Low Libido in Women

Libido can fluctuate due to various factors, including age, stress, and lifestyle. While occasional periods of decreased sexual desire may be common and not always concerning, persistent or significant changes that cause distress should be evaluated. Effective treatment options are available for women of all ages.

Certain medications, such as antidepressants, may decrease libido as a side effect. If you suspect your medication is affecting your sexual desire, discuss this with your prescribing provider. Alternative treatments or adjustments may be available.

Low libido can result from many factors, including hormonal imbalances, psychological stressors, or relationship dynamics. Testosterone therapy may improve libido in some women with low testosterone levels.

The goal is to achieve physiologic testosterone levels similar to those present before menopause. There is no specific “target” level for treatment, as the effectiveness of testosterone therapy is not directly predicted by testosterone levels.

A commonly prescribed option is testosterone gel applied to the calf daily. This method is non-invasive.

Potential side effects include oily skin, acne, hair thinning or loss, and facial hair growth. If these side effects occur, the dose can be adjusted, paused, or discontinued.

Currently, no testosterone products are FDA-approved for women in the US. When prescribed, testosterone products approved for men are used at significantly lower doses to meet the needs of female patients.

Bremelanotide (Vyleesi®) and flibanserin (Addyi®) are both FDA-approved treatments for hypoactive sexual desire disorder (HSDD) but differ in key ways. Bremelanotide is an as-needed injectable that works by activating melanocortin receptors in the brain, while flibanserin is a daily oral medication that modulates dopamine and norepinephrine levels. Bremelanotide offers flexibility for spontaneous use but may cause nausea or high blood pressure, whereas flibanserin requires consistent daily dosing and may cause dizziness or interaction with alcohol. Bremelanotide has no alcohol restrictions. The choice between the two depends on individual preferences, lifestyle, and medical history.

Some women experience improvement in sexual desire and more satisfactory sexual events in as little as 4 weeks after starting flibanserin, however, it may take longer to notice benefit. This medication works in about 60% of women.

Alcohol should be limited/avoided while taking flibanserin. Your risk of severe low blood pressure and fainting increases if you take flibanserin with alcohol. If you consume up to 2 drinks (each drink being a 12-ounce regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits or shot), wait 2 hours before taking flibanserin at bedtime. If you have consumed 3 or more drinks, skip your flibanserin dose that evening. Do not drink additional alcohol after taking flibanserin that evening.

Flibanserin needs to be taken every night at bedtime to treat low libido. It is not an on-demand medication. If you experience improvements in libido on flibanserin and then stop the medication, your low libido symptoms may return.

Do not administer bremelanotide more than once within 24 hours or more than 8 doses in a month. Bremelanotide can cause darkening of the skin, which may be worse in people with darker skin color. The risk of skin darkening is higher when used more frequently and may not go away even after stopping the medication.

Nausea is common with this medication, though most commonly occurs after the first injection. It may last for about 2 hours and typically resolves on its own. Some women take a prescribed anti-nausea medication when doing an injection to limit the nausea.

Administer the medication at least 45 minutes before anticipated sexual activity.