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Hormonal shifts can influence it, but so can vaginal dryness, discomfort during intimacy, stress, emotional fatigue, and changes in tissue health
and Wartiovaara, A
Adverse effects Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, bloating (abdominal distension), belching, low blood sugar (hypoglycemia) in patients with type 2 diabetes, gas (flatulence), gastroenteritis, and gastroesophageal reflux disease
Treatment should be focussed on the individual patient, not lab values
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