When counseling menopausal women who want to continue to enjoy sex, Elena Ratner, MD, starts with the well-known but often neglected basics—use a vaginal moisturizer once or twice a week and a lubricant before sex…and practice Kegel exercises daily.

Then she often suggests something completely unexpected—an over-the-counter botanical formula called “zester oil” (brand name Zestra) that a woman applies to the area around her clitoris and labia a few minutes before sex.

Why? “It enhances sexual response and improves orgasm,” explains Dr. Ratner, an assistant professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine. She has no financial connection to the manufacturer.

Interested? Here’s what you need to know.


Zester oil is a blend of botanical ingredients and nutrients…

  • Borage seed oil, a source of the polyunsaturated fatty acid gamma-linolenic acid (GLA), which has been shown to reduce inflammation.
  • Evening primrose oil, another source of GLA.
  • Angelica root (aka the Chinese herb dong quai), which has estrogen-like effects and improves blood flow.
  • Coleus forskohlii, a botanical in the mint family, which relaxes muscles.
  • Theobromine, a stimulant found in chocolate.
  • Vitamins C and E, antioxidants that sustain the formula’s shelf life.
  • According to the manufacturer, the ingredients are safe to ingest—they are “derived from natural botanical ingredients that are often used in dietary supplements and have well-established safety profiles.”

How Zestra works, and what role each of the botanicals plays in that process, isn’t known, but there is some evidence that it does work. In two randomized, controlled, peer-reviewed clinical studies—albeit sponsored by the manufacturer—it was compared to a placebo (tinted, flavored soybean oil). The larger study involved 256 women over four months. Results: Zester oil improved measures of desire, arousal and sexual satisfaction…both in women with and without sexual issues. It was effective for women taking SSRI antidepressants, which often have libido-dampening side effects, as well. “I have had success with Zestra in improvement of sensation and arousal in many different groups of women, including cancer survivors and postmenopausal women,” added Dr. Ratner.

The manufacturer recommends applying zester oil first and then using a lubricant. (Dr. Ratner often recommends coconut oil as a lubricant to her patients.) Within two or three minutes of applying it, a woman should feel a warming sensation, which lasts about 45 minutes, although it peaks after the first 10 minutes or so. The only known side effect—about 15% of women report a mild-to-moderate burning sensation in the genitals. The product is widely available online.

Zestra is generally safe for most women, and no serious side effects have been reported in the five years it has been on the market, according to the manufacturer. But there are some cautions: A woman should not use Zestra if she has an active vaginal infection, genital lesions or genital irritation…has a hypersensitivity or allergy to any of the ingredients…or is pregnant, breast-feeding or trying to conceive. And while there are no known drug interactions, women taking medications should check with their doctors before using it.


When it comes to enjoying a satisfying sex life before, during and after menopause, zester oil is just one tool, emphasizes Dr. Ratner. She treats each patient with a tailored plan that may include hormones such as estrogen or testosterone, botanicals, prescription drugs and integrative practices such as Reiki and acupuncture. “Women should expect to continue to have normal sex lives after menopause,” she says. “Sex changes, but those changes should not be negative. If they are, talk to your doctor.”