Off-label use of HSDD medications in postmenopausal women is common, highlighting unmet treatment needs and a gap between patient search behavior and clinical terminology.
Off-label prescribing of medications approved for premenopausal hypoactive sexual desire disorder (HSDD) is common among peri- and postmenopausal women, according to new data examining national prescribing patterns alongside patient search behaviors.1 The analysis evaluated use of bremelanotide (Vyleesi) and flibanserin (Addyi), as well as Google Trends data from January 2019 through October 2025, to better understand both clinician practice and patient interest in menopausal sexual health.
Among prescriptions analyzed, 23% of bremelanotide and 26% of flibanserin were written for patients older than 50 years, despite the lack of FDA-approved therapies specifically indicated for postmenopausal HSDD. OB/GYNs accounted for approximately 40% of prescribers for both medications, whereas urologists represented a smaller proportion (2%–4%).
Study author Melissa Moran, DO, urology resident at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, emphasized that limited treatment options are a key driver of off-label use.
“I think it really does a disservice to these women that they are so limited in their treatment options,” she said. Although flibanserin is now FDA approved for women younger than 65 years, other therapies, including testosterone, remain off-label.
In clinical practice, Moran described a selective approach to prescribing.
“Peri and postmenopausal women who meet the criteria for HSDD—so low sexual desire that causes significant distress—[and] who are willing to try a medication that has not been specifically tested in their age group” may be appropriate candidates, she said, particularly in the absence of contraindications.
The study also highlighted a disconnect between clinical terminology and patient search behavior. Google Trends analysis showed that symptom-based phrases such as “increase libido menopause” and “low libido menopause” consistently outpaced more formal diagnostic terms. Searches for “hypoactive sexual desire disorder menopause” were rare, appearing only at 2 time points during the study period.
These findings have implications for patient communication and screening. Moran noted that many patients may not recognize HSDD as a treatable condition.
“Studies have shown that many menopausal women believe that the sexual symptoms that they experience are inevitable, and are not even aware that treatments exist,” she said.
To address this gap, she underscored the importance of tailoring language to patient comfort.
“Clinicians can inquire about patient sexual health in a patient-centered and patient-focused approach,” she said. For patients who may feel hesitant, clinicians can “normalize the conversation and use medical terms like libido or lubrication,” whereas more colloquial language—such as “dryness or pain during sex”—may be appropriate for others.
Overall, the findings suggest that although off-label prescribing is already addressing an unmet need, improved patient education and communication strategies may further enhance care for menopausal women with HSDD.
Reference:
Moran M, Sykes J, Velez Leitner D. Analysis of off-label medication prescriptions and Google search trends for postmenopausal female hypoactive sexual desire disorder. Presented at: International Society for the Study of Women's Sexual Health Annual Meeting. February 12-15, 2026. Long Beach, California. Accessed April 21, 2026. Abstract 025.
