Up until now, women who’d surpassed menopause and were dealing with frustratingly low libido—a.k.a. hypoactive sexual desire disorder (HSDD)—had no dedicated treatment option available to them. But that changed on December 15, 2025, when the FDA expanded its approval for the prescription drug Addyi (flibanserin), which was approved in 2015 to treat HSDD in premenopausal women, to also encompass postmenopausal women under age 65.
The expansion “marks not only a historic milestone but a broader cultural shift of acceptance and recognition that women’s sexual health does not end at menopause,” Cindy Eckert, CEO and founder of Sprout Pharmaceuticals, the maker of Addyi, tells SELF. It also validates HSDD in midlife women as a condition worthy of a medical solution—which is how we’ve long addressed sexual dysfunction in men. For context, 20-plus treatments have been approved to resolve a host of male sexual issues. Viagra, for one, was approved for erectile dysfunction (ED) in 1998 in under six months; by contrast, Addyi took six years to gain its original approval for premenopausal women and then another decade to arrive at this week’s extension, despite ample data demonstrating safety and efficacy in women ages 18 to 80.
That delay reflects how women’s sexual desire, particularly postmenopause, has historically been deprioritized or outright disregarded, Sameena Rahman, MD, a Chicago-based board-certified gynecologist and menopause specialist, tells SELF. “Women in midlife have been told that [loss of libido] is a normal part of aging, something they just have to deal with, or they should plan a date night or try a little harder to push through it,” she says.
The new approval springs from the Priority Review designation that the FDA granted in July to Sprout Pharmaceuticals for their application to broaden Addyi’s indicated age range. (The agency reserves this designation for drugs that could offer “significant improvements” for “serious conditions” over the available options.) The FDA looked at data from the original trial and additional tests run in postmenopausal women to arrive at the conclusion that Addyi is a viable treatment for the wider age group. “We hope this news reinforces that women deserve science-backed solutions for diagnosable medical issues that have been tested in their bodies, not gimmicky marketing plays,” Eckert says.
How does Addyi treat HSDD, or low libido that causes distress, in women?
Though Addyi is often referred to as the female Viagra for its sexual-health benefits, it works differently than the ED drug. While Viagra is an on-demand medication that sends blood flow down south to spark physical arousal, Addyi is a daily pill that works on neurotransmitters in the brain, raising levels of dopamine and norepinephrine and reducing serotonin, to help shift you “toward the mood of wanting to have sex,” Dr. Rahman says. (And as she points out, these changes in the brain can equally benefit pre- and postmenopausal women.)
What Addyi probably won’t do is make you spontaneously crave sex. “It might be that if right now, eight out of 10 times, you decline your partner when they ask you to have sex, with Addyi, perhaps you’re declining them only three out of 10 times,” Dr. Rahman explains. And where Viagra can have an immediate effect, it takes time for Addyi to reach its maximum benefit, Christie Cobb, MD, a board-certified ob-gyn in Little Rock, Arkansas, tells SELF. With continued use, it can essentially make it easier for you to get aroused.
But of course, brain chemistry isn’t the only contributor to sexual desire, Dr. Rahman notes. Other biology can also play a role; for example, if you have a health issue that hinders circulation or causes pain, you may be uninterested in sex, and medications like antidepressants can also dial down libido. And then there are all the psychological and social components—for instance, being depressed or anxious, having a poor relationship with your partner, or even taking on the bulk of the household labor could slash your libido. So Addyi may be more effective for HSDD in some women versus others, depending on the factors that are feeding into low desire in the first place.
Like any medication that acts on the brain, Addyi also has some side effects. It can make you sleepy (which is why it’s recommended to take it at night) and may also lead to dizziness, nausea, and headaches. (For context, these are comparable side effects to many antidepressants.) You’re also at greater risk of low blood pressure and fainting if you mix Addyi and alcohol—but it’s worth noting, the original boxed warning, which called for total abstinence, was changed in 2019 to suggest simply waiting two hours after having one or two drinks to take your daily dose, or skipping it if you’ve had three or more. Addyi can also interact with a variety of other medications, Dr. Cobb points out, so it’s important to tell your doctor all the drugs you’re currently taking if you’re considering it.
Why is the approval of Addyi for women past menopause especially important?
Libido can “fall off a cliff” at menopause, even in perimenopause (the lead-up to menopause), because of a variety of factors, Dr. Rahman says. On the one hand, the above elements that influence libido often take a turn for the worse with age—you’re all the more likely to be on medications or dealing with health issues post-menopause. On the other hand, the menopause transition itself can cause libido to plummet due to both the shift in hormones, particularly the drop in testosterone, and the symptoms this change can spark.
For starters, there’s the shrinking labia and dry vagina (a.k.a. genitourinary syndrome of menopause) that can make sex downright painful. And even other menopause symptoms—like hot flashes, insomnia, and mood swings—can make having sex utterly unappealing. It’s no wonder surveys suggest roughly half of postmenopausal women experience low sexual desire.
The Addyi expansion offers a solution for women in this phase of life who may be especially subject to HSDD, where there previously was no FDA-approved treatment. In some scenarios, ob-gyns may have prescribed hormone therapy (HT), particularly if symptoms like hot flashes or insomnia seemed to be the primary thing hampering sex drive. And vaginal estrogen could be used to help with the vaginal thinning and dryness that makes sex painful. But as for low desire? Doctors might have prescribed testosterone off-label—but that requires jumping through some hoops, like figuring out how to titrate down from a men’s dose (which comes with safety risks) and paying for it out-of-pocket. The FDA approval of Addyi opens the door for insurance coverage of HSDD treatment in women up to age 65.
Dr. Cobb sees Addyi’s expansion as “helping one piece of the libido puzzle” for a key demo. And because it’s a different piece than the ones addressed by hormone therapy for menopause, women in this life stage could experience unique benefits from Addyi, even if they’re on HT too. It also means women in midlife who prefer to avoid hormones or have a contraindication to HT can still take advantage of Addyi, Dr. Cobb adds.
Having this option on the table is a “critical acknowledgement that pleasure is important for women in midlife,” Dr. Rahman says, “for both their quality of life and overall health.”
Related:
- The Best Time to Start Hormone Therapy for Menopause May Be Earlier Than You Think
- How to Cope If Your Anxiety Is Making Menopause Feel So Much Worse
- What to Do If You and Your Partner Have Mismatched Sex Drives
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