From the Guidelines
Perimenopausal women experiencing low libido can benefit from hormone therapy, particularly vaginal estrogen, as it is the most effective treatment for vaginal dryness leading to sexual dysfunction, as shown in a study of 76 postmenopausal survivors of hormone receptor (HR)–positive breast cancer receiving aromatase inhibitor (AI) therapy 1. The causes of decreased libido in perimenopause are multifactorial, including fluctuating hormone levels, particularly decreasing estrogen and testosterone, which affect both physical arousal and desire. Vaginal dryness, hot flashes, mood changes, and sleep disruption during this transition can all negatively impact sexual interest and satisfaction.
Treatment Options
- Hormone therapy:
- Vaginal estrogen is the most effective treatment for vaginal dryness leading to sexual dysfunction, as shown in a study of 76 postmenopausal survivors of hormone receptor (HR)–positive breast cancer receiving aromatase inhibitor (AI) therapy 1.
- Testosterone supplementation, although often off-label, can be considered, with options including transdermal patches or gels at low doses.
- Non-hormonal options:
Lifestyle Modifications
- Regular exercise
- Stress management techniques like meditation
- Adequate sleep (7-8 hours nightly)
- Open communication with your partner about needs and preferences
Addressing Underlying Issues
- Depression or relationship problems through therapy can be beneficial It is essential to note that the safety and efficacy of these treatments may vary depending on individual circumstances, and consultation with a healthcare provider is necessary to determine the best course of treatment. Additionally, the use of vaginal hormones, such as estrogen, should be used with caution in survivors of estrogen-dependent cancers, as the safety of these therapies has not been firmly established in this population 1.
From the FDA Drug Label
The mechanism of action of ADDYI in the treatment of premenopausal women with hypoactive sexual desire disorder is not known.
The FDA drug label does not answer the question about the causes and treatment options for decreased libido in perimenopause, as it only discusses the mechanism of action of flibanserin in premenopausal women with hypoactive sexual desire disorder, and does not provide information on perimenopause or the causes of decreased libido.
From the Research
Causes of Decreased Libido in Perimenopause
- Decreased libido in perimenopause can be caused by a combination of factors, including changing hormone levels, relationship issues, psychological wellbeing, physical wellbeing, and medication use 2
- The decline in sexual interest can precede the onset of a natural menopause, and can be exacerbated by menopausal symptoms 3
- Other factors that can contribute to decreased libido in perimenopause include vasomotor symptoms, anxiety, depression, and sleep disturbances 4
Treatment Options for Decreased Libido in Perimenopause
- Management options for decreased libido in perimenopause can range from informative discussions to counseling and therapeutic intervention 2
- Cognitive behavioral therapy (CBT) has been proposed as a low-risk treatment for menopausal symptoms, including sexual concerns 4
- Testosterone therapy is an option for the restoration of sexual drive in postmenopausal women, with transdermal testosterone administration showing significant improvements in sexual function 5, 6
- Estrogen therapy can attenuate vaginal complaints, but has no effect on sexual desire, highlighting the importance of considering other treatment options for decreased libido 6
- A trial of 5 mg transdermal testosterone (gel or cream) daily or less has been suggested, followed by close monitoring of side effects and hormone level 6