Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Minimal effect of ERT on sexual function in menopausal women
Clinical Question
Does estrogen replacement therapy affect sexual function in menopausal women?
Bottom line
Transdermal, but not oral, estrogen produced a small improvement in sexual function scores in menopausal women. The increases were very small and may not be noticeable by most women. Though the women in this study had low baseline sexual function scores, they were not necessarily distressed by the low scores, so this study did not evaluate women with sexual dysfunction. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
This study is part of a larger study investigating the role of estrogen replacement on atherosclerosis progression. Women less than 3 years from their last menstrual period (average age 52.7 years) were recruited and randomized (using concealed allocation) to receive oral conjugated equine estrogens 0.45 mg/day, transdermal estradiol 50 mcg/day, or placebo for 4 years, along with micronized progesterone for 12 days per month. The study used the Female Sexual Function Inventory (FSFI) to track sexual function, though the authors didn't assess distress associated with low sexual function, which is needed for a diagnosis of sexual dysfunction. FSFI scores, on average, were low at the start of treatment—18.4 to 19.1 out of a possible 36; 74% of women with a score that indicates low sexual function (< 26.55). Over the course of the study, transdermal but not oral estrogen was associated with a small but statistically significant increase in FSFI scores, (average efficacy 2.6; 95% CI 1.11 - 4.10; P = .002), with significant improvements on the lubrication and pain subscales of the inventory. However, 67% of women treated with transdermal estrogen still had low sexual function.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
There seems to have snuck into our sexualized society a meme that we desire and require a lot of fornication. We don't.
Once again the claims for HRT benefit are in doubt. Is the oral estrogen dose equivalent to the transdermal?
ERT has minimal effect on sexual function in postmenopausal
As a 65 yr old woman, I know that improvements in lubrication and pain sub scales are always clinically significant, and there are no adequate substitutions for estrogen in this department. I think that the oral CES dose is about half the transdermal dose in this study.
Good poem
Because one of my patients, age 55 who had a hysterectomy and ovariectom'sy in her 40s was riddled with osteoarthritis following her menopause, and had absolutely no sex drive. I put her on Estradot 50 and Prometrium 100 mg at bedtime and, for the first time in years, she now has a satisfactory sex life, sleeps well and sufferers much less from her osteoarthritis. Bring on HRT!
It has long been known that women using MHT often require additional vaginal estrogen to manage GSM.