Monophasic Estrogen-Progestogen Therapy and Sexuality in Postmenopausal Women

A.M. Fonseca; V.R. Bagnoli; S.R.L. Penteado; J.S. Paixão; A.L. Cavalcanti; J.A. Pinotti


Clin Drug Invest. 2007;27(2):131-137. 

In This Article

Abstract and Introduction

Objective: This study aimed to evaluate the effects of monophasic estrogen-progestogen therapy on the sexuality and climacteric symptoms of postmenopausal women.
Patients and Methods: A prospective, randomised, double-blind, crossover, placebo-controlled, single-centre study was carried out over a total of 12 consecutive months in 40 postmenopausal women with an intact uterus who had no contraindications to hormone therapy. Patients received 17β-estradiol 2mg in combination with norethisterone acetate 1mg (Cliane®) daily for 6 months or one placebo tablet daily for 6 months. The tablets were identical in appearance. After 6 months, the groups were crossed over and the patients were followed up for another 6 months. The groups were homogenous with respect to age, height, bodyweight, body mass index and race. For the statistical analysis, the group receiving hormone therapy was referred to as group A and the placebo group was designated group B, irrespective of the placebo/hormone therapy sequence.
Results: In group A there were fewer hot flashes (F = 22.85, p < 0.01) and an improvement in sexual interest (F = 5.55, p < 0.05). The sequence in which the medication was received resulted in a statistically significant difference with respect to dyspareunia (F = 9.65, p < 0.01) and satisfaction with the duration of penetration (F = 6.58, p < 0.05). In the intrapatient analysis of variation with respect to orgasmic capability and the presence of dialogue with partner regarding the couple's sexual life, whether the placebo was taken prior to or following hormone therapy was significant (F = 17.12, p < 0.001 and F = 7.10, p < 0.05, respectively).
Conclusions: Monophasic estrogen-progestogen therapy has a beneficial effect on sexuality and on hot flashes in postmenopausal women.

As a result of the aging of the worldwide population and the considerable increase in life expectancy, there has been a corresponding increase in the prevalence of various forms of sexual dysfunction in the more advanced phases of women's lives, making sexuality during this period a topic of growing interest.[1,2]

When 471 men and 728 women between 40 and 80 years of age were interviewed in an epidemiological study conducted in Brazil, the investigators concluded that the most common sexual problems reported by women in this age group consisted of difficulties with lubrication (23.4%) and lack of sexual interest (22.7%).[3]

Identifying factors that influence the sexual satisfaction of women in the upper age brackets is extremely important. However, while the effects of hormone therapy on quality of life, climacteric symptomatology and bone metabolism have been well documented,[4] little research has been conducted on the effect of such therapy on sexual dysfunction.[5]

The effects of the menopause on sexuality are a result of multiple factors, including hormonal changes and psychological, interpersonal, economic and behavioural factors.[1] Problems more specifically related to the menopausal transition include a decline in sexual desire and the onset of dyspareunia and vaginal dryness. In addition, a reduction in sexual activity and response occurs as a result of decreased estrogen levels, which affects genital organs and women's self esteem; however, these symptoms usually respond well to hormone therapy.[6,7,8] Indeed, hormone therapy is believed to be capable of restoring sexual function to premenopausal levels, increasing blood flow to the vagina, reducing vaginal pH and increasing vaginal lubrication.[9,10]

The objective of this study was to evaluate the clinical effects of monophasic estrogen-progestogen therapy with respect to sexuality and to climacteric symptoms in sexually active postmenopausal women with a partner capable of performing coitus.


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