Reduced sex drive is a common but little-discussed symptom of menopause. While some women aren’t bothered by this development, others find that it negatively impacts their quality of life and intimate partner relationships. In an interview with Mayo Clinic Radio, Dr. Stephanie Faubion, director of the North American Menopause Society and the Mayo Clinic’s Center for Women’s Health, discusses treatments for decreased sex drive related to perimenopause, particularly a newer drug that has shown promising results.* 

Vyleesi® 

Vyleesi® (bremelanotide) was approved by the Food and Drug Administration (FDA) in 2019 for the treatment of hypoactive sexual desire disorder (HSDD) in pre-menopausal women. 

Early studies of the drug, which increases hormones called melanocortins, indicated that it was effective in increasing sexual desire and reducing distress associated with low sexual arousal. 

Vyleesi® is administered by self-injection in the thigh or abdomen on an as-needed basis, and is generally taken around 45 minutes before having sex, which can make it inconvenient for those who value spontaneity. It’s also not prescribed for post-menopausal women. 

Side Effects of Vyleesi

In early studies regarding Vyleesi’s® side effects, it was found that 40% of women experienced nausea, and 20% experienced problems with flushing of the skin. Other side effects may include: 

• Irritation at the injection site
• Headache 
• Vomiting 
• Itching 

It’s also worth noting that Vyleesi® is only meant to increase sexual arousal and not performance. Dr. Faubion explains that the drug is primarily for women who are experiencing low libido without any apparent or diagnosable cause: “It’s not for the woman with low desires related to medication, or a relationship issue, or vaginal dryness, or pain with sex.” She explains that there is often an exhaustive process to rule out other causes before a prescription is issued. 

Addyi®

Another drug approved to treat menopause-related libido decline is a daily pill called Addyi® (flibanserin). The drug is taken by mouth as a 100 mg tablet once a day, at bedtime. Side effects may include, but are not limited to: 

• Abdominal pain
• Anxiety 
• Dizziness
• Dry mouth 
• Sleep disorder 

The drug is also not approved for women who have completed their menopause transition. 

Speak with your doctor and pharmacist about other potential side effects and complications of both drugs before taking either one. 

Beyond “Not in the Mood” 

Dr. Faubion also discusses how, for some women, going through menopause-related libido decline can lead to serious mental health and relationship issues. According to Faubion, “This is the woman who says ‘I feel guilty about it, I am disappointed, I feel a sense of loss or a sense of grief or loss about lack of  desire and it’s ruining my relationship.’” These are the women, she says, that we really need to reach.

Hormone Therapy and OTC Drugs

Dr. Faubion speaks of hormone therapy as a generally safe and effective treatment for many menopausal symptoms in healthy women who are in their 50s. Studies suggest that health risks go up after age 60. If you are interested in pursuing hormone therapy, she says, then she recommends sticking to FDA-approved therapies instead of the bioidentical, customizable versions that are being touted by many celebrities. The problem with these, she says, is that they tend not to be consistent regarding purity and potency, so you never really know what you’re getting. 

As for over-the-counter (OTC) medications, Faubion says, there is no scientific evidence that they reduce any menopausal symptoms, whether hot flashes or low libido. The most important thing to do, she insists, is to get informed and shift our conversations about menopause toward empowerment and reclamation of sexual and overall health. 

*Mayo Clinic. (2019, July 30). Low libido drug & menopause treatment myths: Mayo Clinic Radio [Video file]. Retrieved from https://www.youtube.com/watch?v=Inw-6jTGgnk 

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