Clinical Question

Does hormone therapy improve sexual function in postmenopausal women?

Evidence-Based Answer

In early postmenopausal women (within 5 years of their last menstrual period), systemic estrogen slightly improves sexual function (i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain). (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.) However, it is not clear whether other types of hormone therapy—including systemic estrogen combined with progesterone—improve sexual function in postmenopausal women. There is insufficient evidence to support the use of systemic hormone therapy in postmenopausal women for sexual function alone; however, in women with vasomotor symptoms, the use of systemic estrogen therapy for other indications may result in a slight improvement in sexual function. The benefits of hormone therapy for postmenopausal women should be balanced with the risks.¹

Practice Pointers

The menopausal transition brings a multitude of problematic symptoms, including vasomotor symptoms, sleep and mood changes, and sexual dysfunction. Sexual dysfunction during this period can include low sex drive or desire, poor vaginal lubrication, dyspareunia, and the inability to achieve an orgasm. Current guidelines suggest that for women younger than 60 years or within 10 years of menopause onset without contraindications, the benefit-risk ratio for systemic hormone therapy for vasomotor symptoms of menopause is favorable^2,3; however, the effect of systemic hormone therapy on sexual function is unclear. The authors of this Cochrane review sought to evaluate the effect of hormone therapy on sexual function in postmenopausal women.