If you’ve noticed your interest in sex has taken a nosedive since menopause, you’re far from alone, and now there’s an FDA-approved pill that may help.
On December 15, 2025, the U.S. Food and Drug Administration (FDA) approved the drug Addyi (flibanserin) for postmenopausal women under age 65 who struggle with low sexual desire. This is a historic first: until now, there was no FDA-approved oral treatment for low libido in postmenopausal women. Here’s everything you need to know, in plain language.
What Is Low Sexual Desire, and Is It Really a Medical Condition?
Yes, when low sexual desire is ongoing, distressing, and not caused by something else (like relationship problems or depression), it’s called Hypoactive Sexual Desire Disorder, or HSDD for short. It simply means a persistent lack of interest in sex that bothers you.
HSDD is the most common form of sexual dysfunction in women, affecting an estimated 40% of women according to the Mayo Clinic. Among postmenopausal women specifically, between 40% and 55% experience low sexual desire, driven largely by falling levels of estrogen, progesterone, and testosterone that happen naturally after menopause.
Despite how common it is, treatment options for postmenopausal women have been almost nonexistent, until now.
Read about sex after 50 misconceptions
What Is Addyi, and How Does It Work?
Addyi (pronounced “add-ee”) is a small pink pill that you take once a day at bedtime. It is not a hormone, it doesn’t contain estrogen or testosterone. Instead, it works on brain chemicals (called neurotransmitters) like serotonin and dopamine that play a role in sexual desire. Think of it like adjusting the balance of “go” and “stop” signals in your brain related to sex drive.
The exact way Addyi works is still not fully understood, other than it works on the neurotransmitters in the brain related to sexual desire. Clinical trials showed it helped postmenopausal women experience more satisfying sexual events and feel less distressed about their low desire compared to women who took a sugar pill (placebo).
Addyi is not a “female Viagra.” It doesn’t work in the moment and must be taken daily for several weeks before you may notice a difference. It also does not improve sexual performance or increase arousal in the physical sense. Instead, it works on desire, the mental and emotional interest in sex.
Why Was It Approved Now?
Addyi is not a brand-new drug. It was first approved by the FDA back in 2015, but only for younger (premenopausal) women. For the past decade, postmenopausal women had no FDA-approved medication for HSDD, even though they’re the group most likely to experience it.
In 2025, the FDA granted Addyi a Priority Review, a special designation given to drugs that could make a significant improvement in treating serious conditions. After reviewing new clinical data specifically on postmenopausal women, the FDA expanded Addyi’s approval to include women under 65 who have gone through menopause.
Health Canada (Canada’s version of the FDA) had already approved Addyi for postmenopausal women back in 2021, so this U.S. decision has been a long time coming.
As OB-GYN and menopause expert Dr. Mary Claire Haver put it: “Menopause does not mark the end of a woman’s sexuality, but for too long, medicine has treated it that way.”
Who Is Addyi For?
Addyi is right for you only if:
- You are under age 65
- You have gone through menopause
- You have low sexual desire that distresses you
- Your low desire is not caused by another condition, medication side effect, or relationship issues
- You are not currently taking certain medications that can interact dangerously with Addyi
It is not for women whose low libido is linked to depression, certain medications (like antidepressants), or other health conditions causing it.
The Pros: What Addyi Can Do
- It’s the first and only FDA-approved oral treatment for low libido in postmenopausal women, a real gap in care finally being addressed
- Non-hormonal, a meaningful option for women who can’t or don’t want to take hormone therapy
- Clinically tested in postmenopausal women, in a 24-week clinical trial, women taking Addyi reported an average of 1.0 satisfying sexual events per month, compared to 0.6 for those on placebo, and reported less distress about their low desire
- Already widely prescribed, more than 30,000 U.S. healthcare professionals prescribe it
- Addresses a real quality-of-life issue that affects relationships, self-esteem, and emotional wellbeing
The Cons: What to Watch Out For
No medication is perfect, and Addyi comes with real limitations and risks you should know about.
Common side effects include dizziness, sleepiness, nausea, tiredness, dry mouth, and trouble sleeping. In clinical trials of postmenopausal women, 10% of those taking Addyi reported somnolence (extreme sleepiness), compared to 6% on placebo.
Black box warning (the FDA’s most serious alert): Taking Addyi with alcohol or certain medications can cause dangerously low blood pressure and fainting. The current guidance is to wait at least 2 hours after 1–2 alcoholic drinks before taking your dose, and to skip a dose entirely if you’ve had 3 or more drinks.
Drug interactions: Addyi cannot be taken with many common medications, including some antibiotics, antifungals, HIV medications, and heart medications. You must also avoid grapefruit juice, St. John’s Wort, ginkgo, and resveratrol supplements.
Do not drive for at least 6 hours after taking Addyi due to risk of dizziness and sleepiness.
Modest results: One medical analysis found postmenopausal women experienced about 0.37 more satisfying sexual events per month than those on placebo, a real but modest improvement. Whether that’s worth it is a personal decision.
Cost: Without insurance coverage, Addyi can cost up to $1,100 per month, though discount programs like GoodRx may reduce this to around $300 per month.
Not for everyone: Women with liver problems cannot take Addyi at all, as it can reach dangerous levels in the blood.
What If You’re Already on Hormone Replacement Therapy (HRT)?
Many women over 50 take hormone replacement therapy (HRT), estrogen, progesterone, or both, to manage hot flashes, sleep problems, and other menopause symptoms. If that’s you, here’s what you need to know before adding Addyi to the mix.
The good news, there is no hard “do not combine” rule between standard HRT and Addyi. But the details matter, and the form your HRT comes in makes a real difference.
How your body processes Addyi is the key. Addyi is broken down by the liver using a pathway involving an enzyme called CYP3A4. Medications that slow down this enzyme cause more Addyi to build up in your blood, raising the risk of side effects like dizziness, extreme sleepiness, and low blood pressure.
Oral HRT pills (swallowed tablets) pass through the liver and can act as weak CYP3A4 inhibitors, meaning they may modestly raise Addyi levels in your blood. Studies on oral contraceptives, which work similarly, found that women taking them had about 1.4 times higher Addyi levels compared to women not taking them, increasing the chance of side effects.
Transdermal HRT, patches, gels, or sprays applied to the skin, bypasses the liver almost entirely. This makes it a much lower-risk option for women who want to use both HRT and Addyi together.
The type of progestogen also matters. Some progestogens used in HRT have anti-androgenic effects, meaning they can actually work against sexual desire. If your HRT contains one of these, it could reduce Addyi’s ability to help. Your doctor can review your specific formulation and suggest an alternative if needed.
The bottom line on HRT + Addyi:
- Patches, gels, and sprays are the safer HRT choice if you’re also taking Addyi
- Oral HRT pills may increase side effect risk, not a dealbreaker, but worth monitoring
- No large clinical trial has specifically studied this combination in postmenopausal women, so the data is still limited
- Always tell your doctor exactly what HRT you’re taking, the form, the estrogen type, and the progestogen type, before starting Addyi
Questions to Discuss With Your Doctor
Before asking about Addyi, use this checklist to make the most of your appointment:
- [ ] Do my symptoms actually match HSDD, or is something else causing my low desire?
- [ ] Could my low libido be a side effect of a medication I’m already taking?
- [ ] Do I have any liver problems that would make Addyi unsafe?
- [ ] What other medications, supplements, or herbal products am I taking that could interact with Addyi?
- [ ] How much alcohol do I typically drink, and is that compatible with taking Addyi safely?
- [ ] Have I tried non-medication options first (therapy, hormone evaluation, lubricants, etc.)?
- [ ] How long should I take Addyi before we decide if it’s working?
- [ ] Will my insurance cover Addyi, and what are my options if not?
- [ ] Am I under age 65 and a good candidate based on my health history?
- [ ] Are there any other conditions I have (heart issues, low blood pressure) that increase my risk?
- [ ] Am I currently on HRT, and if so, is it oral pills or a patch/gel/spray?
- [ ] Could my HRT’s progestogen type be working against my sex drive?
- [ ] Should I switch to transdermal HRT to reduce my interaction risk with Addyi?
Resources
- FDA Drug Label for Addyi (Official): Full prescribing information
- FDA Priority Review Explained: What “Priority Review” means
- WebMD: Addyi for Postmenopausal Women: Plain-language drug overview
- Medical News Today: Expert Q&A on Addyi: Doctors weigh in
- The Menopause Society: Evidence-based menopause health resources
- Mayo Clinic: Low Sex Drive in Women: Overview of causes and treatments
Take the anonymous menopause symptom survey and see compiled results instantly.
Share your experience and tips in the comments below or at The Marigold Woman Facebook Group. Don’t forget to sign up for our newsletter to stay up-to-date with our latest post!
This post was researched and drafted with the assistance of AI. All sources were reviewed and verified to the best of their ability by the editorial team.
Disclaimer: This blog is intended for informational purposes only and should not be considered medical advice, diagnosis, or treatment. We strongly encourage readers to conduct their own research and consult with a qualified healthcare professional before making any decisions or changes to their health and medical routines. Marigold Brands and The Marigold Woman cannot be held accountable for any inaccuracies or adverse outcomes related to the information presented. We strive to provide accurate and up-to-date information. However, medical knowledge is constantly evolving, and individual experiences may vary. Sources and references are provided to support the content and enable readers to further explore topics and do not imply endorsement. Always consult with your healthcare provider before making significant changes to your health routine.
Leave a Reply