Comparison of the Effects of Hormone Therapy Regimens, Oral and Vaginal Estradiol, Estradiol+Drospirenone and Tibolone, on Sexual Function in Healthy Postmenopausal Women

ABSTRACT Introduction Sexual dysfunction is more prevalent in postmenopausal women. Aims To prospectively evaluate and compare the effects of hormone therapy (HT) regimens, oral and vaginal estradiol, estradiol+drospirenone and tibolone, on sexual function in healthy postmenopausal women. Methods The study included 169 consecutive healthy postmenopausal women, and the women were divided into two groups: 111 women received HT, and 58 women received no treatment and served as a control group. As an HT, 23 women with surgically induced menopause received oral 17-β estradiol. The rest of the women with natural menopause were prospectively randomized: 22 received oral 17-β estradiol+drospirenone daily, 42 received oral tibolone, and 24 received vaginal 17-β estradiol. Sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index, including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. Main Outcome Measures The differences in sexual function were compared before and 6 months after the treatment in all women. Results Total sexual function score increased from 19.81 ± 7.15 to 22.9 ± 6.44 in the HT group and decreased from 21.6 ± 8.69 to 17.6 ± 5.7 in the control group, revealing a significant difference from baseline to post-treatment between the two groups (P =0.000). The highest improvement in total score and arousal was achieved with the oral 17-β estradiol (P =0.000 and P =0.000, respectively). The highest improvement in lubrication was achieved with the oral and vaginal 17-β estradiol groups (P =0.000). The highest improvement in orgasm was achieved with the tibolone group (P =0.000). The highest improvement in pain was achieved with the oral and vaginal 17-β estradiol groups (P =0.000). Conclusions HT provided significant improvement in sexual function compared to women receiving no treatment, and therefore, HT regimens should be suggested for improvement in sexual functioning of postmenopausal women.