Sexual health

Vyleesi (Bremelanotide): An On-Demand Option

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Vyleesi (bremelanotide) is a self-injected, on-demand treatment for premenopausal women with distressing low desire, used about 45 minutes before sex. Its benefit is modest and similar to Addyi's, with a large placebo response. About 40% of users get nausea, and it can briefly raise blood pressure.

Last updated: July 2026

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What is Vyleesi and how is it used?

Vyleesi, the brand name for bremelanotide, is a medication you inject under the skin only when you want it, not every day. The U.S. Food and Drug Administration approved it in 2019 for premenopausal women with acquired, generalized hypoactive sexual desire disorder — distress about low desire lasting at least 6 months that is not tied to a single cause 1. It activates melanocortin receptors in the brain, a different pathway from Addyi's serotonin-based action. Women use a small autoinjector in the thigh or abdomen about 45 minutes before anticipated sexual activity 1. According to ACOG, no more than one dose in 24 hours is advised, and it is meant for occasional, on-demand use 1.

How well does Vyleesi work?

Vyleesi's effect on desire is real but small, much like the other approved option. In the RECONNECT trials, more women on bremelanotide than placebo reported meaningful improvement in desire and less distress, though the average change in the number of satisfying sexual events was minimal 1. As with Addyi, a large share of the benefit also appeared in the placebo group, according to ACOG 1. Distressing low desire affects roughly 1 in 10 premenopausal women, so many might consider it, but the modest effect means it helps some and not others 1. For postmenopausal women, a global consensus points instead to testosterone as the better-studied choice 2.

What are the side effects?

Nausea is Vyleesi's most common and limiting side effect. In the trials, about 40% of women experienced nausea, and roughly 1 in 8 needed anti-nausea medicine or stopped because of it, according to ACOG 1. The injection can briefly raise blood pressure and slow the heart rate, so it is avoided in women with uncontrolled high blood pressure or known heart disease 1. Repeated use can cause darkening of the skin or gums in some women, which may not fully fade 1. Because of the blood-pressure effect, it is not used more than once in 24 hours, and headache and flushing can also occur 1.

How does Vyleesi compare with Addyi?

Vyleesi and Addyi treat the same condition but work very differently. Vyleesi is an on-demand injection used before sex, while Addyi is a daily bedtime pill taken every night regardless of activity 1. Both are approved only for premenopausal women with generalized, acquired low desire, and both deliver modest average benefits with notable side effects 1. Neither was studied after menopause, and neither helps when low desire stems from vaginal dryness and pain 3, a relationship concern, or stress and exhaustion. For desire tied to menopausal changes, hormone therapy itself yields only small gains, so treating the underlying cause usually helps more 4.

When low desire is worth a medical conversation

Choosing Vyleesi is a decision for a clinician who treats sexual health, not a first step. According to ACOG, a thorough evaluation first looks for reversible causes — medications, mood, relationships, and physical pain — before any drug is considered 1. A clinician can explain the modest expected benefit, the high nausea rate, and the blood-pressure cautions, and help you decide whether an on-demand injection fits your life. Bringing it up is easier than it sounds; talking with a clinician about sexual health is routine and private. Because sexual well-being is part of overall health, not a performance goal 5, the aim is what feels right to you. Gale can help you prepare for that conversation.

Common questions

It produces a modest improvement in desire and distress for some premenopausal women, similar in size to Addyi, with a large placebo response. It is not a dramatic fix, and about 40% of users get nausea, which leads some to stop.

Vyleesi is a self-injection used on demand about 45 minutes before sex, while Addyi is a pill taken every day at bedtime. They act on different brain pathways, and their main side effects differ — nausea and blood pressure for Vyleesi, alcohol interactions for Addyi.

Nausea is the most common, affecting roughly 40% of users. It can briefly raise blood pressure and slow heart rate, and repeated use may darken skin or gums. It is avoided in uncontrolled high blood pressure or heart disease.

No. Like Addyi, it was only studied and approved for premenopausal women with generalized, acquired low desire. After menopause, testosterone is the more evidence-based option, according to a global consensus statement.

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When to check with a clinician about Vyleesi

  • —A headache that does not ease, chest pain, or symptoms of very high blood pressure after an injection is a reason to seek urgent medical care.
  • —Nausea severe enough to cause dehydration or make you stop the medication is a reason to seek clinician review of whether it fits you.
  • —Low desire accompanied by persistent sadness or loss of interest in everything is a reason to seek clinician review; if thoughts of self-harm arise, call or text 988.
  • —Known heart disease or blood pressure that is not well controlled is a reason to review whether this injection is safe for you before using it.

This article is general health education, not medical advice or a prescription. Whether Vyleesi is appropriate is a decision to make with a gynecologist or primary care clinician who can review your health and blood pressure.

References

  1. 1.American College of Obstetricians and Gynecologists (2019). Female Sexual Dysfunction: ACOG Practice Bulletin, Number 213. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003324 ✓ACOG Practice Bulletin describing bremelanotide (Vyleesi): FDA approval in 2019 for acquired, generalized HSDD in premenopausal women; on-demand subcutaneous injection about 45 minutes before sex with no more than one dose per 24 hours; a modest effect with a large placebo response; distress required for at least 6 months and prevalence of about 1 in 10 women; nausea in about 40% of users (roughly 1 in 8 needing anti-nausea medicine); blood-pressure and skin-darkening cautions.
  2. 2.Davis SR, et al. (International consensus, endorsed by The Endocrine Society and International Menopause Society) (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Clinical Endocrinology & Metabolism. doi:10.1210/jc.2019-01603 ✓Global consensus that after menopause testosterone is the better-studied option, since bremelanotide was studied only in premenopausal women.
  3. 3.The North American Menopause Society (Menopause Society) (2020). The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. doi:10.1097/GME.0000000000001609 ✓Genitourinary syndrome of menopause as a common, treatable cause of low desire and painful sex that a desire drug does not address.
  4. 4.Nastri CO, Lara LA, Ferriani RA, et al. (2013). Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD009672.pub2 ✓Systematic review showing only small benefits of hormone therapy on sexual function for menopausal changes.
  5. 5.World Health Organization (2022). WHO guideline on self-care interventions for health and well-being, 2022 revision. World Health Organization (WHO). link ✓Framing of sexual well-being as part of overall health rather than a performance goal.

5 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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