Hormone therapy for sexual function in perimenopausal and postmenopausal women

Hormone treatment with estrogens alone or in combination with progestogens appears to be effective for improving sexual function in women with menopausal symptoms or in early postmenopause (within five years of amenorrhoea) compared with placebo.

Comment: The quality of evidence is downgraded by study quality ( unclear allocation concealment and unclear blinding of outcome assessment).

Summary

A Cochrane review included 27 studies with a total of 16 393 subjects. For estrogens alone vs control, in symptomatic or early postmenopausal (within five years of amenorrhoea ) women there was a small to moderate benefit in sexual function for the hormone therapy (HT) group (standardized mean difference (SMD) 0.38, 95% CI 0.23 to 0.54, P < 0.00001; 3 trials, n=699, I² = 55%, high-quality evidence). In unselected postmenopausal women, there was no clear benefit (SMD 0.16, 95% CI -0.02 to 0.34, P = 0.08; 2 trials, n=478, I² = 44%, low-quality evidence). For estrogens combined with progestogens vs control, in symptomatic or early postmenopausal a small to moderate benefit for sexual function in the HT group was found (SMD 0.42, 95% CI 0.19 to 0.64, P = 0.0003; 1 trial, n=335, moderate-quality evidence). In unselected postmenopausal women, no clear benefit was shown (SMD 0.09, 95% CI -0.02 to 0.20, P = 0.10; 3 trials, n=1314, I² = 0%, moderate-quality evidence).

For tibolone vs control, in symptomatic or early postmenopausal women no clear benefit was found (SMD 0.13, 95% CI 0.00 to 0.26, P = 0.05; 1 trial, n=883, low-quality evidence); as well as in unselected postmenopausal women (SMD 0.38, 95% CI 0.04 to 0.71, P = 0.03; 2 trials, n=142, I² = 0%, low-quality evidence). In the combined analysis, the 95% CI was compatible with no effect to a small benefit (SMD 0.17, 95% CI 0.04 to 0.29, P = 0.008, 3 studies, 1025 women, I² = 20%).

For selective estrogen receptor modulators (SERMs) vs control, in symptomatic or early postmenopausal no clear benefit was found (SMD 0.23, 95% CI -0.04 to 0.50, P = 0.09, 1 trial, n=215, low-quality evidence) as well as in unselected postmenopausal women (SMD 0.04, 95% CI -0.20 to 0.29, P = 0.72, 1 trial, n=283, low-quality evidence). In the combined analysis, the 95% CI was compatible with no effect to a small benefit (SMD 0.13, 95% CI -0.05 to 0.31, P = 0.16, 2 studies, 498 women, I² = 2%).

Date of latest search: 12 December 2012

Ədəbiyyat

1. Nastri CO, Lara LA, Ferriani RA et al. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2013;6():CD009672.