Review: Hormone therapy for sexual function in perimenopausal and postmenopausal women

Posted January 16, 2024

A metanalysis conducted by the group of Centro INCT Hormona Universidade de São Paulo (USP), Campus Ribeirão Preto, Brazil, evaluated the effects of hormone therapy on sexual function in perimenopausal and postmenopausal women. The review Hormone therapy for sexual function in perimenopausal and postmenopausal women, which can be accessed at the link https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009672.pub3/full , is an update of another review conducted ten years ago: https://pubmed.ncbi.nlm.nih.gov/23737033/

The professor and researcher of INCT Hormona, Dr. Lucia Lara, believes that the selected theme is of vital importance. “In Brazil, 49% of women have sexual complaints, and problems in this area increase with age, and become even worse with the onset of menopause, when more than 50% of women complain of reduced sexual desire, and from 70 to 80% of them complain of pain during sexual intercourse”, she comments.

The specialist states that this situation indicates that the decrease of estrogen to minimum levels after menopause is related to these women’s complaints. “This decrease in the quality of sexual function may have a strong negative impact on women’s overall well-being and on their marital relationship,” she warns.

According to Dr. Lara, the group observed that prescription of estrogen alone, i.e., not combined with progestogen, improves sexual function in premenopausal and postmenopausal women, as well as menopause-related symptoms, such as hot flushes, night sweats, and complaints of vaginal dryness. “In women without these symptoms, the positive effect was very low and questionable,” she comments. “However, use of estrogen alone is safe only for women without a uterus,” she warns.

“In turn, in the case of estrogen combined with progestogen, it is unclear whether this combination has a positive effect on sexual function, due to the low quality of studies,” she states. According to the review, there is no evidence that synthetic sexual steroids and selective estrogen receptor modulators alone or combined with estrogen improve sexual function in these women.

Dr. Lara also comments that this positive effect of estrogen on sexual function in perimenopausal and postmenopausal women indicates that hormone therapy with estrogen should be the first line of treatment for women who started to have sexual problems in this stage of life. “Only after this resource was tested, new second line modalities for the treatment of sexual complaints of these women should be implemented,” she explains.

The specialist explains that the effect of estrogen on improving women’s sexual function was considered from moderate to low due to the heterogeneity observed in the studies. “To improve the quality of investigations, it is necessary to design randomized controlled trials that analyze variables such as: quality of marital relationship, duration of marital relationship, sexual and gender diversity, sample size based on primary outcome,” she concludes.