VITAL: Vitality-Integrated, Trajectory-Adaptive Layering - A unified, evidence-based meta-method for midlife women's libido, intimacy, relationship repair, and dating confidence

This technical note presents VITAL (Vitality-Integrated, Trajectory-Adaptive Layering), a comprehensive, evidence-based framework for addressing interlocking challenges faced by midlife women (ages 35-65): libido changes across the menopausal transition, emotional disconnection in long-term relationships, life transition strain, and dating anxiety.

VITAL integrates hormonal, psychological, and relational evidence with cutting-edge digital health findings into a single, adaptive, privacy-first system that addresses: (1) Biology - hormones, sleep, autonomic balance; (2) Psychology - mindfulness, CBT, self-efficacy; and (3) Relationships - dyadic emotion regulation, communication repair.

The framework is designed as a technology-enabled coaching approach with eight coordinated layers: onboarding and baseline assessment, multimodal tracking, trajectory modeling, right-time micro-interventions, dyadic and dating modules, narrative and stigma work, privacy and trauma safety protocols, and evaluation and adaptation mechanisms.

Key evidence base includes: Mindfulness-Based Sex Therapy (MBST) with moderate-to-large effect sizes (SMD 0.44-0.70) for sexual desire; digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) with large effect sizes (SMD -0.71 to -0.88); relationship interventions showing small-to-moderate effects; and hormone therapy guidance aligned with NAMS 2022 and Global Consensus 2019 guidelines.

This version (2.0) includes 36 peer-reviewed references, a plain language summary, and comprehensive appendices covering evidence quality, glossary, and citation formats. The framework is designed to augment, not replace, clinical care and emphasizes trauma-informed, privacy-first design principles.