What are the treatment options for low libido in postmenopausal women?

From the Guidelines

Treatment of low libido in postmenopausal women should prioritize a comprehensive approach combining medical treatments, such as hormone therapy with estrogen or testosterone, FDA-approved medications like flibanserin, and non-hormonal options like ospemifene, with psychological support and lifestyle changes. This approach is supported by recent guidelines, including the NCCN Guidelines Insights: Survivorship, Version 2.2024 1.

Medical Treatment Options

• Hormone therapy with estrogen (e.g., Premarin 0.3-1.25mg daily or Estradiol patches 0.025-0.1mg) to address vaginal dryness and discomfort
• Testosterone therapy (often prescribed off-label as creams or gels at 1-2% concentration) to directly improve sexual desire
• FDA-approved flibanserin (Addyi, 100mg daily at bedtime) for low desire, with consistent use and avoidance of alcohol
• Non-hormonal options like ospemifene (Osphena, 60mg daily) for painful intercourse
• Over-the-counter lubricants and moisturizers for vaginal dryness

Psychological and Lifestyle Approaches

• Sex therapy, couples counseling, and addressing relationship issues to tackle psychological factors
• Lifestyle modifications such as stress reduction, adequate sleep, and regular exercise to improve sexual function
• Consideration of pelvic physical therapy for pelvic floor dysfunction, which can contribute to sexual dysfunction 1

Safety and Efficacy Considerations

• The use of vaginal hormones, including estrogen and androgens like DHEA, should be approached with caution, especially in survivors of hormonally mediated cancers, due to limited safety data 1
• FDA-approved medications like flibanserin and bremelanotide offer alternatives for treating low sexual desire, with flibanserin showing promise in postmenopausal women despite not being FDA-approved for this population 1

By prioritizing a comprehensive and multifaceted approach, healthcare providers can better address the complex causes of low libido in postmenopausal women, ultimately improving morbidity, mortality, and quality of life outcomes.

From the Research

Treatment Options for Low Libido in Postmenopausal Women

• Hormone therapy is a common treatment option for low libido in postmenopausal women, with estrogen alone probably slightly improving sexual function composite score in symptomatic or early postmenopausal women 2.
• The testosterone transdermal patch has been shown to improve hypoactive sexual desire disorder (HSDD) in postmenopausal women 3.
• Local vaginal therapy with estrogen creams, rings, or tablets may be an appropriate treatment option for women without other indications for systemic estrogen therapy, as it can improve vaginal health and sexual functioning 4.
• Emerging treatments, such as ultra-low-dose vaginal estradiol tablets, new selective estrogen receptor modulators (SERMs), and intravaginal dehydroepiandrosterone (DHEA), are also promising options for postmenopausal women with vaginal atrophy and sexual dysfunction 4.

Factors Affecting Low Libido in Postmenopausal Women

• Physical, hormonal, and psychosocial factors can impact decreased libido in postmenopausal women, including the decline in estrogen levels, vaginal atrophy, and decreased vaginal blood flow 5, 6.
• The interplay of sociocultural factors, past experiences, relationships, and hormones can also affect a woman's experience of menopause and low libido 6.

Importance of Addressing Low Libido in Postmenopausal Women

• Low libido is a common complaint among postmenopausal women, with an estimated 25% to 63% of women in the United States experiencing female sexual dysfunction 5.
• Healthcare providers, including nurse practitioners, play a crucial role in addressing this issue and providing management strategies to improve sexual function and overall well-being in postmenopausal women 5, 6.