Does PT-141 Work for Women After Menopause?

PT-141 (bremelanotide, sold as Vyleesi) has not been tested in women after menopause in the large trials behind its FDA approval. Those trials enrolled only premenopausal women, and the Vyleesi FDA label says it is not indicated for low sexual desire in postmenopausal women. In the premenopausal women studied, PT-141 raised desire and lowered distress about low desire more than placebo. After menopause, whether it will work for you is a question to work through with your clinical team. Nobody can promise it.

Has PT-141 been tested in women after menopause?

Not in the trials that got it approved. The two phase 3 trials, called RECONNECT, randomized 1,267 premenopausal women with low sexual desire. Their average age was 39.

The Vyleesi label follows those trials. It covers premenopausal women whose low desire developed after a time of normal desire and shows up no matter the partner or situation. It says Vyleesi is not indicated for low desire in postmenopausal women. Vyleesi is the brand name, and bremelanotide and PT-141 are the same drug.

Untested is not the same as failed. No study in our research has a result either way for women after menopause. So no one can tell you how well PT-141 works after menopause, and anyone who promises you a result is guessing.

The label's patient information describes Vyleesi as a treatment for women "who have not gone through menopause." If you are in perimenopause, ask your clinical team which side of that line you fall on.

What did PT-141 do for the women in the trials?

Women on PT-141 felt more desire and less distress about low desire than women on placebo. The gains were modest, and nausea was common.

Every number in this table comes from premenopausal women. Keep that in mind before you read these results as your own.

Why does desire drop after menopause, and where does PT-141 fit?

Desire after menopause can drop for several reasons at once. PT-141 targets one of them: the brain's desire pathways. It works by switching on melanocortin receptors, which are involved in how the brain drives sexual response.

Menopause changes other things too. A review of bremelanotide links the drop in estrogen and androgens after menopause to losing desire. The same review notes that vaginal dryness can drag desire down and that antidepressants called SSRIs can blunt it. In one survey it cites, sexual distress was most common in women aged 45 to 64 (14.8%), so midlife is when this hits hardest.

Some low desire comes from the relationship. The label covers low desire that is not caused by relationship problems, a medical condition or a medicine. One woman on Reddit put it this way: "I find it so hard to initiate when I realise that he hasn't taken out the bins." A shot does not take out the bins. Another wrote that she had heard of "far too many women who feel broken or wrong when they lose their libido in a LTR, only to later discover it was because they were ready to leave it."

Our libido plans include PT-141 and kisspeptin, and our hormone plans include bioidentical estrogen. Our clinical team can prescribe PT-141 if it fits your goal, and they decide whether it fits for you after menopause.

What is taking PT-141 like?

• It's a shot you take before sex. You inject 1.75 mg under the skin of your belly or thigh at least 45 minutes before you expect to have sex. You use it as needed, not every day (Vyleesi label).
• There are limits on how often. Take no more than one dose in 24 hours and no more than 8 doses a month (Vyleesi label).
• Plan around nausea. In the trials, nausea started a median of 30 minutes after the shot and lasted about 2.4 hours, so it can overlap with sex. It mostly went away on its own (2020 review of the trials).
• Nausea usually eases with the second dose. For most women it improves the second time. In the trials, 13% needed anti-nausea medicine and 8% stopped because of it.
• Watch for dark patches. About 1% of women got darker patches of skin on the face, gums or breasts. The risk is higher with darker skin and with daily use, and the patches did not always fade after stopping.
• Check in at 8 weeks. Tell your clinical team if your desire has not improved after 8 weeks (Vyleesi label).

What should I tell my clinical team before trying PT-141 after menopause?

• Your blood pressure and heart history. PT-141 briefly raises blood pressure (by up to 6 mmHg on the top number) and lowers heart rate after each dose. Both usually return to normal within 12 hours. It is not for women with uncontrolled high blood pressure or known heart disease (Vyleesi label).
• Every medicine you take. PT-141 may slow how fast your stomach empties, which can change how pills are absorbed. It should not be used with naltrexone pills taken for alcohol or opioid addiction.
• Anything else that could be lowering your desire. Mention hot flashes, dryness, an antidepressant, or a relationship that feels more like managing a roommate. Dryness, falling hormones and SSRIs are all linked to low desire, and your clinical team needs the full picture.
• What you want to feel. Wanting to want sex again is a different goal from wanting sex to feel better, and your plan should match the one you have.

If you want to feel turned on again after menopause, take the quiz. Your clinical team looks at PT-141, kisspeptin and your hormones together and decides which plan fits you.