Clinical Question

Does estrogen replacement therapy (ERT) 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. Although 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. (Level of Evidence = 1b)

Synopsis

This study is part of a larger study investigating the role of estrogen replacement on atherosclerosis progression. Women less than three 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 per day), transdermal estradiol (50 mcg per day), or placebo for four years, with micronized progesterone for 12 days per month. The study used the Female Sexual Function Index (FSFI) to track sexual function, although the authors did not 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), and 74% of women had a score that indicates low sexual function (less than 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% confidence interval, 1.11 to 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.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference:TaylorHSTalAPalLet alEffects of oral vs transdermal estrogen therapy on sexual function in early postmenopause: ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS). JAMA Intern Med2017;177(10):1471–1479.