Menopause hormone therapy
One RCT (with a low risk of bias) in women after breast cancer found an improvement in sexual behaviour and vaginal dryness for tibolone (2.5 mg/d for 2.75 years) compared with placebo,35 while two RCTs (with a high risk of bias) found inconsistent effects of menopause hormone therapy (oestradiol ± progestogen) on sexual enjoyment, sexual activity and discomfort compared with no treatment.78, 82 [ES26]
One RCT (with a low risk of bias) in menopause transition and postmenopausal women found that 8 weeks of low-dose oestradiol (0.5mg/day) or venlafaxine (37.5mg/day for 1 week and 75mg/day for 7 weeks) did not significantly altered sexual function (measured with Female Sexual Function Index) compared to placebo; but venlafaxine significantly improved vaginal dryness compared to the placebo group.83 [ES58]
Twenty seven RCTs (with a moderate risk of bias) identified in a systematic review (with a low risk of bias) in postmenopausal women found that menopause hormone therapy (oestrogen transdermal patch 0.014 mg/day; gel 0.87 g/d, gel 1.7 g/d, 2.6 g/d; oestrogen spray 150mcg/day or 300mcg/day; oestrogen vaginal ring 50mcg/day or 100mcg/day or conjugated equine estrogen 0.625mg plus medroxyprogesterone acetate 2.5mg daily; for 12 weeks) did not significantly improve sexual function (composite score) compared with control; but did show a small to moderate benefit in sexual function compared to control.84 [ES62]
Four RCTs (with a high risk of bias) identified in a Systematic Review (with a low risk of bias) in postmenopausal women (including women surgically treated for breast cancer) found that tibolone (2.5 mg/d for more than two years) did not significantly reduce vaginal dryness or dyspareunia compared with placebo. 38 [ES61]
Vaginal oestrogen therapy
In a population of postmenopausal women, nineteen RCTs identified in a Systematic Review (with a low risk of bias) in postmenopausal women with vaginal atrophy found that at least three months of vaginally administered oestrogen rings, creams and tablets were equally effective at relieving the symptoms of vaginal atrophy, better than placebo.85 Fourteen RCTs and prospective comparative studies (with a high risk of bias) identified in a Systematic Review (with a low risk of bias) in postmenopausal women with genitourinary syndrome of menopause (excluding women with breast cancer) found that vaginal oestrogen was more effective than placebo in the relief of vaginal dryness, itching, and dyspareunia.86 [ES63]
Other hormone therapies
In a population of peri- and postmenopausal women, nine RCTs analysed in a Systematic Review (with a low risk of bias) found a statistically significant improvement in sexual function with testosterone in combination with menopause hormone therapy versus menopause hormone therapy alone.44 [ES59]
Thirty five RCTs identified in a Systematic Review (with a low risk of bias) in postmenopausal women (with an unknown history of breast cancer) found a statistically significant improvement in sexual function with therapy containing testosterone versus therapy without testosterone.87 [ES60]
Two RCTs (with a low risk of bias) identified in a Systematic Review (with a low risk of bias) in postmenopausal women with vulvovaginal dyspareunia and atrophy found that oral ospemifene (60 mg/d) significantly reduces dyspareunia compared with placebo.43 Twenty seven RCTs (with a moderate risk of bias) identified in a systematic review (with a low risk of bias) in postmenopausal women found that selective oestrogen receptor modulators (SERMs) (bazedoxifene 20 mg alone or plus conjugated estrogens 0.45mg or 0.625mg daily; for 12 weeks) did not significantly improve sexual function (composite score) compared with control; but showed a small benefit in sexual function when compared with control.84 [ES65]