Hormone Therapy for Sexual Function in Perimenopausal and Postmenopausal Women

Summary

A Cochrane review [Abstract] 1 included 36 studies with a total of 23 299 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%). In unselected postmenopausal women, there was no clear benefit (SMD 0.64, 95% CI −0.12 to 1.41; I² = 94%; 6 studies, n=608). For estrogens combined with progestogens vs control, in unselected postmenopausal women, no clear benefit was shown (SMD 0.08 95% CI −1.52 to 1.68; 1 study, n=104).

For selective estrogen receptor modulators (SERMs) vs control, in symptomatic or early postmenopausal no clear benefit was found (MD −1.00, 95% CI −2.00 to ‐0.00; 1 study, n=215) as well as in unselected postmenopausal women (MD 2.24, 95% 1.37 to 3.11 2 studies, 1525 women, I²=1%).

Another Cochrane review 2 included 28 studies with a total of 1 273 subjects. Dehydroepiandrosterone (DHEA) is one of the main precursors of androgens, which in turn are converted to testosterone and estrogens. Compared to placebo, DHEA did not improve quality of life (SMD 0.16, 95% CI -0.03 to 0.34, P = 0.10; 8 studies, n=287, I² = 0%). DHEA was associated with androgenic side effects (mainly acne) (OR 3.77, 95% CI 1.36 to 10.4, P = 0.01, 5 studies, 376 women, I² = 10%) when compared to placebo. DHEA was found to improve sexual function (SMD 0.31, 95% CI 0.07 to 0.55, P = 0.01, 5 studies, 261 women, I² = 0% compared to placebo).