those three words - loss of libido - would have. Almost without exception, every woman in the 40- to 55-year age bracket who comes to see me now ticks, underlines or circles them. These women might have booked an appointment to discuss weight loss, hypothyroid, irritable bowel syndrome or menopausal symptoms, but underneath all of this is, invariably, a lack of interest in sex.
An independent sex survey conducted in the UK in 2014 suggested a decline in those of us who describe ourselves as having a high sex drive from 44pc in 2008 to 34pc six years later. Almost a third of the respondents also said they had not had sex in the previous month.
In the US, experts have quoted statistics suggesting a whopping 43pc of all women there suffer reduced libido. This seems unfeasibly high and there is some suggestion that these inflated stats could be being driven by a desire to classify low libido in women as a "condition" that needs to be "treated", so creating a market for female Viagra - the holy grail for some.
But while low libido has been given a medical name - hypoactive sexual desire disorder - it is clear among my clients that many women are confused by it and certainly don't know what to do about it.
Below are some of the most important factors that can reduce libido and what to do about them.
Body image insecurity is something I see in my clinic every day and especially among those who report low libido. For women in their 30s, it may be a case of post-childbirth "mum tum". For older women, menopause can accelerate the effects of gravity (everything going south) and also cause weight gain, especially around the midsection.
Sex therapist and relationship counsellor Clare Prendergast says: "We're in our mid-40s, we've put on weight. We find ourselves looking at our bodies and feeling 'yuck!' We don't feel like a lover."
In the main, body anxiety is internally, not externally driven. It's how you feel about yourself that matters.
What you can do: Switch off the negative self-talk and replace it with something positive. Find five things you like about your body and repeat them to yourself every day.
Exercise helps too and increases blood flow, lifts mood, can build self-esteem and reconnects you with physical sensation, important for sexual response. Prendergast says: "Some women have never been connected to their body. They've had high-powered jobs and lived in their heads."
You could also try the naked sex ban. Prendergast gets clients to undertake a sex ban for two to three months, during which time couples have to spend time with each other two or three times a week naked, touching but in a non-sexual way. "The aim is to get to know your own and your partner's bodies again."
As a woman nears menopause, she experiences drops in three key hormones: testosterone, oestrogen and progesterone. The latter two are most often given together as hormone replacement therapy (HRT) to reduce common menopause symptoms such as hot flushes and night sweats. However, what is less known is that testosterone, which is often thought of as a "male" hormone, may also be important to women in maintaining sex drive.
Testosterone treatment for women is controversial and while it has some high-profile fans, the jury is still out on whether it is effective in lifting libido. A US study from 2003 concluded that "testosterone therapy improves well-being, mood and sexual function in premenopausal women".
What you can do:
Get your hormones checked, not just the sex hormones. Dr Sohere Roked is a specialist in bio-identical (synthetic) HRT. Before she prescribes anything at her London clinic she checks a whole range of hormones. "I do tests for the sex hormones (oestrogen and progesterone), plus thyroid, adrenal (cortisol) and insulin," she says. Low thyroid can cause depression, which may affect sex drive. Elevated cortisol is a stress hormone and can also interrupt sex hormone production and action, and insulin is inflammatory. High levels (a fasting level of over 25) of insulin can disrupt other hormones, including the sex ones, again lowering sex drive.
Consider HRT. "Quite often, if women start oestrogen and progesterone therapy, that alone will improve libido," says Dr Roked. Oestrogen is safest taken "transdermally", that is as a gel or patch, while progesterone can be taken as a tablet. And don't be tempted to self-diagnose or buy online. "It is important that you don't have uncontrolled oestrogen in the body," says Dr Roked.
As oestrogen levels drop at menopause, so do those of the neurotransmitter serotonin. Low levels of serotonin can be associated with reduced sex drive.
What you can do:
Discuss possible treatment (cognitive behavioural therapy or medication) with your doctor.
Take a daily walk to boost your vitamin D from sunlight. Vitamin D is an antidepressant. Alternatively, take a daily vitamin D3 tablet.
Eat a mood-elevating diet high in brain-healthy vitamins, minerals and fats. Dr Roked says: "Lifestyle plays a huge part in libido - what you eat, how you sleep, how you move your body. If you can get these sorted out, libido often improves."
Think about your sleep patterns. Tiredness really is a passion killer, and depression and anxiety can often disrupt sleeping patterns. Diet Sadly, there is no one magic food for libido boosting. When clients come to me complaining of loss of libido, I advise a healthy, balanced diet, which usually means reducing sugar, caffeine and alcohol, but not fat.
What you can do:
Eat foods to promote healthy blood circulation. Garlic, onions, chilli and ginger are sources of a natural compound called allicin, which dilates blood vessels.
Eat foods that improve brain function. Omega-3 fatty acids from oily fish, such as salmon, trout and sardines improve brain signalling, so helping increase sexual response.
Reduce tea, coffee and sugar and instead drink water and eat wholegrain lean protein, vegetable and complex carbohydrates.
Eat foods that help you sleep. Sleep hormone melatonin is made from the amino acid tryptophan, but as this is a small molecule it needs the release of insulin, which is stimulated by sugar, to get across the blood/brain barrier. Include a healthy, slow-release carb food with dinner such as brown rice, bread or pasta, to promote healthy sleep.
Reduce alcohol. You may think you need Wine O'Clock, but it reduces the quality of your sleep.