The term perimenopause refers to the transition phase when the female body is switching off the monthly reproductive cycles. It is the end of your reproductive years as with declining physical fitness your body decided to let go of the ability to bear children and use the resources more wisely. This brings a shift in many bodily functions and changes on neurochemical and hormonal levels resulting in many physiological and emotional changes.

Perimenopause Symptoms

When going through the menopausal transition you might experience some subtle — and some not-so-subtle — changes in your body may take place. These include :

• Irregular periods and decreasing fertility.
• Mood changes, Hot flashes, and sleep problems.
• Vaginal and bladder problems and changes in sexual function.
• Loss of bone density and Changing cholesterol levels. 
• Change in sexual arousal and desire 

Do not hesitate to consult your doctor if any of these symptoms appear and are causing discomfort to you on regular basis. 

Change in Libido Perimenopause

.When you are going through the perimenopausal stage you may experience a change in the ability to experience sexual arousal and desire. While some women can experience an increase in libido, most women go through a decline in libido, and difficulty in having sex. This is mainly attributed to declining estrogen levels and can physically be experienced in the following ways.

• Painful sex: Just like your skin gets drier and loses elasticity as your age, vaginal tissues may also lose lubrication and elasticity resulting in painful sex after menopause. 
• Infections: Urinary or vaginal infections are also more prevalent due to low estrogen, giving you an itch and discomfort down there. 
• Urinary incontinence: Loss of tissue tone may contribute to loss of bladder control and occasional leakage.  

HSDD due to Perimenopause

If in the transnational period before hitting menopause, your libido goes down to a level that it causes significant distress you might qualify for the diagnosis of HSDD Hypoactive Sexual Desire Disorder. The significant distress can either be personal distress or distress in your relationship with your partner. HSDD symptoms include lack of sexual fantasies, lack of desire to initiate or participate in sexual activity, and inability to experience the level of arousal and sexual pleasure that was previously part of your life.

Treatment Options for Perimenopause HSDD

Considering sex is an important part of life for many women and lack of sexual desire in them can cause them and their partner distress and impact their lives on a larger scale, there is very little help and safe options available. Viagra and testosterone were initially tested for relying on low libido in perimenopausal women, but they did not give the required results. So far there are very limited safe treatment options for HSDD that improve sex drive and sexual experience in perimenopausal women. 

Addyi or Pink Pill 

It was initially tested as an anti-depressant as it unblocks the blocked neurotransmitter receptors. It is FDA-approved but has some serious side-effects and drug interactions due to which FDA was initially hesitant to approve it as HSDD medication, rejected it twice, and finally approved it the third time in 2016. Alcohol consumption is banned while taking the Addyi.

Vyleesi Shots

Bremelanotide is a melanocortin receptor agonist taken as a course of self-administered shots that are injected into the abdomen or thigh 45 minutes before the intended sex. It was approved by FDA in 2019 but with a warning that there should be a gap of at least 24 hours between two injections.  Nearly 40% of women experience severe nausea afterward and some other side effects such as flushing, headaches, and vomiting,

O Shot

These are patent injections that are injected into your vaginal walls and use the PRP technique to enhance vaginal sensitivity towards stimulation. This procedure is not FDA approved and there is very little research on the procedure to say for certain how effective it is or what are the side-effects. As no drug but platelets from your own blood is injected into your vagina there is little risk involved other than the damage done with the wrong administration of the injection. It is claimed that results last up to a year. Read more about O Shot here.

Comparison between Addyi, and Vyleesi, O Shot 

The three treatment options will be compared across the merits of dosage and administration, effectiveness and safety.

Dosage and Administration

Vyleesi limits consumption by 1 shot per 24 hours and not more than 8 injections must be consumed during a month. For Addyi one pill needs to be taken orally every day, preferably at night time. With O shots vaginal injections can be repeated after a gap of a minimum of 8 weeks. Both Vyleesi and Addyi need to be discontinued after two months and can be purchased on a doctor’s prescription but O-Shot can only be administered by certified doctors. 

Effectiveness

Vyleesi has shown significant improvement in 25% of women which is 7% more than the placebo group while Addyi has shown a significant improvement in 10% more than the placebo group. These are results from separate studies and no comparative study has been conducted. Although O Shot claims a 70% success rate the sample size of only one pilot study was 11 women and thus results are not reliable enough to be generalized.

Safety

Vyleesi and Addyi are FDA-approved treatments for perimenopause HSDD, while O Shot is not FDA approved. The common side-effects of Vyleesi include overwhelming nauseous feeling, flushing, and in some cases vomiting. Common side effects of Addyi are very low blood pressure and nausea and in some cases vomiting and fainting. Alcohol consumption is strictly banned while on Addyi but Vyleesi has no alcohol interaction. All three treatments are not recommended for breastfeeding or pregnant women.

Conclusion

There are very few FDA-approved options available to help relieve perimenopause symptoms, especially to improve libido.  If you want to consider Vyleesi or Addyi for helping with your perimenopause induced HSDD please discuss with your doctor and make safe choices.