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Hormone Therapy for Sexual Function in Perimenopausal and Postmenopausal Women (Review)

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Hormone Therapy for Sexual Function in Perimenopausal and Postmenopausal Women (Review) Hormone therapy for sexual function in perimenopausal and postmenopausal women (Review) Nastri CO, Lara LA, Ferriani RA, Rosa-e-Silva ACJS, Figueiredo JBP, Martins WP This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 6 http://www.thecochranelibrary.com Hormone therapy for sexual function in perimenopausal and postmenopausal women (Review) Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 5 OBJECTIVES ..................................... 6 METHODS ...................................... 6 RESULTS....................................... 9 Figure1. ..................................... 10 Figure2. ..................................... 12 Figure3. ..................................... 13 Figure4. ..................................... 15 Figure5. ..................................... 17 Figure6. ..................................... 19 Figure7. ..................................... 20 Figure8. ..................................... 22 ADDITIONALSUMMARYOFFINDINGS . 23 DISCUSSION ..................................... 25 AUTHORS’CONCLUSIONS . 27 ACKNOWLEDGEMENTS . 27 REFERENCES ..................................... 27 CHARACTERISTICSOFSTUDIES . 36 DATAANDANALYSES. 77 Analysis 1.1. Comparison 1 Estrogens alone, Outcome 1 Compositescore.... ... ... ... ... 82 Analysis 1.2. Comparison 1 Estrogens alone, Outcome 2 Frequency of sexual activity. 83 Analysis 1.3. Comparison 1 Estrogens alone, Outcome 3 Libido, desire or interest in sex. 84 Analysis 1.4. Comparison 1 Estrogens alone, Outcome 4 Arousal................... 85 Analysis 1.5. Comparison 1 Estrogens alone, Outcome 5 Fantasy................... 85 Analysis 1.6. Comparison 1 Estrogens alone, Outcome 6 Orgasm................... 86 Analysis 1.7. Comparison 1 Estrogens alone, Outcome 7 Number of orgasms. 87 Analysis 1.8. Comparison 1 Estrogens alone, Outcome 8 Pleasure or enjoyment of sex. 88 Analysis 1.9. Comparison 1 Estrogens alone, Outcome 9 Satisfaction.................. 89 Analysis 1.10. Comparison 1 Estrogens alone, Outcome 10 Dyspareunia. ............... 90 Analysis 2.1. Comparison 2 Estrogens + progestogens, Outcome 1 Composite score. 91 Analysis 2.3. Comparison 2 Estrogens + progestogens, Outcome 3 Libido, desire or interest in sex. 92 Analysis 2.4. Comparison 2 Estrogens + progestogens, Outcome 4 Libido, desire or interest in sex. 93 Analysis 2.5. Comparison 2 Estrogens + progestogens, Outcome5Arousal.. 93 Analysis 2.6. Comparison 2 Estrogens + progestogens, Outcome 6 Fantasy. 94 Analysis 2.8. Comparison 2 Estrogens + progestogens, Outcome 8 Number of orgasms. 95 Analysis 2.10. Comparison 2 Estrogens + progestogens, Outcome 10 Satisfaction. 95 Analysis 2.11. Comparison 2 Estrogens + progestogens, Outcome 11 Satisfaction. 96 Analysis 2.12. Comparison 2 Estrogens + progestogens, Outcome 12 Dyspareunia. 97 Analysis 2.13. Comparison 2 Estrogens + progestogens, Outcome 13 Dyspareunia. 97 Analysis 3.1. Comparison 3 Synthetic steroids, Outcome 1 Composite score. 98 Analysis 3.3. Comparison 3 Synthetic steroids, Outcome 3 Libido, desire or interest in sex. 99 Analysis 3.4. Comparison 3 Synthetic steroids, Outcome 4 Arousal. ................. 100 Analysis 3.7. Comparison 3 Synthetic steroids, Outcome 7 Number of orgasms. 100 Analysis 3.9. Comparison 3 Synthetic steroids, Outcome 9 Satisfaction. 101 Analysis 3.10. Comparison 3 Synthetic steroids, Outcome 10 Dyspareunia. 101 Analysis 4.1. Comparison 4 SERMs, Outcome 1 Composite score. ................. 102 Analysis 4.2. Comparison 4 SERMs, Outcome 2 Frequency of sexual activity. 103 Hormone therapy for sexual function in perimenopausal and postmenopausal women (Review) i Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 4.3. Comparison 4 SERMs, Outcome 3 Libido, desire or interest in sex. 103 Analysis 4.4. Comparison 4 SERMs, Outcome 4 Arousal. .............. 104 Analysis 4.5. Comparison 4 SERMs, Outcome 5 Arousal. .............. 104 Analysis 4.6. Comparison 4 SERMs, Outcome 6 Fantasy. .............. 105 Analysis 4.7. Comparison 4 SERMs, Outcome 7 Fantasy. .............. 105 Analysis 4.8. Comparison 4 SERMs, Outcome 8 Orgasm. ............. 106 Analysis 4.9. Comparison 4 SERMs, Outcome 9 Number of orgasms. ................ 106 Analysis 4.10. Comparison 4 SERMs, Outcome 10 Pleasure or enjoymentofsex.. 107 Analysis 4.11. Comparison 4 SERMs, Outcome 11 Satisfaction. ................. 107 Analysis 4.12. Comparison 4 SERMs, Outcome 12 Dyspareunia. ................. 108 Analysis 5.1. Comparison 5 SERMs + estrogens, Outcome 1 Composite score. 108 Analysis 5.4. Comparison 5 SERMs + estrogens, Outcome 4 Arousal.................. 109 Analysis 5.5. Comparison 5 SERMs + estrogens, Outcome 5 Fantasy.................. 109 Analysis 5.9. Comparison 5 SERMs + estrogens, Outcome 9 Satisfaction. 110 APPENDICES ..................................... 110 CONTRIBUTIONSOFAUTHORS . 124 DECLARATIONSOFINTEREST . 124 SOURCESOFSUPPORT . 124 DIFFERENCES BETWEEN PROTOCOL AND REVIEW . .... 125 Hormone therapy for sexual function in perimenopausal and postmenopausal women (Review) ii Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Hormone therapy for sexual function in perimenopausal and postmenopausal women Carolina O Nastri1,2, Lucia A Lara1, Rui A Ferriani1, Ana Carolina JS Rosa-e-Silva1, Jaqueline BP Figueiredo1,2, Wellington P Martins 1,2 1Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil. 2Ultrasonography and Retraining Medical School of Ribeirao Preto (EURP), Ribeirao Preto, Brazil Contact address: Wellington P Martins, [email protected]. Editorial group: Cochrane Menstrual Disorders and Subfertility Group. Publication status and date: New, published in Issue 6, 2013. Review content assessed as up-to-date: 12 December 2012. Citation: Nastri CO, Lara LA, Ferriani RA, Rosa-e-Silva ACJS, Figueiredo JBP, Martins WP. Hormone therapy for sexual function in perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009672. DOI: 10.1002/14651858.CD009672.pub2. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. Objectives To assess the effect of hormone therapy (HT) on sexual function in perimenopausal and postmenopausal women. Search methods We searched for articles in the Cochrane Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, ClinicalTrials.gov, Current Controlled Trials, WHO International Clinical Trials Registry Platform, ISI Web of Knowledge and OpenGrey. The last search was performed in December 2012. Selection criteria We included randomised controlled trials comparing HT to either placebo or no intervention (control). We considered as HT estrogens alone; estrogens in combination with progestogens; synthetic steroids (for example tibolone); or selective estrogen receptor modulators (SERMs) (for example raloxifene, bazedoxifene). Studies of other drugs possibly used in the relief of menopausal symptoms were excluded. We included studies that evaluated sexual function using any validated assessment tool. The primary outcome was a composite score for sexual function and the scores for individual domains (arousal and sexual interest, orgasm, and pain) were secondary outcomes. Studies were selected by two authors independently. Data collection and analysis Data were independently extracted by two authors and checked by a third. Risk of bias assessment was performed independently by two authors. We contacted study investigators as required. Data were analysed using standardized mean difference (SMD) and relative risk (RR). We stratified the analysis by participant characteristics with regard to menopausal symptoms. The overall quality of the evidence for the primary outcome was evaluated using the GRADE criteria. Hormone therapy for sexual function in perimenopausal and postmenopausal women (Review) 1 Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results The search retrieved 2351 records from which 27 studies (16,393 women) were included. The ’symptomatic or early post-menopausal’ subgroup included nine studies: perimenopausal women (one study), up to 36 months postmenopause (one study), up to five years postmenopause (one study), experiencing vasomotor or other menopausal symptoms (five studies), or experiencing hot flushes and sexual dysfunction (one study). The ’unselected postmenopausal women’ subgroup included 18 studies, which included women regardless of menopausal symptoms and permitted the inclusion of women with more than five years since the final menstrual period. No studies were restricted to women with sexual dysfunction. Only five studies evaluated sexual function as a primary outcome. Eighteen studies were deemed at high risk of bias, and the other nine studies were at unclear risk of bias. Twenty studies received commercial funding. Findings for sexual function (measured by composite score): For estrogens
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