Low Libido in Women: Causes and Treatment Options
Low desire is common and has many causes, including stress, sleep, relationships, medications and hormones. Options range from addressing those causes and sex therapy to FDA-approved medicines such as bremelanotide (PT-141) and flibanserin for some premenopausal women.
Low sexual desire is common in women and usually has more than one cause, such as stress, poor sleep, relationship strain, pain with sex, medications like some antidepressants, and hormone changes after childbirth or in perimenopause and menopause. It becomes a medical concern when it persists and causes you distress. Options include treating the underlying causes, sex therapy, vaginal estrogen for menopause dryness or pain, and, for some premenopausal women, FDA-approved medicines such as bremelanotide (PT-141) or flibanserin.
Key takeaways
- Changes in desire are common after kids, during stressful periods and around menopause.
- Clinicians focus on whether low desire is persistent and distressing to you, not on a "normal" number.
- Address contributors first: sleep, mood, pain, medications, relationship factors and hormones.
- Bremelanotide (PT-141) is used as needed; flibanserin is a daily pill. Both are FDA-approved for some premenopausal women.
- Testosterone has evidence for some postmenopausal women but no FDA-approved product for women in the US.
Is low desire normal or a medical problem?
Both can be true. ACOG's practice bulletin on female sexual dysfunction explains that sexual response is shaped by biology, psychology, relationships and culture, and that many women experience responsive desire, meaning desire that appears after arousal starts rather than before. A dip in desire after having children, during caregiving, or during a stressful stretch is very common.
Clinicians usually consider it a disorder when low desire lasts for months and causes personal distress. If it does not bother you, there is nothing that needs fixing. If it does, it is worth talking about, and you deserve a respectful conversation.
Common contributors
- Sleep and fatigue, including night sweats in perimenopause.
- Stress, anxiety and depression, and some medications used to treat them.
- Pain with sex from vaginal dryness, which is common in menopause and treatable.
- Hormone changes after childbirth, while breastfeeding and in the menopause transition.
- Relationship factors, such as conflict, communication or a partner's sexual health.
- Other medications, including some blood pressure medicines and hormonal birth control in some women.
The AAFP review recommends a stepwise approach: education, addressing contributing factors, and therapy, with medicines considered when appropriate.
Treatment options
| Option | What it is | Who it may suit |
|---|---|---|
| Sex therapy or counseling | Talk-based, individual or couples | Anyone; strong evidence for many causes |
| Vaginal estrogen or moisturizers | Local treatment for dryness and pain | Peri and postmenopausal women with discomfort |
| Bremelanotide (PT-141) | As-needed injection, a melanocortin receptor agonist | Premenopausal women with acquired, generalized low desire |
| Flibanserin | Daily pill acting on brain serotonin and dopamine pathways | Premenopausal women with acquired, generalized low desire |
| Testosterone | Transdermal, prescribed off-label in the US | Some postmenopausal women with low desire and distress |
PT-141 and flibanserin compared
Both medicines are FDA-approved for premenopausal women with acquired, generalized hypoactive sexual desire disorder that is not caused by a medical or psychiatric condition, relationship problems or medications. Bremelanotide (the brand is Vyleesi) is taken as needed before sexual activity. According to FDA's Drug Trials Snapshot, nausea was the most common side effect, and it can temporarily raise blood pressure, so it is not for people with uncontrolled high blood pressure or heart disease.
Flibanserin is taken daily at bedtime and carries warnings about low blood pressure and fainting, especially with alcohol. Benefits for both medicines in trials were modest, and neither works for everyone.
Golden Glow offers compounded PT-141 after an online visit with a licensed provider. Compounded medications are not FDA-approved.
What about testosterone?
The 2019 Global Consensus Position Statement found evidence that testosterone can modestly help postmenopausal women with low desire that causes distress, using doses aimed at premenopausal levels. There is no FDA-approved testosterone product for women in the US, and Golden Glow does not currently offer testosterone.
What about kisspeptin?
Kisspeptin is a natural hormone researchers at Imperial College London have studied for low desire in small early trials. It is investigational, and evidence is limited.
Frequently asked questions
PT-141 vs flibanserin: what's the difference?
PT-141 (bremelanotide) is an as-needed injection that acts on melanocortin receptors; flibanserin is a daily pill that acts on serotonin and dopamine pathways. Both are FDA-approved for some premenopausal women with low desire, and both had modest benefits in trials.
Is it normal to have low desire after kids and stress, or is it a medical problem?
It is very common. It is considered a medical issue mainly when it lasts for months and bothers you. Sleep, stress, pain and hormones are all worth looking at first.
Can menopause cause low libido?
Yes. Falling hormones can lower desire and cause vaginal dryness and pain with sex. Vaginal estrogen and other menopause treatments can help with discomfort.
Does hormone therapy increase libido?
Estrogen therapy is not a treatment for low desire itself, but it can ease dryness, pain, hot flashes and sleep problems that get in the way. NAMS notes testosterone is the hormone with evidence for low desire in postmenopausal women.
Talk to a licensed provider
If low desire is bothering you, a licensed provider can review your history and options in an online visit. Learn about PT-141 for women or menopause hormone therapy. This article is educational and does not determine eligibility for any treatment.
Sources
- ACOG Practice Bulletin No. 213, Female Sexual Dysfunction (2019)
- AAFP, Female Sexual Dysfunction: Common Questions and Answers (2025)
- FDA, Drug Trials Snapshots: Vyleesi (bremelanotide)
- Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019)
- The 2022 hormone therapy position statement of The North American Menopause Society
- Imperial College London, Kisspeptin hormone injection could treat low sex drive in women and men (2023)
This article is educational and is not medical advice. Golden Glow content is written to be accurate and is reviewed against the sources above. Rx programs require an online visit with a licensed provider. Results vary.