Management of sexual dysfunction in menopause: an update on evidence-based strategies

Introduction: Female sexual dysfunction (FSD) at menopause is a group of prevalent and multifactorial conditions that significantly impair quality of life and well-being. Hormonal decline, particularly estrogen and androgen deprivation, along with aging-related changes, contribute to genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD), the two most relevant clinical entities. Areas covered: This narrative review provides an updated revision of the literature regarding evidence-based strategies for FSD in menopausal women. Emphasis is placed on pharmacologic treatments, including systemic and local hormonal and non-hormonal therapies, selective estrogen receptor modulators (SERM), and centrally acting agents. Non-pharmacological interventions are also discussed, such as pelvic floor rehabilitation, laser therapies, and psychosexual approaches (cognitive behavioral therapy, mindfulness, couple therapy). The content draws mainly on recent clinical trials, consensus statements, and guideline-based recommendations, based on Pubmed search updated to July 2025. Expert opinion: Management of FSD associated with menopause requires a multidimensional, individualized approach integrating biological, psychological, and relational factors. A proactive and structured clinical framework, supported by validated diagnostic tools, is essential. Healthcare providers (HCPs) should address sexual health openly, recognize the couple’s dynamics, and tailor interventions to each woman’s needs and preferences, while considering the evolving evidence and regulatory landscape.