Is low libido in women over 50 just part of getting older?

It is common, but it is not inevitable, and it is rarely one thing. In women over 50 it is often a comfort problem that has become a desire problem, or a desire problem driven by sleep, mood or a medication. Sorting out which one has changed matters more than age. Distress is the line: a change that bothers you is worth looking into, and one that does not is not a disorder. More on low libido.

What is the treatment for painful sex after menopause?

It depends on the cause, which is why new or severe pain needs an examination first. When the cause is genitourinary syndrome of menopause, The Menopause Society's position statement describes a stepwise approach: lubricants and moisturizers for milder symptoms, then prescription options such as vaginal estrogen. At ACT 2 the local option is a compounded estriol cream within the HRT program. More on painful sex.

Is the Triple Action Blend the same as Vyleesi?

No. Vyleesi is bremelanotide, FDA-approved only for acquired, generalized hypoactive sexual desire disorder in premenopausal women; its label says it is not indicated for postmenopausal women. The Triple Action Blend is a compounded combination of tadalafil, oxytocin and PT-141. It is not FDA-approved and is not equivalent to Vyleesi or any branded product, and tadalafil's use in women is off-label and at the clinician's discretion.

Do you prescribe testosterone for women?

No. The global consensus statement on testosterone for women recognizes one evidence-based use, hypoactive sexual desire disorder in postmenopausal women, but there is no FDA-approved testosterone product for women in the US, and the statement recommended against compounded testosterone. ACT 2 does not offer it. If you want to understand the evidence, read testosterone in women and raise it with your own clinician.

Will hormone therapy bring my sex drive back?

It is not prescribed as a libido treatment. What hormone therapy addresses is the vaginal dryness, hot flashes and broken sleep that often sit underneath a fall in desire. Both local and systemic estrogen relieve dryness, according to ACOG. When comfort and sleep improve, desire sometimes follows, but that is not something we can promise. Hormone therapy for women.

Do I need lab tests before treatment?

For hormone therapy, yes: the first month includes the baseline panel, and your prescribing clinician reviews the labs the treatment depends on. For oxytocin or the Triple Action Blend, the clinician decides based on your history. No blood test diagnoses low desire on its own, and the consensus statement is clear that a testosterone level should not be used to diagnose it. When testing is worth it.

FOR WOMEN · SEXUAL WELLNESS

Sexual Wellness for Women After 45: Desire, Comfort and the Transition

"My libido is gone" usually describes three different problems. Treatment depends on which one it is.

A woman in her late forties or fifties who says sex has changed may mean that she no longer thinks about it, that her body no longer responds the way it did, or that it has started to hurt. Often it is two of those at once, and one can feed the other. A generic libido product treats all three as one thing and usually misses the one that matters.

This page explains how ACT 2 approaches a woman's sexual health after 45: what we look at first, the three treatment routes we offer, who each one fits, what they cost, and when a prescription is the wrong answer. For the causes and models of desire itself, see low libido. For the general page that covers men and women, see sexual wellness.

See if you're eligibleA short, confidential online assessment. Reviewed by a clinician.

Three separate things, and how each changes in the transition

MedlinePlus groups women's sexual problems into four: lack of desire, difficulty becoming aroused, difficulty reaching orgasm, and pain with sex. It notes that the causes can be physical, including hormone changes, other conditions and some medications, or psychological, including stress, depression and relationship strain. In practice we sort them into three questions, because each one has a different set of answers.

Desire. This is wanting sex, whether it arrives on its own or builds once intimacy starts. It is shaped by mood, sleep, stress, medications, the relationship and hormones. Desire is the most complex of the three and the one most often handed a pill it does not need. Desire is not the same as arousal, and responsive desire is normal, not a disorder.

Arousal and response. This is the body's side: blood flow, sensation, lubrication and orgasm. It can fade even when interest is intact, and it is affected by circulation, nerve health, some medications, and falling estrogen in the genital tissue.

Comfort. This is the one most specific to the transition. As estrogen falls, ACOG explains, the lining of the vagina can become thinner, drier and less elastic, and that dryness can make sex painful; the urethra can be affected too, with more frequent urination and urinary infections. The clinical name is genitourinary syndrome of menopause, or GSM. The Menopause Society's 2020 position statement makes the point that matters most: unlike hot flashes, which usually ease with time, GSM is generally progressive without treatment. Waiting it out does not work.

Low sex drive in perimenopause is often a desire problem driven by sleep and mood. Sex after menopause is more often a comfort problem that has turned into a desire problem. Telling them apart is the first job.

What we look at first

Before anything is prescribed, the clinician builds a picture of which of the three has changed and why. The assessment covers:

Your history. When the change started, whether it is constant or situational, what has already been tried, and whether there is pain, where and when.
Your medications. MedlinePlus notes that some drugs affect desire and function, and a change of medication can matter more than an added one. Medications that lower libido covers the list.
Mood and sleep. Depression, anxiety and night sweats that break up sleep each lower desire on their own, and none of them is fixed by a sexual-wellness product.
The relationship. Not as an intrusion, but because it is one of the most common answers, and the clinician would rather ask than prescribe around it.
Hormones, where they are relevant. Estradiol and FSH read against your cycle history, thyroid function including TSH, and, where the history points to it, testosterone and SHBG. Your prescribing clinician reviews the labs a treatment depends on. For when testing is worth it and when it is not, see when low desire is worth testing.

One caution about testosterone. The 2019 Global Consensus Position Statement on testosterone therapy for women is explicit that a blood testosterone level should not be used to diagnose low desire. A number on its own decides nothing here. And when the labs come back unremarkable, that is an answer too: see when the cause is not in the blood.

The three treatment routes at ACT 2, and who each one fits

1. Hormone therapy, local or systemic, within the HRT program. This is the route for comfort, and often the right place to start.

For dryness, pain with sex and urinary symptoms, the Menopause Society's statement describes a stepwise approach: over-the-counter lubricants and moisturizers first for milder symptoms, then prescription vaginal estrogen, among other options, for moderate to severe symptoms. Local estrogen acts on the tissue itself. ACOG notes that both local and systemic estrogen relieve vaginal dryness, and that a woman whose only symptom is dryness may be offered the local form alone.

At ACT 2 the local option is estriol vaginal cream, prescribed within the hormone therapy for women program and used to support vaginal and urinary comfort. It is a compounded preparation: it is not FDA-approved and is not the same as, equivalent to, or interchangeable with any branded vaginal estrogen. A woman who also has hot flashes, night sweats or broken sleep may be offered systemic hormone therapy as well, which treats the transition more broadly. The estradiol preparations in the program are compounded too, and the same statement applies. Local estrogen does nothing for hot flashes, so some women need both. More detail: painful sex, bladder and pelvic floor and recurrent UTIs. For the wider picture, see menopause and perimenopause.

2. Oxytocin. This route is for the felt side of intimacy: closeness and connection, in a woman whose comfort and hormones have been addressed or ruled out. Oxytocin is a compounded sublingual preparation that has been studied for sexual response in women. It is not FDA-approved for any sexual-wellness use, and the evidence for it is small and mixed. We would rather you know that before you buy it. It is the mildest of the three routes and is not a first move.

3. The Triple Action Blend. This route is for a woman for whom more than one of desire and response is in play, after the simpler explanations have been looked at. The Triple Action Blend is a compounded combination of tadalafil, oxytocin and PT-141. The combination is not FDA-approved. Each part needs a plain statement:

Tadalafil is approved for sexual function only in men, for erectile dysfunction. It is not FDA-approved for sexual-wellness use in women, and its use in women is off-label and at the prescribing clinician's discretion.
PT-141 (bremelanotide) is FDA-approved, as Vyleesi, only for acquired, generalized hypoactive sexual desire disorder in premenopausal women. Its label states that it is not indicated for postmenopausal women. That approval does not extend to postmenopausal women or to this compounded blend, and ACT 2 does not prescribe PT-141 on its own. More on PT-141.
Oxytocin, as above.

A combination makes it impossible to know which part is doing anything, which is a reason to start with a single route where one fits.

A note on testosterone. The global consensus statement, endorsed by The North American Menopause Society (now The Menopause Society), the Endocrine Society and others, recognizes one evidence-based use of testosterone in women: hypoactive sexual desire disorder in postmenopausal women. It also noted that no product for women had been approved by a national regulator, and none is FDA-approved for women in the US. ACT 2 does not offer testosterone for women. If it is a conversation you want to have, start with testosterone in women.

What it costs

Each program includes a live visit with a licensed clinician. Everything is a subscription you can cancel at any time.

Hormone therapy for women (local and systemic): $349 for the first month, which includes the baseline lab panel, then $99 a month after that.
Oxytocin: $149 a month, or $349 for three months, which works out to $116 a month.
Triple Action Blend: $149 a month, $249 for two months, or $299 for three. The longer the package, the lower the monthly cost.

New patients can use the 10% welcome code.

When to see someone in person

ACT 2 is a telehealth practice, and some symptoms need a clinician who can examine you. Do not wait for an online visit if you have:

Any bleeding after menopause. ACOG lists bleeding after menopause as abnormal uterine bleeding. It always needs an in-person evaluation, and it is never a reason to start or adjust hormone therapy online.
Pain that is new or severe. Pain with sex has several causes besides dryness, including infection, vulvodynia and pelvic conditions, according to ACOG. Pain that came on suddenly, or that is getting worse despite treatment, needs an examination.
Pelvic symptoms. A feeling of pressure or a bulge, unusual discharge, sores, or pain that is not only with sex.

If any of these apply, see your gynecologist or primary care clinician first. We are glad to pick up afterward.

When a prescription is not the answer

Some of the most useful conversations here end without a prescription.

Dryness that is mild. Lubricants with sex and a regular vaginal moisturizer are first-line for milder symptoms, and they are not a prescription. See vaginal dryness.
A medication doing the damage. If a newer prescription lines up with the change, the conversation belongs with whoever prescribed it.
Depression, anxiety or exhaustion. These lower desire directly. Treating them is the treatment.
The relationship. If the change is with one partner and not in general, a sex therapist or couples therapist is often the right referral, and we will say so.
No distress. Desire that has changed but does not bother you is not a disorder. Nothing needs fixing.

Questions

Frequently asked questions

It is common, but it is not inevitable, and it is rarely one thing. In women over 50 it is often a comfort problem that has become a desire problem, or a desire problem driven by sleep, mood or a medication. Sorting out which one has changed matters more than age. Distress is the line: a change that bothers you is worth looking into, and one that does not is not a disorder. More on low libido.
It depends on the cause, which is why new or severe pain needs an examination first. When the cause is genitourinary syndrome of menopause, The Menopause Society's position statement describes a stepwise approach: lubricants and moisturizers for milder symptoms, then prescription options such as vaginal estrogen. At ACT 2 the local option is a compounded estriol cream within the HRT program. More on painful sex.
No. Vyleesi is bremelanotide, FDA-approved only for acquired, generalized hypoactive sexual desire disorder in premenopausal women; its label says it is not indicated for postmenopausal women. The Triple Action Blend is a compounded combination of tadalafil, oxytocin and PT-141. It is not FDA-approved and is not equivalent to Vyleesi or any branded product, and tadalafil's use in women is off-label and at the clinician's discretion.
No. The global consensus statement on testosterone for women recognizes one evidence-based use, hypoactive sexual desire disorder in postmenopausal women, but there is no FDA-approved testosterone product for women in the US, and the statement recommended against compounded testosterone. ACT 2 does not offer it. If you want to understand the evidence, read testosterone in women and raise it with your own clinician.
It is not prescribed as a libido treatment. What hormone therapy addresses is the vaginal dryness, hot flashes and broken sleep that often sit underneath a fall in desire. Both local and systemic estrogen relieve dryness, according to ACOG. When comfort and sleep improve, desire sometimes follows, but that is not something we can promise. Hormone therapy for women.
For hormone therapy, yes: the first month includes the baseline panel, and your prescribing clinician reviews the labs the treatment depends on. For oxytocin or the Triple Action Blend, the clinician decides based on your history. No blood test diagnoses low desire on its own, and the consensus statement is clear that a testosterone level should not be used to diagnose it. When testing is worth it.

Your next step

Where this fits in your plan

Start by naming which of the three has changed: wanting sex, the body's response, or comfort. Tell the clinician plainly about pain, sleep, mood and your medications, because those answers decide whether the first step is hormone therapy, something else, or no prescription at all.

We look first. Then we treat.

We measure first. Then we act.

References

Sexual Problems in Women. MedlinePlus, National Library of Medicine. https://medlineplus.gov/sexualproblemsinwomen.html
The Menopause Years. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/the-menopause-years
When Sex Is Painful. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/when-sex-is-painful
The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society (now The Menopause Society). Menopause 2020;27(9):976–992. https://www.isswsh.org/images/content/2020-NAMS-GSM-Paper.pdf
Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab 2019;104(10):4660–4666. https://pmc.ncbi.nlm.nih.gov/articles/PMC6821450/
Vyleesi (bremelanotide injection) prescribing information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/210557s000lbl.pdf
Tadalafil. MedlinePlus Drug Information, National Library of Medicine. https://medlineplus.gov/druginfo/meds/a604008.html
Abnormal Uterine Bleeding. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding
Compounding and the FDA: Questions and Answers. U.S. Food and Drug Administration. https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers

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How we write and review our content

ACT 2 Health provides clinician-led care. Treatments are available only to eligible patients following clinical evaluation and within applicable regulations. This content is educational and is not medical advice. Individual results vary.

Diagnostic testing does not diagnose or rule out disease on its own and is interpreted by a licensed provider alongside your history and examination.

Compounded medication. Prepared by a licensed compounding pharmacy under a prescription written for you. Compounded medications are not FDA-approved, are not reviewed by the FDA for safety or effectiveness, and are not equivalent to or interchangeable with any branded product. Prescribed only when a licensed provider determines it is medically appropriate.

Care is delivered via telemedicine by healthcare professionals licensed in the state where the patient is located. Services are available only in states where our providers are licensed.

We measure first. Then we act.

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