A Pill for Women’s Libido

I'm picture a couple where they mix up the bottles of Viagra and this miracle drug and the wheels come off the cart.

A Pill for Women’s Libido Meets a Cultural Moment

A decade ago, Cindy Eckert struggled to convince skeptics about a drug for premenopausal women. Lately, her business is booming.

Cindy Eckert, the chief executive of Sprout, the company behind Addyi, a prescription drug that treats hypoactive sexual desire disorder, or H.S.D.D.

By Issie Lapowsky, NY Times

Reporting from Raleigh, N.C.

Nov. 16, 2025

Entering Cindy Eckert’s home quickly makes clear that the whole pink thing was never the gimmick her haters once made it out to be.

Gracing the entryway is an oversize pink statue of her French bulldog, Mortimer. In the interior courtyard, a glass-enclosed garage showcases a pink-wrapped 1940s Chevy truck. A pink metal staircase leads to a room filled with rack after rack of Ms. Eckert’s pink feathered-and-frilled wardrobe. Even the coop out back, occupied by a small flock of chickens and two overgrown pigs, is dedicated to Ms. Eckert’s signature hue. She calls it the Pink Poultry Club.

Then there is Ms. Eckert herself, who, on an October day in Raleigh, N.C., was dressed, as ever, in pink from the tip of her rose-lacquered toes to the top of her magenta-streaked head. “I was recently at a conference, and a woman that I love said, ‘Oh, we’re still doing pink,’” said Ms. Eckert, 52. “I said, ‘Just still doing me.’”

Ms. Eckert is the co-founder and chief executive of Sprout Pharmaceuticals, the maker of the women’s libido drug Addyi, which treats the condition known as hypoactive sexual desire disorder, or H.S.D.D., in premenopausal women. Sometimes erroneously referred to as “female Viagra” — Addyi targets neurotransmitters, not blood flow — its proper name is flibanserin, and in 2015, Ms. Eckert won a knock-down, drag-out battle to get it approved by the Food and Drug Administration.

Naturally, she has embraced the name “little pink pill.”

In Ms. Eckert’s fight with the government agency, critics accused Sprout of trying to medicalize the natural ebbs and flows of women’s sexual desire. They also saw Ms. Eckert’s colorful style as a sleight of hand to distract from the scientific debates about her product. When, one day after winning F.D.A. approval, Ms. Eckert sold Sprout for $1 billion to a company that soon hiked the price and effectively shelved Addyi, it was all the more proof for her detractors that she didn’t have patients’ best interest at heart.

But a decade later, after winning back her company in a 2018 legal battle, Ms. Eckert’s critics have quieted. Some have even been converted.

“My mind has been changed,” said Laurie Mintz, a psychologist and sex therapist, who once argued that likening low libido to a disease could drive women away from “less dangerous” remedies.

Thanks to the loosening of F.D.A. guidelines surrounding Addyi and a wider, ongoing reckoning with women’s health care, there are now more than 30,000 doctors prescribing Addyi and more than half a million prescriptions on the market. As women binge-read copies of Miranda July’s best seller about a perimenopausal mother’s sexual awakening, or devour stories about Gen X women having the best sex ever, women of all ages are prioritizing their own sex lives. And Ms. Eckert’s drug — and other treatments for women struggling with their libido — are reaping the benefits.

“We played the long game,” Ms. Eckert said. “Culture caught up.”

For much of the last half-century, the fight for women’s sexual freedom has hinged largely on economic arguments. Giving women access to birth control, advocates’ reasoning went, would allow them to determine if and when they had children, empowering them to study, to work and to attain financial independence.

What are perimenopause and menopause? Perimenopause is the final years of a woman’s reproductive years that leads up to menopause, the end of a woman’s menstrual cycle. Menopause begins one year after a woman’s final menstrual period.

What are the symptoms of menopause? The symptoms of menopause can begin during perimenopause and continue for years. Among the most common are hot flashes, depression, genital and urinary symptoms, brain fog and other neurological symptoms, and skin and hair issues.

How can I find some relief from these symptoms? A low-dose birth control pill can control bleeding issues and ease night sweats during perimenopause. Avoiding alcohol and caffeine can reduce hot flashes, while cognitive behavioral therapy and meditation can make them more tolerable. Menopausal hormone therapy and the selective serotonin reuptake inhibitor paroxetine can also ease some symptoms.

What is Veozah? Veozah is the first nonhormonal medication to treat hot flashes in menopausal women; it was recently approved by the F.D.A. The drug targets a neuron in the brain that becomes unbalanced as estrogen levels fall. It might be particularly helpful for women over 60 because, at that age, starting hormonal treatments can be considered risky.

How long does perimenopause last? Perimenopause usually begins in a woman’s 40s and can last for four to eight years. The average age of menopause is 51, but for some it starts a few years before or later. The symptoms can last for a decade or more, and at least one symptom — vaginal dryness — may never get better.

What can I do about vaginal dryness? There are several things to try to help mitigate the discomfort: lubricants, to apply just before sexual intercourse; moisturizers, used about three times a week; and/or estrogen, which can plump the vaginal wall lining. Unfortunately, most women will not get 100% relief from these treatments.

What is primary ovarian insufficiency? The condition refers to when their ovaries stop functioning before the age of 40; it can affect women in their teens and 20s. In some cases the ovaries may intermittently “wake up” and ovulate, meaning that some women with primary ovarian insufficiency may still get pregnant.

Fact, or fiction? We asked gynecologists, endocrinologists, urologists and other experts about the biggest menopause misconceptions they had encountered. Here’s what they want patients to know.

Whether women actually desired or enjoyed the sex they were now free to have was, for a long time, a far more taboo question — one that even their doctors weren’t trained to ask.

It was on Ms. Eckert’s mind, though, when she ran into the urologist Dr. Irwin Goldstein at a sexual medicine conference in 2010. She was attending on behalf of another company she co-founded with her then-husband, Bob Whitehead, which sold testosterone pellets. Dr. Goldstein had something he wanted Ms. Eckert to see.

It was a series of videos from women who had been part of a clinical trial for flibanserin. A German company was studying the drug for treatment of H.S.D.D., but the F.D.A. had rejected it, and now the company was giving up on the trials. The women in the videos were distraught that they would no longer have access to a treatment they said helped them.

Dr. Goldstein, who led clinical trials for Viagra, wanted Ms. Eckert to take up the cause. The timing was apt: At the same conference, a research cohort was presenting the results of a study that demonstrated the difference in brain activity between women with H.S.D.D. and women without it. Ms. Eckert was indignant that, for so long, women’s sexual desire had been dismissed purely as a matter of stress levels and marital woes.

One year after the conference, Ms. Eckert and Mr. Whitehead acquired the rights to flibanserin and founded Sprout, hoping to take another crack at approval.

That turned out not to be so easy. Clinical trials showed flibanserin slightly increased women’s sexual desire and activity and lowered their distress, compared with placebos, but it also made them drowsy and lowered their blood pressure, particularly when mixed with alcohol. The side effects gave F.D.A. officials pause, and the agency rejected Sprout’s application for approval for the drug, too.

To be turned down twice by the F.D.A. is typically a death sentence for new drugs. But for flibanserin, the decision had the opposite effect: It galvanized a movement of women who believed the rejection reeked of sexism.

Shortly after the F.D.A. denial, the feminist activist Susan Scanlan started a new and noisy advocacy group focused on flibanserin’s approval called Even the Score. The group, which received partial funding from Sprout, included dozens of women’s groups, consumer organizations and medical societies. Ms. Eckert, though, became perhaps its most visible champion, her wardrobe growing pinker by the day.

Sally Greenberg, chief executive of the National Consumers League, said she joined the group after attending a meeting with Dr. Goldstein, the urologist, and his patients. She believed there was a double standard in how regulators treated the well-known risks associated with drugs for men’s sexual dysfunction.

“Because sex is so important for men to have, we’re willing to take a chance — but women can’t be trusted,” she said. (The F.D.A., which did not comment for this article, denied the claims of sexism at the time.)

But as support for the drug swelled, so did the backlash. Some accused Even the Score’s leadership of being bought off by Sprout. Other feminist and medical organizations charged the group with crying sexism where none existed and argued that Even the Score was another example of the creeping influence of pharmaceutical money at the F.D.A.

Ms. Eckert is still sensitive about Sprout’s financial ties to Even the Score. According to the company, Sprout spent $25,000 helping produce one ad campaign and a few thousand more flying in three women to speak at an F.D.A. advisory meeting, financing all of the women publicly disclosed. Still, Ms. Eckert bristles at the insinuation that the outrage was manufactured.

“When they were treated like, ‘Oh, you’re just doing Cindy’s bidding for her,’ I’m thinking, ‘Man, you’ve never met these women,’” Ms. Eckert said.

The F.D.A. approved flibanserin in 2015, writing later in the New England Journal of Medicine that while “the average treatment effects were small” (about 10 percent higher than placebo) “efficacy had been established.”

But the wait for the drug was far from over. Regulators imposed strict guardrails, including a boxed warning on Addyi’s label. The F.D.A. also required doctors and pharmacists to get special certification to prescribe and dispense it, and women to sign a waiver promising to abstain from alcohol while taking it.

Then, within a year, Valeant, the company that acquired Sprout, effectively imploded, causing the entire Sprout team in Raleigh to be wiped out in a move so swift there was rotting food left in the refrigerator. Ms. Eckert had initially viewed the sale as an “entrepreneur’s dream.” In the hands of a bigger company, she believed Addyi would get out to the market faster than if Sprout had tried to commercialize it on its own. (The $1 billion price tag certainly didn’t hurt.)

When her plan fell apart, “it was really the feeling of just having let everybody down,” she said.

The pink pill’s second coming

That feeling, though, was also a powerful motivator. In 2016, Sprout’s former investors sued Valeant for failing to meet their contractual obligation to market Addyi. Two years later, Valeant made a deal, handing the keys to the company back to Ms. Eckert in exchange for 6 percent of the royalties, with an added bonus: a $25 million loan to help her bring Addyi back from the dead.

Today, Sprout 2.0, as Ms. Eckert calls it, operates out of an unremarkable office building and shopping complex about four miles from Ms. Eckert’s home. The team is small enough to fit around one big table for daily lunches and has a family feel, owing in part to the fact that some of them actually are Ms. Eckert’s family. Her older brother, Brian, is chief strategy officer. Justin Miller, Ms. Eckert’s fiancé, is Sprout’s chief operating officer. Even her ex-husband and co-founder, Mr. Whitehead, now chairs Sprout’s board.

The other employees inside this “unapologetically pink” office — as it says on the walls — are 20-or-so designers, marketers, supply chain specialists and one customer service agent with a particularly spicy inbox.

Their jobs are a bit different this time around. In the last few years, menopause and perimenopause have become, well, hot topics, and Silicon Valley investors and celebrities alike are contributing to a booming menopause economy.

At the same time, telehealth sites like Hims and Hers have wallpapered the world with ads about sexual enhancement treatments, chipping away at the stigma that has dogged the field for decades.

All of it has recently given Ms. Eckert’s company a boost. This year, Sprout is on track to double its revenue, and it is finding celebrity supporters along the way. In an ad for her podcast, the actress Jennie Garth shared that she was personally on the drug, and raved about how it had helped her. Gwyneth Paltrow, whose brand Goop sells its own libido supplement for women, wrote about Addyi earlier this year.

This weekend, Ms. Eckert is also the subject of a new documentary about the F.D.A. fight called “The Pink Pill,” premiering at the DOC NYC film festival. “This is a conversation that people have been desperate to have for such a long time,” said Aisling Chin-Yee, the film’s director.

This cultural shift has mirrored a regulatory one. Since Ms. Eckert won back Sprout, the F.D.A. has walked back many of its constraints on Addyi, removing the certification requirements on doctors and pharmacists and lifting the total restriction on alcohol intake for women.

Now, Addyi’s label recommends that women — who are supposed to take the pill daily at bedtime — wait two hours after drinking or skip it entirely if they’ve had three or more drinks. This summer, the F.D.A. also fast-tracked Addyi’s application to expand approval for postmenopausal women. A final decision could come as early as this year.

These changes have made Addyi far more accessible to patients, said Dr. Rachel Rubin, a urologist and sexual medicine specialist, who used to lecture other clinicians on prescribing the drug and said she’s seen no major adverse events in her practice. “We’ve had years of experience with this medication,” Dr. Rubin said. “It’s just not scary.”

There are still plenty of women for whom it doesn’t work and who do require the therapeutic interventions that Dr. Mintz, the sex therapist who was once an Addyi critic, and others have long practiced. But for some women, Dr. Mintz has since found, Addyi “really is helpful, and I don’t think it should be dismissed.”

Some of Addyi’s skeptics remain as unconvinced as ever. In 2016, Dr. Steven Woloshin, a professor at Dartmouth’s Geisel School of Medicine who specializes in medical communication, wrote in a medical journal that the F.D.A. “approved a marginally effective drug for a non-life-threatening condition in the face of substantial — and unnecessary — uncertainty about its dangers.”

He stands by that, pointing to Addyi’s limited benefits over placebos. “There’s lots of things that can affect sexual desire, and the way to help people isn’t necessarily to give this particular chemical,” Dr. Woloshin said.

Addyi and Ms. Eckert have also occasionally drawn the ire of regulators. Shortly after she reintroduced her business, the F.D.A. sent Ms. Eckert a warning letter over a radio ad that failed to disclose all of Addyi’s risk factors. In May, it sent Ms. Eckert another, accusing her of doing much the same thing when she shared a People magazine article about Addyi on Instagram.

As of this week, she still hadn’t taken the post down.

Ms. Eckert is now working on another public pressure campaign, this time to expose what she says is a lack of parity in the way insurers cover drugs targeting women’s health conditions versus men’s. The idea was born during a recent salon Ms. Eckert attended at Gloria Steinem’s home.

As Addyi’s profile has grown, of course, so has the interest from potential acquirers. “We get offers,” Ms. Eckert said, and she isn’t ruling them out. But she’s a lot more hesitant to walk away. “This would be a really hard time, when we finally hit our stride, to ever give it up,” she said.