Does Transdermal Estrogen Improve Sexual Function in Early Postmenopause?

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t-E<sub>2</sub> therapy modestly improved sexual function in early postmenopausal women, but researchers are unclear if symptoms of distress were also relieved.
t-E2 therapy modestly improved sexual function in early postmenopausal women, but researchers are unclear if symptoms of distress were also relieved.

Early post-menopausal women treated with transdermal estradiol may have improved sexual function compared with women treated with oral conjugated equine estrogens or placebo, according to a study published in JAMA Internal Medicine.

A total of 670 individuals (average age: 52.7) were randomly assigned to 1 of 3 groups; treatment with 0.45 mg/d oral conjugated equine estrogens (o-CEE), 50 µg/d transdermal 17β-estradiol (t-E2), or placebo were conducted over 4 years. There were no significant differences in baseline patient characteristics.

Study results from the t-E2 treatment group compared with placebo demonstrated a significant improvement in the overall Female Sexual Functioning Index (FSFI) score across all time points (average efficacy: 2.6; 95% CI, 1.11-4.10; adjusted P =.002), an increase in mean lubrication (0.61; 95% CI, 0.25-0.97; P =.001), and a decrease in pain (0.67; 95% CI, 0.25-1.09; P =.002).  No significant differences in FSFI scores were found between patients treated with o-CEE and placebo (mean efficacy: 1.4; 95% CI, –0.1 to 2.8; adjusted P =.13), as well as between t-E2 and o-CEE groups across 48 months (adjusted P =.22).  In addition, the number of women with low sexual function (LSF) was significantly lower in women treated with t-E2 compared with placebo (67%; 95% CI, 55%-77% vs 76%; 95% CI, 67-83%; P =.04).

The investigators concluded that modest sexual function benefits were identified in post-menopausal women treated with t-E2.  Efficacy of improved sexual function was noted to be higher in women treated with t-E2 compared with women treated with o-CEE, but no statistically significant difference was found between treatment groups in overall sexual function.

Reference

Taylor H, Tal A, Pal L, et al.  Effects of oral vs transdermal estrogen therapy on sexual function in early postmenopause. Ancillary study of the kronos early estrogen prevention study (KEEPS) [published online August 28, 2017].  JAMA Internal Medicine. doi:10.1011/jamainternmed.2017.3877

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