PT-141 Peptide: Can it Help Menopause Libido?

Can it Help Menopause Libido?

It's common for sexual desire to change during the menopause transition. “Low libido" is a term that describes an experience, not a diagnosis, and there's often more than one reason sex feels different in midlife.

Why Libido Can Change During Menopause

Changing estrogen and testosterone levels during the menopause transition can affect desire, blood flow to the genitals, arousal, and the intensity of orgasms. Vaginal dryness, painful sex, poor sleep, stress, mood changes, medications, chronic health conditions, and relationship strain can also lower a woman’s interest in sex. In addition, more than one of these factors can occur at a time. A woman who sleeps badly because of night sweats and also has pain during sex is dealing with two separate issues, but both can dampen desire.

Hypoactive sexual desire disorder (HSDD) is a medical diagnosis with a more specific definition than simply wanting sex less. It means sexual desire stays low, or keeps coming back low, and can’t be explained by another condition, medication, pain, or relationship problems.

What Is PT-141 and How Does It Work?

PT-141 was the development code name for bremelanotide which is a prescription drug now sold under the brandname Vyleesi. Online it's sometimes referred to as just a "peptide" or a "libido injection,” but it shouldn’t be confused with an unproven wellness treatment.

Bremelanotide is an FDA- approved, regulated medication indicated for acquired, generalized HSDD in premenopausal women. Acquired means that the low desire started after a period of normal or typical desire. Generalized means it now happens regardless of the partner, situation, or type of sexual activity.

Bremelanotide or PT-141 is given by a self-injected dose of 1.75-mg under the skin of the abdomen or thigh at least 45 minutes before expected sexual activity.

The FDA states that it isn't known exactly how bremelanotide improves HSDD. However, it is thought to activate receptors in the central nervous system, which affect pathways involved in sexual desire. This makes it different from other treatments like hormone-based vaginal estrogen that targets the tissue changes of genitourinary syndrome of menopause (GSM), such as dryness and pain during sex.

Can PT-141 Help Menopausal Women?

In two phase 3 trials, bremelanotide improved desire and reduced the distress linked to low desire more than a placebo did, but the improvements were modest. The trials also did not find a significant difference between bremelanotide and placebo in the number of satisfying sexual events.  

Placebo responses are also large in sexual dysfunction research. A 2018 meta-analysis found that placebo accounted for a large share of the improvement seen with active treatment. The actual real-world benefits can be smaller than headlines suggest.

For menopausal women, the biggest limitation is who was studied. The pivotal trials enrolled only premenopausal women, and bremelanotide isn't approved for postmenopausal women.

“Unfortunately, many women after menopause struggle with poor sleep, achy joints, hot flashes, and night sweats. These symptoms can leave you feeling exhausted, uncomfortable, and less interested in sex,” according to Dr. Kathryn Williams, a board-certified OB/GYN. “For women in perimenopause or before menopause, changes in hormones, stress, relationships, and overall health can also affect sex drive. Treatments like bremelanotide may help some women, but low libido is rarely caused by just one thing. Finding the right solution often means looking at the whole picture and creating a treatment plan that fits your individual needs.”

What Are the Side Effects and Safety Concerns?

Nausea was the most common side effect, affecting about 40% of women in the trials. It was usually worse after the first dose and eased with later doses, however, about 8% of women stopped treatment because of it. Other common effects were flushing (about 20%), injection-site reactions (13%), headache (11%), and vomiting (about 5%). Most reported side effects were mild to moderate.

Each dose of PT-141 can briefly raise blood pressure and lower heart rate. Women with uncontrolled high blood pressure or known cardiovascular disease shouldn't use it, and anyone considering it should have their blood pressure and heart risk checked first.

Focal hyperpigmentation, a specific local area of darkness on the skin, has been shown to occur with use of bremelanotide on areas of the face, gums, and breasts. The risk for this appears to be greater with more frequent use and in people with darker skin. In some women, the pigmentation did not resolve on its own after the medication was stopped.

The prescribing information recommends no more than one dose within 24 hours and no more than eight doses per month. If symptoms have not improved after eight weeks, treatment should be discontinued. PT-141 can also lower blood levels of oral naltrexone, so women taking naltrexone should tell their prescriber.

Is PT-141 the Right Treatment for Low Libido During Menopause?

The right treatment depends on which part of sexual function has changed. Symptoms that show up together don't always share a cause.

When dryness, irritation, or painful sex is the main problem, GSM is often behind it, and treating desire directly may not help much. Vaginal estrogen, moisturizers, and lubricants address the tissue changes themselves and can improve comfort, arousal, and satisfaction over time. Some women notice that desire often can come back once sex stops hurting.

Some women are bothered less by low desire than by weaker sensation or less intense orgasms. For them, a treatment aimed at blood flow and arousal may fit better than a desire-focused drug.

For a premenopausal woman who meets the criteria for acquired, generalized HSDD, PT-141 is an FDA-approved option if she has no contraindications and the benefits outweigh the side effects for her. After menopause, there is no strong evidence to show that it will continue to be effective and its use becomes off label.

Questions to Ask Before Trying PT-141

• Do my symptoms fit HSDD, or could dryness, pain, sleep, mood, or medications be causing them?

• Is my blood pressure well controlled? Do I have any cardiovascular risk factors?

• Could any of my current medications be affecting my desire or interact with bremelanotide?

• Would vaginal estrogen, hormone therapy, testosterone, counseling, sex therapy, or pelvic floor therapy make sense first?

• Is this treatment approved for my menopausal stage, or would it be off-label?

• How will we tell whether it's working, and when should we check in again?

Frequently Asked Questions

Is PT-141 approved to treat low libido in menopausal women?

PT-141 (bremelanotide) is FDA-approved specifically for acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. The pivotal clinical trials only enrolled premenopausal women, meaning it is not approved for postmenopausal women, and using it after menopause is considered off-label with no strong evidence demonstrating its effectiveness.

How does PT-141 work compared to treatments like vaginal estrogen?

PT-141 is thought to activate receptors in the central nervous system that influence pathways involved in sexual desire. By contrast, treatments like hormone-based vaginal estrogen specifically target physical tissue changes associated with genitourinary syndrome of menopause (GSM), helping to alleviate vaginal dryness and painful intercourse rather than acting centrally on desire.

What are the side effects and safety risks associated with PT-141?

The most common side effect is nausea, affecting approximately 40% of clinical trial participants, followed by flushing, injection-site reactions, headache, and vomiting. PT-141 can temporarily raise blood pressure and lower heart rate, making it unsafe for women with uncontrolled high blood pressure or known cardiovascular disease. It can also cause focal hyperpigmentation on the face, gums, and breasts, which does not always resolve after stopping the drug.

Sexual symptoms and responses to treatment can change over time, so follow-up visits are important. A doctor who specializes in menopause or sexual health can help work out  which symptoms will benefit from treatment.

References

1. Vyleesi (bremelanotide injection). Prescribing information. Palatin Technologies; 2020. Accessed October 5, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210557s002lbl.pdfaccessdata.fda

2. Kingsberg SA, Clayton AH, Portman D, et al. Bremelanotide for the treatment of hypoactive sexual desire disorder: two randomized phase 3 trials. Obstet Gynecol. 2019;134(5):899-908. doi:10.1097/AOG.0000000000003500

3. Weinberger JM, Houman J, Caron AT, et al. Female sexual dysfunction and the placebo effect: a meta-analysis. Obstet Gynecol. 2018;132(2):453-458. doi:10.1097/AOG.0000000000002733

4. 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. doi:10.1210/jc.2019-01603

5. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976-992. doi:10.1097/GME.0000000000001609