Hormone therapy for sexual function in perimenopausal and postmenopausal women.

摘要: Background The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. Objectives To assess the effect of hormone therapy (HT) on function in women. Search methods We searched for articles Cochrane Menstrual Disorders Subfertility Group (MDSG) Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, ClinicalTrials.gov, Current Controlled Trials, WHO International Clinical Trials Registry Platform, ISI Web Knowledge OpenGrey. The last search was performed December 2012. Selection criteria We included randomised controlled trials comparing HT to either placebo or no intervention (control). We considered as estrogens alone; combination progestogens; synthetic steroids (for example tibolone); selective estrogen receptor modulators (SERMs) raloxifene, bazedoxifene). Studies other drugs possibly used relief menopausal symptoms were excluded. studies that evaluated using any validated assessment tool. primary outcome a composite score scores individual domains (arousal interest, orgasm, pain) secondary outcomes. selected by two authors independently. Data collection analysis Data independently extracted checked third. Risk bias authors. contacted study investigators required. Data analysed standardized mean difference (SMD) relative risk (RR). stratified analysis participant characteristics regard symptoms. overall quality evidence GRADE criteria. Main results The retrieved 2351 records from which 27 (16,393 women) included. 'symptomatic early post-menopausal' subgroup nine studies: women (one study), up 36 months postmenopause five years experiencing vasomotor (five studies), hot flushes dysfunction study). 'unselected women' 18 studies, regardless permitted inclusion more than since final menstrual period. No restricted dysfunction. Only outcome. Eighteen deemed at high bias, unclear bias. Twenty received commercial funding. Findings (measured score): For alone versus control, symptomatic SMD 95% CI compatible small moderate benefit group (SMD 0.38, 0.23 0.54, P < 0.00001, 3 699 women, I² = 55%, high-quality evidence). In unselected 0.16, -0.02 0.34, 0.08, 2 478 44%, low-quality subgroups not pooled because considerable heterogeneity. For combined progestogens 0.42, 0.19 0.64, 0.0003, 1 study, 335 moderate-quality 0.09, 0.20, 0.10, 1314 0%, tibolone 0.13, 0.00 0.26, 0.05, 883 0.04 0.71, 0.03, 142 analysis, 0.17, 0.29, 0.008, 1025 20%). For SERMs 0.23, -0.04 0.50, 215 harm 0.04, -0.20 0.72, 283 -0.05 0.31, 498 2%). A comparison control only women. 0.21, 0.43, 542 evidence). Authors' conclusions HT treatment improvement function, particularly pain, when (within amenorrhoea), but Evidence regarding HTs (synthetic SERMs) is low we uncertain their function. current does suggest an important More evaluating steroids, SERMS association SERM + would improve these treatments peri Future should also evaluate solely among complaints.